Table 5. Some Contributing Medications/Substances
ÎÎ Alcohol
ÎÎ Caffeine
ÎÎ Stimulants/sympathomimetics
>> Amphetamines
>> Methylphenidate
>> Modafinil
>> Appetite suppressors (diet pills)
>> OTC decongestants
`` Phenylephrine
`` Pseudoephedrine
>> Cocaine
>> Ecstasy
ÎÎ Bronchodilators
>> Albuterol
>> Theophylline
ÎÎ Certain antidepressants
>> Bupropion
>> Fluoxetine
ÎÎ Steroids
ÎÎ Alpha-adrenergic agents
ÎÎ Lipid-lowering agents
ÎÎ Other
>> Opiates*
>> Diuretics (nocturia)
>> Nicotine
* Opiates may improve sleep in patients with acute or chronic pain, but also have potentially adverse effects
on sleep.
Table 6. Contributing Cognitive/Behavioral Factors
ÎÎ Pre-sleep activities incompatible with sleep
>> Alcohol/caffeine/nicotine consumption
>> Heavy meal
>> Exercise
>> Reading
>> Talking on telephone
>> Watching TV
>> Paying bills
>> Working
ÎÎ Sleep-wake schedule changes
>> Work shift rotations
>> Weekdays different from weekend
>> Travel across time zones
>> "Sleeping in" to make up for lost sleep
ÎÎ Conditioned factors
>> Learned arousal in response to efforts to fall asleep (drowsy before bed and wide
awake once in bed)
>> Negative expectations about sleeping
>> Excessive time in bed awake
>> Cognitive distortions regarding sleep
`` "I can't sleep without medication."
`` "I have a chemical imbalance."
`` "I should stay in bed and rest when I can't sleep."
`` Catastrophizing (eg, "My life will be ruined if I don't sleep.")
