Insomnia

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Insomnia
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Definition of Insomnia

• Sleep poorly at night
• -it takes more than 30min to fall asleep
• -and/or the sleep duration is
• This adversely affects daytime functioning

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Insomnia Classification

• Transient
• Short-term 1-3 weeks
• Chronic or long-term 3 weeks to years

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Signs and Symptoms

• Difficulty falling asleep
• Frequent awakening
• Early morning awakening
• Inability to fall back to sleep
• Disturbed quality of sleep with unusual dreams
• Poor sleep in general

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What Causes Insomnia?
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Medications

• Drugs that may cause insomnia
• Antidepressants
• Antihypertensives
• Decongestants
• Oral contraceptives
• Histamine2-receptor antagonists

• Drugs that may produce withdrawal insomnia
• Antihistamines
• Barbiturates

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Medical Conditions

• Depression
• Cancer
• Nighttime heartburn
• Asthma
• Bronchitis
• Constipation
• Diabetes mellitus
• Hypertension

• Pregnancy
• Anxiety disorders
• Arthritis
• Delayed sleep phase syndrome (as in night-shift
  workers)

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Principles of Good Sleep Hygiene

• Follow a regular sleep pattern
• Make sure the bed is comfortable
• Exercise regularly but not late in the evening
• If hungry, eat a light snack, but avoid eating
  meals or large snacks immediately before bedtime.
• Eliminate daytime naps
• Avoid using caffeine after noon

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Treatment

• Diphenhydramine
• 30-60 mins before bedtime
• No more than 50mg/night. Ave 25mg/night
• Melatonin (alternative therapy)
• 1-2 hours before bedtime
• No more than 1mg/night. Ave 0.3µg/night
• Pregnant women and nursing mothers should be
  more cautious with these drugs.

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Treatment continue

• NOT recommended alternative therapies
• L-Tryptophan
• -Not safe to use, death associated
• Alcohol
• -increases side effects and interactions with
  other drugs
• Valerian
• -Questionable efficacy, and known adverse
  effects.
• Do not take the sleep aid longer than 7-10 days

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When to Refer?

• When insomnia has lasted longer than 3 weeks
• When the problem is not limited to difficulty
  falling asleep
• When insomnia is not resolved after recommended
  treatment period (7-10 days)