Insomnia: Introduction FeedbackA general introduction to Insomnia.Source: Clinical Knowledge Summaries, 17 Jun 2014
Insomnia is difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.
There is no standard definition of what constitutes normal sleep.
It usually takes less than 30 minutes for a person to fall asleep.
Average total nocturnal sleep time decreases with age from about 8 hours at 15 years of age to less than 6 hours at 80 years of age.
Insomnia can be categorized according to duration or likely duration:
Short-term insomnia lasts less than 4 weeks.
Long-term (or persistent) insomnia lasts for 4 weeks or longer.
Sleep disorders that need to be excluded when making a diagnosis of insomnia are:
Sleep apnoea — suspect in people with excessive daytime sleepiness and snoring and/or impaired concentration, especially if there are witnessed apnoeas or chocking noises when asleep.
Circadian rhythm disorders such as shift work, jet lag, advanced sleep phase syndrome (ASPS) and delayed sleep phase syndrome (DSPS).
Parasomnias such as restless legs syndrome, periodic limb movement disorder.
Narcolepsy — suspect if there are recurrent periods of an irrepressible need to sleep.
Stress, anxiety or depression.
Physical health problems such as chronic obstructive pulmonary disorder, congestive heart failure or gastroesophageal reflux disease.
Drugs and substance abuse such as excessive alcohol intake.
Medications such as methylphenidate.
Insomnia may be associated with stress, psychiatric comorbidities, medical comorbidities, drug and substance misuse, or current medication (secondary insomnia). However, in up to 20% of people with persistent insomnia, there is no associated cause or comorbidity (primary insomnia).
A sleep diary can help identify how much someone is actually sleeping each night, and any factors that may exacerbate insomnia. The diary should be kept for at least 2 weeks.
Good sleep hygiene should be established in all people with insomnia. This aims to make people more aware of behavioural, environmental, and temporal factors that may be detrimental or beneficial to sleep.
For short-term insomnia, a short course (less than 2 weeks) of a hypnotic drug may be considered if daytime impairment is severe.
For long-term insomnia, cognitive and behavioural interventions are recommended first line.
A short course of a hypnotic drug may be considered for immediate relief or to manage an acute exacerbation of persistent insomnia.
For older people (more than 55 years of age) with persistent insomnia following cognitive and behavioural interventions, modified-release melatonin is an option.
Long-term hypnotics and other sedative drugs, complementary and alternative therapies, and herbal remedies are not recommended.
Referral to a sleep clinic or a specialist with expertise in sleep medicine may be required if a primary sleep disorder is suspected, there is doubt regarding the diagnosis, or long-term insomnia has not responded to management in primary care.
Insomnia: Guidance FeedbackThe most relevant search results for Insomnia from producers of guidance information.
Information for the public
Insomnia: Information for the public FeedbackThe most relevant search results for Insomnia, from Department of Health accredited producers of patient information.
- NHS Choices, 09 December 2013
- Bupa , 22 February 2013
- Bupa , 16 April 2013
- Macmillan Cancer Support, 01 April 2012
- Cancer Research UK, 25 March 2014
- Patient UK
- Patient UK
- Cancer Research UK, 06 August 2014
- Bupa , 20 November 2013
- NHS Choices, 12 August 2014
Insomnia: Medicines FeedbackAppropriate medicines information for Insomnia supplied by Datapharm, a leading source of trusted, credible information about medicines.
Insomnia - Medicines Information
- Circadin (a brand of Melatonin)
- Dalmane (a brand of Flurazepam Hydrochloride)
- Heminevrin capsules
- Mogadon (a brand of Nitrazepam)
- Passion flower/Valerian/Hops (a generic version of Sominex Herbal Tablets)
- Passion flower/Valerian/Hops/Scullcap/Jamaica dogwood
- Phenergan (a brand of Promethazine Hydrochloride)
- Sleepeaze tablets
- Sominex Herbal tablets
- Somnite (a brand of Nitrazepam)
- Sonata (a brand of Zaleplon)
- Stilnoct (a brand of Zolpidem Tartrate)
- Valerian/Hops (a generic version of Natrasleep)
- Zimovane (a brand of Zopiclone)
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