n CME : Your SA Journal of CPD - 'Im not sleeping well.' : main article
|Article Title||'Im not sleeping well.' : main article|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||CME : Your SA Journal of CPD|
|Publication Date||Aug 2006|
|Pages||446 - 448|
|Keyword(s)||Causes, Diagnosis, Primary insomnia, Secondary insomnia, Treatment and Underlying conditions|
Secondary insomnia is less common than primary insomnia. <BR>Secondary causes of insomnia include:<UL><LI> depression and anxiety</LI><LI> conditions causing nocturnal pain or breathlessness</LI><LI> side-effects of medications and substance abuse</LI><LI> less common but usually obvious medical conditions, such as hyperthyroidism</LI><LI> frank sleep disorders such as obstructive sleep apnoea and restless legs syndrome (RLS).</LI></UL>The main symptom of insomnia is insufficient sleep to carry out the full range of daily functions. <BR>The patient who sleeps for only 5 hours a night, but is not sleepy during the day, is a 'short sleeper' and not an insomniac. <BR>Primary insomniacs have a good response to hypnotics, but feel out of control if they use them continuously. <BR>Two components are involved in maintaining the insomnia - a psychological anxiety and a physiological response to this anxiety, including raised muscle tone and respiratory rate. <BR>A behavioural regimen based on a cognitive-behavioural approach designed to improve sleep quality gradually over a period of 4 - 6 weeks is often helpful. <BR>A hypnotic can be prescribed for use every third night during this regimen - zolpidem and zopiclone are preferred. <BR>Referral to a sleep specialist may be necessary if this approach does not work.
Article metrics loading...