5 However, patients prescribed medications for short-term use require close monitoring for medication dependence, psychiatric status, unproductive sleep-specific coping strategies and maladaptive cognitions, as well as the severity of stressors, as these factors may precipitate and perpetuate insomnia.Ĭognitive behavioural therapy for insomniaĬBT-I refers to a range of evidence-based techniques packaged into a multiple-session treatment that includes behavioural and cognitive strategies (Box 2). Patients presenting with acute symptoms of insomnia may benefit from short-term medication in concert with sleep hygiene education. The Australasian Sleep Association (ASA) 1, American Academy of Sleep Medicine 2, American College of Physicians 3 and European Sleep Research Society 4 all recommend cognitive behavioural therapy for insomnia (CBT-I) as the first-line treatment for patients with insomnia disorder. Both pharmacologic and psychological interventions are indicated for the treatment of insomnia disorder however, selecting the right treatment is dependent on the chronicity of symptoms, with medical and psychiatric factors taken into account. Insomnia must be evaluated and treated as a serious medical condition.Insomnia disorder is characterised by inadequate sleep despite adequate sleep opportunity, accompanied by daytime dysfunction. Sleep is a necessary component in personal health, personal safety, and the safety of others. A specific follow-up plan and time frame should be outlined with the patient for the evaluation to be accurate and treatment options to be adjusted. Physicians must monitor patients with clinical evaluation, questionnaires, sleep logs, and continued sleep studies. The ultimate goals of insomnia treatment include reduction of sleep and waking symptoms, improvement of daytime function, and the reduction of distress. Depression, suicidal tendencies, chronic pain, and inappropriate alcohol or substance abuse must be identified and evaluated for treatment of insomnia to be effective. While helping patients gain quality and quantity of sleep is most certainly a goal, it is essential to recognize and treat comorbid conditions that commonly occur with insomnia. Insomnia symptoms occur in approximately 33-50% of the adult population, with distress or impairment occurring in 10-15% of those affected with insomnia. The primary treatment goals for insomnia are to improve sleep quality and quantity, and to improve insomnia related daytime impairments. The history study allows for physicians to establish the type and evolution of insomnia through perpetuating factors, and identification of comorbid medical, substance, and/or psychiatric conditions. The sleep history should cover all aspects of sleep complaints including: the inability to fall asleep, the inability to stay asleep, other sleep-related symptoms, and daytime consequences from the lack of sleep or poor quality of sleep. Insomnia is primarily diagnosed by clinical evaluation through a thorough sleep history study as well as a detailed medical, substance, and psychiatric history study. Insomnia is one of these because of how sleep deprivation affects a person's cognitive awareness, reflexive and reaction capability, and the physical impairment that can result in injury to self or to others. In the realm of conditions and diseases, those that affect not only the specific patient but others in the general population make up a small percentage of diseases. Insomnia is an important public health concern that requires accurate diagnosis and intervention because of its effect on the patient and the public at large. Chronic insomnia is present for at least a month and may present itself with a variety of specific patient complaints and etiologies. According to the American Academy of Sleep Disorders, insomnia is the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment. Insomnia is the most prevalent sleep disorder in the general population. Insomnia has a direct relationship on a person's physical, emotional, and psychological health and will impact every area of his or her life. Sleep is a necessary component for life, and a person's health is directly affected by the amount and quality of sleep that s/he receives.
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