AASM Insomnia

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Key Points Definition ÎChronic insomnia is a complaint of difficulty initiating or maintaining sleep or of non-restorative sleep that: > Occurs despite adequate opportunity and circumstances for sleep > Lasts for at least 1 month > Causes clinically significant distress or impairment of social, occupational, or other areas of function Evaluation Ε Obtain sleep history (Table 1) and sleep log (Table 2) > Fundamental to assessment of presenting insomnia complaint > Principal diagnostic tools ÎPolysomnography and the Multiple Sleep Latency Test should not be routinely used in assessment of insomnia ÎMajor indication for polysomnography is a reasonable clinical suspicion of sleep disorders such as sleep apnea, periodic limb movement disorder, or narcolepsy Formulation Ε Identify: > Associated medical condition (Table 3) or psychiatric disorder (Table 4) that may contribute to insomnia > Contributing substances (eg, prescription/OTC medications, substances of abuse) (Table 5) > Insomnia-perpetuating cognitive and behavioral patterns (Table 6) > Primary sleep disorders (eg, sleep apnea, periodic limb movement disorder, restless legs > Sleep-wake schedule disturbances (eg, delayed or advanced sleep phase, irregular/shift work) Management ÎTreat any medical, mental, or other factors that may contribute to or exacerbate insomnia (Tables 3, 4, 5) ÎTreat primary sleep disorders ÎAdvise proper sleep hygiene ÎJudicious use of hypnotic medication may be indicated for short-term relief of insomnia symptoms (Table 7). Instructions are necessary concerning side effects, follow-up for efficacy, discontinuation syndrome, narcolepsy); polysomnography may be indicated, especially for suspected sleep apnea

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