Insomnia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Adnan Ezici, M.D[2] , Amber Ehsan Faquih, MD[3] , Kiran Singh, M.D. [4] , Jyostna Chouturi, M.B.B.S [5] , Sanjana Nethagani, M.B.B.S.[6]
Synonyms and keywords: Insomnia disorder
Overview
Historical Perspective
Pathophysiology
Classification
Causes
Differentiating Insomnia from other Diseases
Epidemiology and Demographics
Risk Factors
Common risk factors for insomnia include[1]:
- Gender(Female)
- Increasing age
- Depression
- Unemployed
- Widow/Divorced/Separated
- Lower educational qualification
- Economic inactivity
- Military Deployment
- Racial Discrimintion
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies
History and Symptoms
DSM-5 diagnostic criteria for insomnia includes[2]:
- Symptoms occur ≥ 3 days/week for ≥ 3 months
- Symptoms cause functional impairment or distress
- Problems initiating or maintaining sleep, or awakening early in the morning and being unable to return to sleep
- Symptoms occur despite having enough time to sleep
- Symptoms are not caused by an underlying substance or medication use
- No underlying or coexisting psychiatric or medical disorder that explains symptoms
Laboratory Findings
- Blood tests: Medical conditions can also cause/exacerbate sleep. Based on the questionnaire and physical exam, the doctor may recommend blood tests to check for other pre-existing conditions.[3].
Diagnostic Studies
The doctor won’t be able to confirm an insomnia diagnosis in some cases without further testing. Following are the tests one might have to undergo
- Sleep study: Overnight sleep stud or the polysomnogram test.In this study, one has to spend the night at a sleep center with sensors on the face, scalp, eyelids, one finger, chest and limbs. The sensors then monitor brain wave activity, oxygen level, heart rate, respiratory rate and muscle movement that occur prior, during, and post sleep. Also, some daytime tests monitor sleep latency during a series of naps, evaluate abilities to stay awake and alert after a night of normal sleep. However, irrespective of home-based monitoring kits or the procedures mentioned above, they will be non-invasive and pain-free.
- Actigraphy: Actigraphy tests, similar to overnight sleep studies, but most are conducted at home. In this one has to wear a sensor on the wrist or ankle to monitor their sleep and wakefulness pattern. Recommended Duration for wearing the sensors is three to 14 consecutive days. The test is safe for children and adults but the sensor may cause some light albeit temporary irritation.
If the diagnostic criteria for chronic or short-term insomnia based on the sleep disorder test are met, then we may advance to insomnia treatment.
Treatment
Medical Therapy | Non-pharmacological therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Management is guided by available clinical practice guidelines[4].
Case Studies
See also
References
- ↑ "Insomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy | AJMC".
- ↑ "Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population | Read by QxMD".
- ↑ "Diagnosing Insomnia | Sleep Foundation".
- ↑ Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C; et al. (2020). "The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines". Ann Intern Med. doi:10.7326/M19-3575. PMID 32066145 Check
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