Insomnia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Common Causes

• Primary insomnia
• Delayed sleep phase disorder
• Depression
• Anxiety
• Obstructive sleep apnoea
• Restless legs
• Alcohol problem
• Other substance problem
• Bruxism
• Sleep walking
• General health problems :
  • Chronic pain
  • Cancer
  • Diabetes
  • Heart disease
  • Asthma
  • Gastroesophageal reflux disease (GERD)
  • Overactive thyroid
  • Parkinson's disease
  • Alzheimer's disease.
• Sleep walking
• Stress
• Environmental factors like noise, light, or temperature
• Jet lag
• Work shift insomnia
• Medication induced insomnia:
  • Medications for colds
  • Allergies
  • Medications fordepression
  • Medications for high blood pressure
  • Medications for asthma
• Caffeine
• Hyperthyroidism and other endocrine problems
• Age related insomnia

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Insomnia

Patient with insomnia

Take complete history

Do initial screening

Ask the following questions about Sleep pattern : ❑ Can you describe to me the pattern of your sleep? ❑ What time do you go to bed? ❑ How much time do you take to fall asleep ❑ Can you tell me the number and duration of awakenings per night? ❑ How many hours do you sleep? ❑When do you wake up in the morning? ❑ How many nights per week have you suffered from the same problem? ❑How is your routine different at the weekends or during holidays? Do you have the same bedtime?

Ask the following questions about Sleep quality : ❑ How do you feel about the quality of your sleep? ❑ Do you feel refreshed in the morning or restless?

Ask the following questions about Effects on regular daily activity : ❑Does it interfere with your function the next day? ❑ Do you feel unrefreshed in the morning, fatigued, have poor concentration or irritability

Ask the following questions about Onset of the complaint : ❑ Do you remember how did it start? ❑ For how long are you having this sleeping problem? ❑Was there any particular event going on that that time? ❑Has there been any variation in your sleep patterns since then? ❑Is there any exacerbating factors? ❑Is there any alleviating factors? ❑Tell me more about the impact or intrusiveness

Ask the following questions about Past history : ❑ Were you a good sleeper previously? ❑ Tell me more about your sleep pattern in childhood? ❑Tell me more about your sleep pattern in adulthood? ❑Has there been any similar episode previously? If yes, how did you overcome it? Have you taken any medication or therapy for it in the past? ❑

Ask the following questions about General Health : ❑ Do you have any chronic illness? If yes, what medications do you take for it? ❑

Ask the following questions about Psychological functioning : ❑Are you the kind of person who copes up well with stressfull situations? ❑

Do initial screening for depression with patient health questionnaire (PHQ)-9

PHQ-9 questionnaire :Over the last 2 weeks, how often have you been bothered by any of the following problems? ❑Have you felt little interest or pleasure in doing things? ❑have you been feeling down, depressed, or hopeless ❑ did you have trouble falling or staying asleep, or sleeping too much ❑ Have you had a feeling of being tired or having little energy ❑Did you have a poor appetite or habit of overeating ❑have you felt bad about yourself—or that you are a failure or have let yourself or your family down ❑Was there any trouble concentrating on things, such as reading the newspaper or watching television ❑Moving or speaking so slowly that other people could have noticed? Have you been fidgety or restless that you have been moving around a lot more than usual ❑Have you ever had thoughts that you would be better off dead or of hurting yourself in some way

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• Patient should keep your bedtime and wake time consistent from day to day, including weekends.
• Patient should stay active and do regular exercise. Regular activity helps promote good sleep.
• Patient should check your medications to see if they may contribute to insomnia.
• Make the bedroom comfortable for sleep. The room should be dark, quiet, and the temperature should be comfortable, not too warm or too cold.
• If light causes problems during sleep, the patient should use a sleeping mask.
• If sound causes the problem, the patient should cover up sounds by trying earplugs, a fan, white noise machine.
• Always create a relaxing bedtime ritual, such as taking a warm bath, reading, or listening to soft music.
• If the patient can't fall asleep and is not sleepy, he/she should get up and do something calming, like reading until you feel sleepy
• Patient should follow a routine to relax before bed. Read a book, listen to music, or take a bath.

Don'ts

• Advise patient to not take naps during the day, because naps make people less sleepy at night.
• Patient should not use phones before bed,the light can make it harder to fall asleep.
• Avoid caffeine, nicotine, and alcohol before going to bed. Caffeine and nicotine are stimulants and prevent from falling asleep
• Avoid eating a heavy meal late in the day.
• Avoid using the bed for anything other than sleep and sex

References

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