Difference between revisions of "Insomnia"

(Differential Diagnosis)
Line 11: Line 11:
==Differential Diagnosis==   
==Differential Diagnosis==   
* [[Alcohol Abuse]]
* [[Alcohol Abuse]], [[alcohol withdrawal|alcohol]], [[benzodiazepine withdrawal|benzo]], or [[opioid withdrawal]]
* [[Depression]]/[[anxiety]]
* [[Depression]]/[[anxiety]]
*[[Bipolar disorder]]
*[[Bipolar disorder]], [[schizophrenia]]
*[[Hepatic encephalopathy]]
*[[Acute mountain sickness]]
*Medications (many!)
*Excess [[caffeine]]
* Sleep-disruptive environmental circumstances
* Sleep-disruptive environmental circumstances
* Restless legs syndrome  
* Restless legs syndrome  

Latest revision as of 03:29, 3 October 2019


  • 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


  • 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


  • 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)


  • Discharge home unless patient acutely psychotic
  • Follow up with primary care doctor
  • Consider outpatient polysomnography-sleep study

See Also

External Links


  1. Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([1])