Insomnia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Common Causes

• Primary insomnia
• Delayed sleep phase disorder
• Depression
• Anxiety
• Obstructive sleep apnoea
• Restless legs
• Alcohol problem
• Other substance problem
• Bruxism
• Sleep walking
• General health problems :
  • Chronic pain
  • Cancer
  • Diabetes
  • Heart disease
  • Asthma
  • Gastroesophageal reflux disease (GERD)
  • Overactive thyroid
  • Parkinson's disease
  • Alzheimer's disease.
• Sleep walking
• Stress
• Environmental factors like noise, light, or temperature
• Jet lag
• Work shift insomnia
• Medication induced insomnia:
  • Medications for colds
  • Allergies
  • Medications fordepression
  • Medications for high blood pressure
  • Medications for asthma
• Caffeine
• Hyperthyroidism and other endocrine problems
• Age related insomnia

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Insomnia

Patient with insomnia

Take complete history

Do initial screening

Ask the following questions about Sleep pattern : ❑ Can you describe to me the pattern of your sleep? ❑ What time do you go to bed? ❑ How much time do you take to fall asleep ❑ Can you tell me the number and duration of awakenings per night? ❑ How many hours do you sleep? ❑ How many nights per week have you suffered from the same problem?

Ask the following questions about Sleep quality : ❑ How do you feel about the quality of your sleep? ❑ Do you feel refreshed in the morning or restless?

Ask the following questions about Effects on regular daily activity : ❑Does it interfere with your function the next day? ❑ Do you feel unrefreshed in the morning, fatigued, have poor concentration or irritability

Ask the following questions about Onset of the complaint : ❑ Do you remember how did it start? ❑ For how long are you having this sleeping problem? ❑Was there any particular event going on that that time?

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• Patient should keep your bedtime and wake time consistent from day to day, including weekends.
• Patient should stay active and do regular exercise. Regular activity helps promote good sleep.
• Patient should check your medications to see if they may contribute to insomnia.
• Make the bedroom comfortable for sleep. The room should be dark, quiet, and the temperature should be comfortable, not too warm or too cold.
• If light causes problems during sleep, the patient should use a sleeping mask.
• If sound causes the problem, the patient should cover up sounds by trying earplugs, a fan, white noise machine.
• Always create a relaxing bedtime ritual, such as taking a warm bath, reading, or listening to soft music.
• If the patient can't fall asleep and is not sleepy, he/she should get up and do something calming, like reading until you feel sleepy
• Patient should follow a routine to relax before bed. Read a book, listen to music, or take a bath.

Don'ts

• Advise patient to not take naps during the day, because naps make people less sleepy at night.
• Patient should not use phones before bed,the light can make it harder to fall asleep.
• Avoid caffeine, nicotine, and alcohol before going to bed. Caffeine and nicotine are stimulants and prevent from falling asleep
• Avoid eating a heavy meal late in the day.
• Avoid using the bed for anything other than sleep and sex

References

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