Problems to sleep?
Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness.
Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. The prevalence of insomnia disorder is approximately 10% to 20%, with approximately 50% having a chronic course. (Buysee, 2013)
- Insomnia is the most common sleep disorder.
- Numerous individual studies and an influential meta-analysis have demonstrated the relationship between insomnia and subsequent development of depression.
- Longitudinal studies have demonstrated a relationship between insomnia and incident cardiovascular disease and even mortality.
- There is a relationship between insomnia and affective and cognitive difficulties, as well as subjective-objective sleep discrepancies in insomnia.
- Insomnia is comorbid with several important psychiatric disorders. CBT-I and related techniques may be useful for a broader range of patients, including those with comorbid psychiatric conditions such as depression, bipolar disorder, posttraumatic stress disorder, and schizophrenia.
- Older adults are at higher risk for the medical and psychiatric effects of insomnia.
- For acute insomnia, reversal of the trigger (if possible) and treatment with safe, effective sleep medication are advised.
- Chronic insomnia is best managed using non-drug strategies such as cognitive behaviour therapy. For patients with ongoing symptoms, there may be a role for adjunctive use of medications.
First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics and antidepressants depending on the patients’ needs and comorbidities. (Bragg et al, 2019).
Behavioral therapies are an effective treatment for adults with chronic insomnia. (Trauer et al, 2015).
Possible medications include suvorexant (orexin receptor antagonists), low-dose doxepin (TCA), Z-drugs or non-benzos (eszopiclone, zolpidem, zaleplon), benzodiazepines (triazolam, temazepam), and ramelteon (melatonin receptor agonists).