Insomnia Overview and Epidemiology

Insomnia Overview

• Insomnia is a sleep disorder marked by difficulty initiating or maintaining sleep.
• Acute insomnia typically lasts several days to weeks (less than 3 months) and is often triggered by stress.
• Chronic insomnia persists for more than 3 months, classified as either primary (sleep disturbance independent of another condition) or secondary (related to an existing medical or psychological issue).

Epidemiology of Insomnia

• Insomnia is the most common sleep disorder.
• Symptoms affect 33-50% of adults.
• Daytime impairment linked to insomnia occurs in 10-15% of the population.

Risk Factors for Insomnia

• Increasing age
• Female gender
• Existing comorbidities (other health conditions)
• Shift work patterns
• Lower socioeconomic status

Signs of Insomnia

• Difficulty initiating sleep
• Difficulty maintaining sleep
• Waking up too early
• Sleep that's nonrestorative or poor quality
• Significant daytime impairment

Assessment/Diagnosis: Pre-Sleep Conditions

• Behaviors can unintentionally affect sleep.
• Examples include spending excessive time in bed, pre-sleep lighting, anxiety, exercise, and the surrounding temperature.

Assessment/Diagnosis: Sleep-Wake Schedule

• Time to fall asleep
• Number of nighttime awakenings
• Wake time after sleep onset
• Sleep latencies exceeding 30 minutes
• Sleep efficacy below 85%
• Total sleep time under 6.5 hours
• These are general parameters, and variations depending on individual sleep patterns exist.

Assessment/Diagnosis: Nocturnal Symptoms

• Respiratory problems (snoring, coughing, gasping)
• Parasomnias (sleep-walking, unusual vocalizations)
• Psychosocial factors (depression)
• Overall health conditions (pain, seizures, anxiety)

Assessment/Diagnosis: Daytime Activities

• Napping
• Work
• Regular lifestyle activities
• Travel
• Daily stressors impacting quality of life

Assessment/Diagnosis: History/Examination

• Full medical history, including medications
• Physical examination for other health conditions
• Psychiatric history
• Substance use history
• Insomnia questionnaire
• Two-week sleep log

Medications that Can Affect Sleep

• Antidepressants (e.g., SSRIs, SNRIs)
• Stimulants (e.g., caffeine, amphetamines)
• Decongestants
• Narcotic analgesics
• Cardiovascular medications
• Pulmonary medications
• Alcohol

Sleep Questionnaires

• Epworth Scale
• Insomnia Severity Index
• Fatigue Severity Scale
• Pittsburg Sleep Quality Index

Diagnostic Criteria for Insomnia

• Difficulty initiating sleep, maintaining sleep, or waking too early.
• Persistent sleep difficulties despite an adequate opportunity to sleep.
• At least one significant daytime impairment (as listed).

Daytime Impairment

• Fatigue and malaise
• Attention or concentration problems
• Memory difficulties
• Motivation or energy issues
• Poor or reduced initiative
• Proneness to errors
• Issues with concentration while driving
• Social or vocational problems
• Issues with school performance
• Headaches or gastrointestinal problems due to sleep loss
• Concerns or worry about sleep

Non-Pharmacological Therapy

• Identify & address maladaptive sleeping behaviors
• Restructure sleep routines with cognitive approaches
• Minimize time spent in bed, while awake
• Implement a regular sleep-wake schedule
• Address underlying medical conditions.
• Promote a healthy sleep environment

Ideal Sleep Environment/Sleep Hygiene

• Avoid daytime naps
• Exercise regularly (but not right before bed)
• Optimize room temperature
• Maintain a dark and quiet sleep environment.
• Use white-noise machines or other sound masking devices.
• Invest in a comfortable mattress and pillows.
• Evaluate snoring, if applicable

Pharmacological Therapy: Non-Benzodiazepines

• Zolpidem (Ambien)
• Immediate release: 5-10 mg before bed
• Extended release: 6.25–12.5 mg before bed

Pharmacological Therapy: Benzodiazepines

• Temazepam (Restoril)
• 7.5–30 mg at bedtime
• Improved extended sleep-wake times

Other Pharmacological Options

• Sedating low-dose antidepressants (e.g., trazodone, mirtazapine) (Caution: not FDA approved for this specific use).
• Benzodiazepines (not FDA approved for insomnia).
• Counter medications proven to have limited effectiveness

Follow-Up/Referrals

• Follow up within 1–2 weeks to assess intervention effectiveness
• Refer patients with other concerns such as sleep apnea, depression, and anxiety

Geriatric Considerations

• Many medications (nBZRA/BZRA) require careful consideration due to potential increased sensitivity/decreased metabolism.
• Be cautious about potential issues with cognitive impairments, increased fall risks, and/or delirium.
• Possible sleep disturbances from pain and discomfort
• Consider urinary issues and comorbid factors.

This quiz covers the fundamental aspects of insomnia, including its types, prevalence, risk factors, and signs. Learn about the common sleep disorder affecting a significant portion of the adult population and its impact on daily life.