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INSOMNIA - Coggle Diagram
INSOMNIA
Management
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Advise not to drive if feel sleepy- DVLA must be informed if excessive sleepiness having adverse effect on driving
If sleep hygiene measures fail and insomnia not likely to resolve - offer CBTi - behavioural interventions to control stimulus and sleep restrictions
If daytime impairment severe causing significant distress and insomnia due to short term stressor - short course 3-7 days of non- benzodiazepine hypnotic medication
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If hypnotic prescribed use lowest dose for shortest period possible - do not continue treatment for longer than 2 weeks. Do not use further prescription without seeing the person again.
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Signpost for sources of information on insomnia and arrange a follow up review 2-4 weeks, alternative diagnosis if symptoms not improved and need for referral.
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Assessment
Difficulty getting or maintaining sleep. Early waking, non-restorative sleep/daytime impairment
Duration and frequency of sleep symptoms - unsatisfactory sleep without functional impairment does not meet diagnostic criteria. Ask about beliefs on normal sleep
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Sleep schedule e.g. bedtimes, time take to get to sleep, awakenings and rise time
Sleep environment/possible triggers (stress or shift work)/behaviours during sleep (snoring, apnoea, restless legs) - history from partner/family member can be useful
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Past/current medical history - previous sleep problems/treatment. Comorbidities e.g. chronic pain, medical disorders COPD, heart failure, diabetes, tinnitus mental health issues.
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Substance misuse e.g. caffeine, alcohol or illicit drugs
Carry out examination - Screen for depression/anxiety with PHQ-9 and GAD-7 questionnaire and physical examination
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Diagnosis
Persisting difficulty in getting to sleep. Difficulty maintaining sleep or non-restorative sleep resulting in impaired daytime functioning/wellbeing.
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Short term insomnia - if symptoms present for less than 3 months
Chronic Insomnia - if symptoms at least 3 nights / week for 3 months or more.