Insomnia

Insomnia can be a difficulty falling asleep, a difficulty remaining asleep or a feeling of non-restorative sleep. It is a subjective symptom with multiple possible causes and aggravating factors. A history of insomnia should seek to clarify what sleep issue is experienced and whether there are identifiable physical or psychological factors.

Causes

• Anxiety/depression
• Pain/breathlessness
• Nocturia
• Environmental changes
• Stimulant drugs (steroids, caffeine) or side effects of drugs (hallucinations with opioids, nightmares from beta blockers)

Non-drug treatment

• Establish and maintain good sleep hygiene habits
• Relaxation techniques
• Complementary therapy

Drug treatment

• Z drugs (zopiclone, zolpidem) often cause less residual sleepiness than benzodiazepines so are preferred first line
• Benzodiazepines e.g. diazepam
• Tricyclic antidepressants e.g. amitriptyline
• Other antidepressant if depression a factor
• Melatonin can be used as a short course to try to correct sleep/waking pattern
• Haloperidol may be beneficial if evidence of delirium or hallucinations