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INSOMNIA is difficulty in getting to sleep, difficulty maintaining sleep,…
INSOMNIA is 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 — transient insomnia is common and typically lasts a few days or weeks. It can occur in association with:
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.
CAUSES: Chronic insomnia — factors involved in the maintenance of insomnia are not fully understood but are thought to include maladaptive behaviours and cognitive processes. Persistence of the initial stressor may also contribute:
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Medical disorders such as COPD, heart failure, neurodegenerative diseases, malignancy, musculoskeletal conditions and chronic pain.
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Bidirectional or interactive effects often exist between chronic insomnia and co-morbid conditions (for example anxiety, depression and substance abuse).
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Consider the need for referral to a sleep clinic or neurology if symptoms of another sleep disorder are present.
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The DVLA must be informed if excessive sleepiness is having, or is likely to have, an adverse effect on driving such as:
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Offer cognitive behavioural therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia in adults of any age.
CBT-I typically includes behavioural interventions (such as stimulus control and sleep restriction), cognitive therapy and relaxation training. It can be provided face-to-face or digitally.
Pharmacological therapy should be avoided in the long-term management of insomnia, however:
For some people with severe symptoms or an acute exacerbation a short course of a hypnotic drug (preferably less than 1 week) may be considered as a temporary adjunct to behavioural and cognitive treatment.
Zopiclone. In adults — 7.5 mg once daily at bedtime. In the elderly (avoid if possible due to increased risk of adverse effects) — if essential reduce dose; initially 3.75 mg once daily at bedtime. DO NOT re-administer during the same night.
Zolpidem.In adults — 10 mg once daily at bedtime; for debilitated patients, use elderly dose. In the elderly (avoid if possible due to increased risk of adverse effects) — if essential reduce dose; 5 mg maximum once daily at bedtime. NB: DO NOT re-administer during the same night.
The recommended oral dose of modified-release melatonin for insomnia (short-term use only) for an adult aged 55 years and over is 2 mg once daily (1–2 hours before bedtime and after food) for up to 13 weeks.
The recommended initial duration of treatment is 3 weeks continued if there is a response to treatment for a further 10 weeks only.