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
Section titled “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
Section titled “Non-drug treatment”- Establish and maintain good sleep hygiene habits
- Relaxation techniques
- Complementary therapy
Drug treatment
Section titled “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 e.g. mirtazapine 15mg (although this is subtherapeutic for treatment of depression)
- 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