Diagnostic Criteria
- Difficulty initiating or maintaining sleep or waking up too early, despite adequate opportunity for sleep.
- Daytime impairment or distress related to sleep difficulties (e.g., fatigue, mood disturbances, cognitive impairment).
Types of Insomnia
- Acute Insomnia: Short-term, often related to stress or changes in sleep environment.
- Chronic Insomnia: Lasts at least three months, occurring at least three times per week.
Etiology
- Primary Insomnia: Not attributable to other medical, psychiatric, or environmental causes.
- Secondary Insomnia: Associated with other conditions such as depression, anxiety, chronic pain, or substance use.
Assessment Tools
- Sleep Diary: Track sleep patterns over 1-2 weeks.
- Polysomnography: Used if sleep apnea or other sleep disorders are suspected.
- Actigraphy: Wrist-worn device to monitor sleep-wake cycles.
Treatment Approaches
- Cognitive Behavioral Therapy for Insomnia (CBT-I): First-line treatment, includes sleep hygiene, stimulus control, sleep restriction, and cognitive therapy.
- Pharmacotherapy: Short-term use of medications like benzodiazepines, non-benzodiazepine hypnotics, melatonin receptor agonists, and orexin receptor antagonists.
Medications
- Benzodiazepines: E.g., temazepam, lorazepam.
- Non-Benzodiazepine Hypnotics: E.g., zolpidem, eszopiclone.
- Melatonin Receptor Agonists: E.g., ramelteon.
- Orexin Receptor Antagonists: E.g., suvorexant.
Sleep Hygiene Tips
- Maintain a regular sleep schedule.
- Create a comfortable sleep environment.
- Avoid caffeine and heavy meals before bedtime.
- Limit screen time before bed.
Common Comorbidities
- Psychiatric Disorders: Depression, anxiety.
- Medical Conditions: Chronic pain, asthma, GERD.
- Other Sleep Disorders: Sleep apnea, restless legs syndrome.
A helpful book for both clinicians and patients Sleep through insomnia.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.