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? ❑When do you wake up in the morning? ❑ How many nights per week have you suffered from the same problem? ❑How is your routine different at the weekends or during holidays? Do you have the same bedtime?

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? ❑Has there been any variation in your sleep patterns since then? ❑Is there any exacerbating factors? ❑Is there any alleviating factors? ❑Tell me more about the impact or intrusiveness

Ask the following questions about Past history : ❑ Were you a good sleeper previously? ❑ Tell me more about your sleep pattern in childhood? ❑Tell me more about your sleep pattern in adulthood? ❑Has there been any similar episode previously? If yes, how did you overcome it? Have you taken any medication or therapy for it in the past?

Ask the following questions about General Health : ❑ Do you have any chronic illness? If yes, what medications do you take for it?

Ask the following questions about Psychological functioning : ❑Are you the kind of person who copes up well with stressfull situations?

Do initial screening for depression with patient health questionnaire (PHQ)-9

PHQ-9 questionnaire :Over the last 2 weeks, how often have you been bothered by any of the following problems? ❑Have you felt little interest or pleasure in doing things? ❑Have you been feeling down, depressed, or hopeless ❑ Did you have trouble falling or staying asleep, or sleeping too much ❑ Have you had a feeling of being tired or having little energy ❑Did you have a poor appetite or habit of overeating ❑Have you felt bad about yourself—or that you are a failure or have let yourself or your family down ❑Was there any trouble concentrating on things, such as reading the newspaper or watching television ❑Moving or speaking so slowly that other people could have noticed? Have you been fidgety or restless that you have been moving around a lot more than usual ❑Have you ever had thoughts that you would be better off dead or of hurting yourself in some way

Do initial screening for alcohol abuse with CAGE questionnaire

Ask the following CAGE questionnaire : ❑Have you ever felt you needed to Cut down on your drinking? ❑Have people Annoyed you by criticizing your drinking? ❑ Have you ever felt Guilty about drinking? ❑Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

2 yes answers indicate that there is a possibility of alcoholism, so should be investigated further

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