oa SA Pharmaceutical Journal - 'I'm not sleeping well' : clinical



Secondary insomnia is less common than primary insomnia.

Secondary causes of insomnia include:
  • depression and anxiety
  • conditions causing nocturnal pain or breathlessness
  • side-effects of medications and substance abuse
  • less common but usually obvious medical conditions, such as hyperthyroidism
  • frank sleep disorders such as obstructive sleep apnoea and restless legs syndrome (RLS).

The main symptom of insomnia is insufficient sleep to carry out the full range of daily functions.
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.
Primary insomniacs have a good response to hypnotics, but feel out of control if they use them continuously.
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.
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.
A hypnotic can be prescribed for use every third night during this regimen - zolpidem and zopiclone are preferred.
Referral to a sleep specialist may be necessary if this approach does not work.


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