Insomnia: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[Alcohol | * [[Alcohol Abuse]], [[alcohol withdrawal|alcohol]], [[benzodiazepine withdrawal|benzo]], or [[opioid withdrawal]] | ||
* [[Depression]]/[[anxiety]] | * [[Depression]]/[[anxiety]] | ||
* | *[[Bipolar disorder]], [[schizophrenia]] | ||
*[[Hepatic encephalopathy]] | |||
*[[TBI]] | |||
*[[Acute mountain sickness]] | |||
*[[Delirium]] | |||
*[[Hyperphosphatemia]] | |||
*Medications (many!) | |||
*Excess [[caffeine]] | |||
* Sleep-disruptive environmental circumstances | * Sleep-disruptive environmental circumstances | ||
* Restless legs syndrome | * Restless legs syndrome | ||
* | * [[Obstructive sleep apnea]] | ||
* Short duration sleep circadian rhythm disorders | * Short duration sleep circadian rhythm disorders | ||
* Chronic sleep restriction | * Chronic sleep restriction | ||
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==Management== | ==Management== | ||
* Sleep hygiene education, relaxation, and stimulus control | * Sleep hygiene education, relaxation, and stimulus control | ||
* | * Zaleplon for sleep onset insomnia, [[Zolpidem]] (Ambien) or Eszopiclone for sleep maintenance insomnia<ref>Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([https://www.uptodate.com/contents/treatment-of-insomnia-in-adults?source=see_link])</ref> | ||
* [[Trazodone]], [[gabapentin]], and melatonin agonists | * [[Trazodone]], [[gabapentin]], and melatonin/melatonin agonists | ||
** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances) | ** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances) | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Neurology]] | [[Category:Neurology]] [[Category:Psychiatry]] | ||
[[Category:Symptoms]] | |||
Latest revision as of 03:22, 12 June 2024
Background
- Daytime dysfunction due to difficulty initiating sleep or lack of good sleep.
- A common emergency department complaint among patients in recovery from a substance use disorder or a psychiatric disorder
- Most substances of abuse affect sleep during active use, acute withdrawal, and with sustained abstinence
- Specific medications for insomnia should be avoided in patients with history of substance abuse.
Clinical Features
- Difficulty falling asleep and staying asleep
- Impaired daytime function (must also be reported for a diagnosis of an insomnia disorder)
- Simultaneous psychiatric, medications/substances, are usually present
Differential Diagnosis
- Alcohol Abuse, alcohol, benzo, or opioid withdrawal
- Depression/anxiety
- Bipolar disorder, schizophrenia
- Hepatic encephalopathy
- TBI
- Acute mountain sickness
- Delirium
- Hyperphosphatemia
- Medications (many!)
- Excess caffeine
- Sleep-disruptive environmental circumstances
- Restless legs syndrome
- Obstructive sleep apnea
- Short duration sleep circadian rhythm disorders
- Chronic sleep restriction
- Psychosis
Evaluation
- A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia
- Screen for mood disorders, PTSD, substance use disorders
- A sleep history and review of sleep and wake diaries can be helpful in determining the cause
Management
- Sleep hygiene education, relaxation, and stimulus control
- Zaleplon for sleep onset insomnia, Zolpidem (Ambien) or Eszopiclone for sleep maintenance insomnia[1]
- Trazodone, gabapentin, and melatonin/melatonin agonists
- Benzodiazepines should be avoided (due to risks of overdose when mixed with alcohol or other substances)
Disposition
- Discharge home unless patient acutely psychotic
- Follow up with primary care doctor
- Consider outpatient polysomnography-sleep study