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Insomnia (History (past and current symptoms of sleep apnea, restless legs…
Insomnia
History
past and current symptoms of sleep apnea, restless legs syndrome, hypothyroidism, arthritis, cardiopulmonary disease, neurologic disease, and depression
history of medication and other substance use, including caffeine and other stimulants, alcohol, and over-the-counter medications, and a detailed description of sleep behavior and sleep environment is essential
Management
Nonpharmacologic Therapy
In a 2016 clinical practice guideline, the ACP strongly recommends cognitive-behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia
which consists of educational interventions (such as sleep hygiene), cognitive therapy, and behavioral interventions (such as sleep restriction therapy, stimulus-control therapy, and relaxation techniques)
Pharmacologic Therapy
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Prescription Medications
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1.Benzodiazepines, which are nonselective γ-aminobutyric acid (GABA)-receptor agonists 2. Nonbenzodiazepines (are more selective GABA-receptor agonists)
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Doxepin, in low doses, is the only antidepressant approved for the treatment of insomnia. Doxepin, trazodone, and mirtazapine can be useful if a sedating antidepressant is indicated
Dopaminergic agonists have been effective in reducing involuntary leg movement and, hence, improving sleep. Pramipexole or ropinirole are the drugs of choice.
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can lead to daytime somnolence, work absenteeism, motor vehicle accidents, poor general health, functional impairment, and impaired quality of life.