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Source: Dopp JM, Phillips BG. Sleep Disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. Accessed June 5, 2012.

  • Sleeplessness

  • Difficulty in falling asleep or remaining asleep for an adequate period of time.

  • See Table 1 for common causes of insomnia.

Table 1. Common Causes of Insomnia

Signs and Symptoms

  • 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

  • Assess:
    • 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.
  • Relieve symptoms.
  • Avoid side effects and complications of pharmacologic therapy.
  • Improve quality of life.

  • 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.

  • Stimulus control therapy
  • Sleep hygiene education
  • Short-term cognitive behavioral therapy
  • Relaxation therapy
  • Cognitive therapy
  • Sleep restriction
  • Paradoxical intention

Table 2. Nonpharmacologic Recommendations for Insomnia

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