Insomnia is a condition in which a person typically has difficulty falling asleep (sleep onset), trouble maintaining sleep (intermittent awakening) or wakes up at an undesirably early time and is unable to return to sleep (early awakening).
This can be a debilitating condition and there are varying causes of insomnia. In order to effectively manage this condition, it is important to take a good history. Understanding the possible precipitating factors are key to coming up with an effective management plan for this condition.
There are various forms of insomnia noted and these include but are not limited to:
- Psychophysiologic insomnia
- Drug induced insomnia
- Idiopathic insomnia
- Familial fatal insomnia
The diagnostic modalities with insomnia are heavily weighted towards collecting a good history and using sleep logs and occasionally actigraphy to understand the extent of the patients’ insomnia. Diagnostic sleep polysomnogram are not typically required for the evaluation of insomnia
The management of insomnia is complicated and any good plan should incorporate behavioral/ psychological management.
The importance of good sleep hygiene must be emphasized along with the institution of varying behavioral modifications techniques such as:
• Stimulus Control
• Relaxation Techniques
• Psychotherapy
• Biofeedback
If these modalities in themselves are not totally effective, then the addition of pharmacologic agents may be necessary. The choices with these may vary depending on the underlying clinical condition and assumed etiology of the insomnia.
Optimal management of this condition is best achieved when performed by a physician with good training and understanding of insomnia.
