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Insomnia:Difficulty in getting to sleep, difficulty maintaining sleep,…
Insomnia:Difficulty in getting to sleep, difficulty maintaining sleep, early wakening, or non-restorative sleep which occurs despite adequate opportunity for sleep and results in impaired daytime functioning.
Causes
Short term insomnia- Insomnia symptoms occurring for less than 3 months duration (typically a few days or weeks).
Stressful events such as bereavement, illness, changes in employment, exams, pending deadlines or financial difficulties.
Changes in sleeping patterns due to the birth of a child or environmental disturbance such as excess noise or light or extremes of temperature.
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Assessment
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PMhx- pain, physical and psychological conditions
History of symptoms- duration and frequency, sleep schedule, sleep environment
Drug Hx and substance abuse, caffine
Impact of insomnia- QOL, ability to drive, employment, behaviour, mood, relations
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Management
Short term insomnia
where sleep hygiene measures fail, daytime impairment is severe causing significant distress and
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A short course (3-7 days) of a non-benzodiazepine hypnotic medication (z-drug) may be considered, these should be avoided in older people.
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Adjunctive treatment with a short-term hypnotic medication (a z-drug or prolonged released melatonin if over 55 years of age) may be appropriate.
Long term insomnia
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Pharmacological therapy should be avoided in the long-term management of insomnia, however, adjunctive treatment with a short-term hypnotic medication (a z-drug or prolonged released melatonin if over 55 years of age) may be appropriate for some people with severe symptoms or an acute exacerbation.
Differential Diagnosis
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Narcolepsy — may present with falling asleep in the daytime without warning and collapse or muscle weakness triggered by emotion
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Parasomnias — may present with unusual or unpleasant experiences or behaviours associated with sleep that are troublesome or dangerous.
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