difficulty in falling or staying asleep -> leading to daytime functioning

• 1/3 adults

• 1/10 chronically

• frequently experience excessive daytime sleepiness, irritability and lack of energy

• may lead to:

  • psychiatric

  • problem use of drugs

  • EtOH

  • reduced quality of life

  • cognitive impairment in elderly people

Diagnosis

• only about 15-20% with insomnia have no other associated diagnosis

• usually secondary to other factors:

  • underlying health issues

  • poor sleep environment

  • shift work

  • use of medicaitons or other substances

• common causes:

  • psychological

    • loss

    • crisis

    • worry

    • anxiety

    • depresison

    • dementia

  • physical

    • movement disorders - RLS, periodic leg movmeents

    • respiratory disorders

    • painful conditions

    • urinary frequence

    • endocrine disorders

      • hypertyroidism, DM, DI

  • drugs

    • ceasing medications

    • etoh

    • caffeine

    • medications

      • appetiett suppressants

      • chronic bdz use

      • antidepressants

        • ssri

      • betablockers

      • steroids

      • diuretics

    • illicit drugs

mistaken beliefs

• people require different amounts fo sleep

• 15yo = 8hrs

• 70yo = \<6hrs

Treating insomnia

• treat any underlying problems

• use non-drug options

ASLEEP

• Alcohol, caffeine and nicotine should be avoided

• Sleep and sex should be only uses of the bed

• Leave laptops, TV and paperwork out of the bedrrom

• Exercise regularly but not within 2-3 hrs of bedtime

• Early risin - avoid sleepin-in or daytime naps

• Plan for bed time

  • establish a routine

consider not reading in bed - trial

Pharmacological treatments

• drug therapy effective in short term

• concern re dependence, tolerance and difficulty withdrawing people after long-term continuous use

Short acting benzodiazepines

• shorter time and have no active metabolites and little/no hangover

• use shorted amount and lowest dose

  • \<4wks

  • pref. 5-10days

• prescribe hypnotics intermittently and for short durations

• avoid in:

  • substance abuse

  • myasthenia gravis

  • respiratory impairment

  • acute cerebrovascular accidnet

• elderly;

  • increase risk of falls

  • increase risk confusion

• temazepam

• zopiclone

  • non-benzodiazepein hypnotic

  • selective GABA agonist

• antidepressants increase falls, cardiac dysrhythmia and orthostatic hypotension = not recommended

• antihistamines = hangover effect; not recommended