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Insomnia

Susanne Wild, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep

  • Causes at least one of the following forms of daytime impai...

DIAGNOSIS

HISTORY

  • Daytime sleepiness and napping

  • Unintended sleep episodes (driving, working)

  • Insomnia history

    • Duration, time of problem

    • Sleep latency, difficulty in maintaining sleep (repeated awakening...

TREATMENT

  • Transient insomnia

    • May use medications for short-term use only; hypnotic sedatives favored

    • Self-medicating with alcohol can increase awakenings and sleep-stage changes.

  • Chronic insomnia

    • Trea...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • Daily exercise improves quality of sleep and may be more effective than medication.

  • Avoid exercise within 4 hours of bedtime.

Patient Monitoring

  • Reassess need for me...

REFERENCES

1
Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep.  2005;28(4):499–521. [Vi...

ADDITIONAL READING

Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ.  2005;331(7526):1169. [View Abstract on Ovi...

SEE ALSO

  • Anxiety (Generalized Anxiety Disorder); Depression; Fibromyalgia; Sleep Apnea, Obstructive

  • Algorithms: Anxiety; Insomnia, Chronic; Restless Legs Syndrome

CODES

ICD10

  • G47.00 Insomnia, unspecified

  • F51.02 Adjustment insomnia

  • F51.01 Primary insomnia

  • F51.09 Oth insomnia not due to a substance or known physiol cond

  • G47.01 Insomnia due to medical condition

  • F51.03 P...

CLINICAL PEARLS

  • Treatment of underlying etiology of the insomnia and consistent sleep hygiene are key.

  • Most medications are indicated for short-term use only.

  • Sedative hypnotics are not recommended in t...

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