n CME : Your SA Journal of CPD - 'Im not sleeping well.' : main article

Volume 24, Issue 8
  • ISSN : 0256-2170



Secondary insomnia is less common than primary insomnia. <BR>Secondary causes of insomnia include:&lt;UL&gt;&lt;LI&gt; depression and anxiety&lt;/LI&gt;&lt;LI&gt; conditions causing nocturnal pain or breathlessness&lt;/LI&gt;&lt;LI&gt; side-effects of medications and substance abuse&lt;/LI&gt;&lt;LI&gt; less common but usually obvious medical conditions, such as hyperthyroidism&lt;/LI&gt;&lt;LI&gt; 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.

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