Insomnia

Insomnia Insufficient sleep with daytime anergia, malaise, cognitive slowness & irritability

Assessment & Management

Insomnia 10-30% adult population; 15% are primary

Causes • • • •

Painful organic conditions Depressive disorder Anxiety disorder Psychosocial stresors

Parasomnias • Nightmares • Night terrors • Sleep walking

Perpetuating factors • Alcohol • Tobacco • Caffeine

Hypersomnias • Narcolepsy • Sleep apnoea • Primary (ideopathic)

Management (Cognitive behavioural)

Do not go to bed until sleepy Lie in bed only while attempting to sleep If unable to sleep, get out of bed Use relaxation techniques • Progressive muscular relaxation • Visualization • Correct negative thoughts: I did not sleep last night, cannot sleep tonight • Avoid catastrophic thoughts: I’ll die if do not get good sleep tonight • Insert positive thoughts

Good sleep hygiene Quiet comfortable environment Avoid • • • •

Stimulants Alcohol Heavy meals Vigorous exercise within 4 hours

Moderate exercise earlier than 4 hours before bed time No daytime naps Regular wake time Reinforce waking hours with exposure to light and physical activity Address life stressors Avoid obsession concerns regarding sleep difficulty

Objectives     

Establish rapport Take chronological account Determine sleep timings, any day time naps Ask about quality of sleep (feeling after waking up) Inquire about

• • • •

Effect of insomnia on daytime activities/job/family Painful physical conditions Alcohol, stimulants, tobacco, caffeine Psychosocial stressors

 Invite questions  Reassure