Sleep problems are seen in people who report poor sleep quality, find it difficult going to sleep or maintaining sleep. Insomnia is classified by its duration:
Transient (a few days)
Short-term (up to 4 weeks)
Chronic (greater than 4 weeks).
Causes
- Age
- Depression
- Anxiety
- Work shift pattern
- Sleeping during the day
- Underlying medical condition such as pain, movement disorders (e.g. restless legs) or respiratory conditions (e.g. sleep apnoea)
- Medications (Stimulants, SSRI, diuretics, beta blockers, antieplieptics)
- Environmental noise
- Pregnancy
Referral Criteria
GP Referral:
- Over 4 weeks
- Children under 12 years
- Daily activities affected by insomnia
- Signs of depression or anxiety
- Drug abuse e.g. amphetamines
- No cases of insomnia lasting longer than 4 weeks should be treated with OTC medication.
- If insomnia has caused by the patient’s pre- existing condition/medicines
Differntial Diangnosis
- Insomnia can be symptoms of depression.
- Signs of drug abuse e.g. amphetamines.
- Rebound insomnia may be seen with withdrawal symptoms with hypnotics or antidepressants.
Patient Tips
- ‘Good sleep hygiene’ should be promoted
- Remove elements that stimulate activity, such as televisions or mobile phones
- A hot bath, with the addition of lavender essential oils
- Advise to avoid caffeine in the evening and avoid heavy meals before bedtime.
- Advise not to use alcohol as a sedative as rebound excitation can cause early morning wakening and its diuretic effects can affect your sleep.
- Keep a sleep diary to find factors which trigger irregular sleep.