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Insomnia

Susanne Wild, MD Reviewed 06/2022
 


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 (e.g. dozing at a stoplight while driving, working)

  • Insomnia history

    • Duration, time of problem

    • Sleep latency, difficulty in mainta...

TREATMENT

  • Transient and short-term insomnia

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

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

  • Chronic i...

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. ...

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...

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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