Source: Dopp JM, Phillips BG. Sleep–wake disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=134128126. Accessed January 7, 2017.
One-year prevalence of insomnia in the U.S. reports that one-third of surveyed individuals complain of insomnia.
Women complain of insomnia twice as much as men.
Those who are elderly, unemployed, separated, widowed or with lower socioeconomic status report higher incidence of insomnia.
TABLE 1.Common Causes of Insomnia |Favorite Table|Download (.pdf) TABLE 1. Common Causes of Insomnia
|Work or financial stress, major life events, interpersonal conflicts |
|Jet lag or shift work |
|Cardiovascular (angina, arrhythmias, heart failure) |
|Respiratory (asthma, sleep apnea) |
|Chronic pain |
|Endocrine disorders (diabetes, hyperthyroidism) |
|Gastrointestinal (gastroesophageal reflux disease, ulcers) |
|Neurologic (delirium, epilepsy, Parkinson disease) |
|Mood disorders (depression, mania) |
|Anxiety disorders (eg, generalized anxiety disorder, obsessive-compulsive disorder) |
|Substance abuse (alcohol or sedative-hypnotic withdrawal) |
|Central adrenergic blockers |
|Selective serotonin reuptake inhibitors |
Difficulty falling asleep or staying asleep.
Not feeling rested despite sufficient opportunity to sleep.
Intermittent awakenings during night.
Early morning awakening.
MEANS OF CONFIRMATION AND DIAGNOSIS
Onset, duration, and frequency of symptoms.
Effect on daytime functioning.
Sleep hygiene habits.
History of prior treatment.
Transient (2 or 3 nights) and short-term (<3 weeks) insomnia usually related to precipitating factor.
Chronic insomnia (>1 month) may be related to medical or psychiatric disorders, medications, or psychophysiologic causes. Perform physical and mental status examinations and routine laboratory tests in these patients.
Identify and remove underlying cause.
Improve daytime functioning and sleepiness.
Avoid side effects and complications of pharmacologic therapy.
TREATMENT: GENERAL APPROACH
Educate patient about sleep hygiene, manage stress, monitor for mood symptoms, and eliminate unnecessary pharmacotherapy.
Treat transient and short-term insomnia with good sleep hygiene and cautious use of sedative-hypnotics if necessary.
For chronic insomnia: assess for medical causes, employ nonpharmacologic treatments, and use sedative-hypnotics cautiously.
TREATMENT: NONPHARMACOLOGIC THERAPY
TABLE 2.Nonpharmacologic Recommendations ...