7/1/2023 0 Comments Global insomnia definitionAre there times when sleep returns to normal? Was there an initial trigger or did the symptom arise spontaneously? Was it related to a period of stress, anxiety or depression? Did it start during childhood and continue thereafter? Are there lifestyle factors contributing to insomnia, such as too much caffeine or exercise late in the day, television or pets in the bedroom, or use of alcohol or nicotine? Knowing the patient’s cognitions, beliefs and worries about sleep, which are often apparent in the language and emotion used when they describe their sleep, can assist in the formulation of specific behavioural and calming approaches to assist with sleep. Therefore, part of the sleep assessment is asking for the patient’s narrative of typical bedtime, time taken to fall asleep after lights out (sleep latency), frequency and rough duration of awakenings in the middle of the night, and what time the patient gets out of bed. Insomnia assessment involves understanding the patient’s typical sleep pattern at night and over a time frame of weeks to months. To assist in establishing premorbid baseline sleeping patterns and formulating treatment goals, clinicians must ask patients about their typical sleeping pattern before they developed insomnia. The assessment and diagnosis of insomnia is formulated mainly from a systematic sleep history. Health care providers need to see insomnia as a chronic illness and emphasise the role of strategies to prevent relapses, rather than focusing on treatment of acute episodes or crises. Therefore, the treatment approach needs to match this, with a chronic disease management model educating and upskilling patients on how best to manage their insomnia symptoms over time. 8 The long-term course is then generally one of relapse and remission rather than resolution, 9 which continues well after the acute precipitating circumstances have passed. Once people have had difficulty sleeping for over 4 weeks, they have usually begun to behave and think about sleep differently, in ways that are maladaptive and perpetuate their sleep difficulties. However, if patients have repeated episodes of acute insomnia or ongoing comorbidities, insomnia symptoms can persist and evolve into chronic insomnia, which requires a different treatment approach. This is the usual approach in primary care, with 95% of general practitioner consultations for insomnia resulting in the prescription of a hypnotic, usually a benzodiazepine. Hence, treatment for acute insomnia is focused on avoiding or withdrawing the precipitant, if possible, and supporting the acute distress of not sleeping with short-term use of hypnotics if symptoms are significant. Once the precipitating event passes, sleep settles back to its usual pattern. 6 Generally, acute insomnia is triggered by precipitating events such as ill health, change of medication or circumstances, or stress. 6 Having a sleep experience that does not meet our expectation, such as with some transient awakenings but with good daytime functioning, does not constitute insomnia.Īcute insomnia is defined as sleep disturbance meeting the DSM-5 definition of insomnia, but with symptoms occurring for less than 4 weeks. Insomnia is defined in the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5) as difficulty getting to sleep, staying asleep or having non-restorative sleep despite having adequate opportunity for sleep, together with associated impairment of daytime functioning, with symptoms being present for at least 4 weeks. 3 Insomnia doubles the risk of future development of depression, and insomnia symptoms together with shortened sleep are associated with hypertension. Around 50% of patients with depression have comorbid insomnia, and depression and sleep disturbance are, respectively, the first and third most common psychological reasons for patient encounters in general practice. 1, 2 Insomnia can occur as a primary disorder or, more commonly, it can be comorbid with other physical or mental disorders. Australian population surveys have shown that 13%–33% of the adult population have regular difficulty either getting to sleep or staying asleep. I nsomnia is a very common disorder that has significant long-term health consequences. Statistics, epidemiology and research design.
0 Comments
Leave a Reply. |