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| '''For patient information click [[Insomnia (patient information)|here]]''' | | '''For patient information click [[Insomnia (patient information)|here]]''' |
| {{Insomnia}} | | {{Insomnia}} |
| {{CMG}}; {{Adnan Ezici}} , {{AF}} , {{KS}} , {{JC}} , {{NS}} | | {{CMG}}; {{AE}} {{Adnan Ezici}} , {{AF}} , {{KS}} , {{JC}} , {{NS}} |
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| {{SK}} Insomnia disorder | | {{SK}} Insomnia disorder |
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| ==[[Insomnia classification|Classification]]== | | ==[[Insomnia classification|Classification]]== |
| [[Insomnia]] has been classified by the International Classification of Sleep Disorders, 2nd Edition into 11 categories<ref name="urlInsomnia: Practice Essentials, Background, Anatomy">{{cite web |url=https://emedicine.medscape.com/article/1187829-overview#a5 |title=Insomnia: Practice Essentials, Background, Anatomy |format= |work= |accessdate=}}</ref>:
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| *Psychophysiologic insomnia (primary insomnia)
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| *Adjustment insomnia (acute insomnia)
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| *Paradoxical insomnia
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| *Behavioral insomnia of childhood
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| *Primary sleep disorders causing insomnia
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| *Idiopathic insomnia
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| *Inadequate sleep hygiene
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| *Insomnia due to mental disorder
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| *Insomnia due to drug or substance abuse
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| *Insomnia due to a medical condition
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| *Insomnia not due to a substance or known physiologic condition, unspecified
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| Insomnia has also been classified by the International Classification of Sleep Disorder, 3rd Edition into<ref name="urlSleep Medicine: Insomnia and Sleep">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390785/ |title=Sleep Medicine: Insomnia and Sleep |format= |work= |accessdate=}}</ref>:
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| *Chronic Insomnia Disorder
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| *Short-term Insomnia Disorder
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| *Other Insomnia Disorder
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| ==[[Insomnia causes|Causes]]== | | ==[[Insomnia causes|Causes]]== |
| Symptoms may include waking up a night, waking up too early, difficulty falling asleep at night, daytime fatigue, impaired concentration and recall, irritability, Constant worries about sleep, [[Depression]], [[anxiety]] and increased accidents or error prone.
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| Common causes include<ref name="urlInsomnia - Symptoms and causes - Mayo Clinic">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167 |title=Insomnia - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref>:
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| *Excess consumption of caffeine, nicotine and alcohol
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| *Medication induced
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| **Prescription drugs
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| **Over the counter drugs
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| *Bad sleep habits: Using bed for work, eating or any other leisure, disrupted bedtime schedule, frequent naps, stimulating activities before bed, disturbed sleep environment.Use of electronic gadgets just before bed can also interfere with the sleep cycle.
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| *Eating too much before bedtime causing GI discomfort or heartburn while lying down.
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| *Jet lags, Constant change in shifts, working too late or an early shift can disrupt the body's circadian rhythm
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| *Trauma and Stressful life experiences
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| *Depression or Anxiety or [[PTSD]]
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| *Medical conditions like [[GERD]], chronic pain, cancer, cardiac diseases, asthma, overactive thyroid, urinary complaints in elderly.
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| *Sleep-related disorders like [[Restless leg syndrome]] and [[sleep apnea]]
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| ==[[Insomnia differential diagnosis|Differentiating Insomnia from other Diseases]]== | | ==[[Insomnia differential diagnosis|Differentiating Insomnia from other Diseases]]== |
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| ==[[Insomnia epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Insomnia epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Gender===
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| Females have a higher prevalence of insomnia in adolescence and especially high during menopause.
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| ===Age=== | | ==[[Insomnia risk factors|Risk Factors]]== |
| Higher prevalence of insomnia in the elderly population.
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| ===Socioeconomic status===
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| More common in those with poor health, low socioeconomic status and quality of life.
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| ==[[Insomnia risk factors|Risk Factors]]== | | ==[[Insomnia screening|Screening]]== |
| Common risk factors for insomnia include<ref name="urlInsomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy | AJMC">{{cite web |url=https://www.ajmc.com/view/insomnia-overview-epidemiology-pathophysiology-diagnosis-and-monitoring-and-nonpharmacologic-therapy |title=Insomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy | AJMC |format= |work= |accessdate=}}</ref>:
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| *Gender(Female)
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| *Increasing age
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| *Depression
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| *Unemployed
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| *Widow/Divorced/Separated
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| *Lower educational qualification
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| *Economic inactivity
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| *Military Deployment
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| *Racial Discrimintion
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| ==[[Insomnia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== | | ==[[Insomnia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Insomnia history and symptoms|History and Symptoms]] | [[Insomnia physical examination|Physical Examination]] | [[Insomnia laboratory findings|Laboratory Findings]] | [[Insomnia other diagnostic studies|Other Diagnostic Studies]] | | [[Insomnia diagnostic criteria|Diagnostic Study of Choice]] | [[Insomnia history and symptoms|History and Symptoms]] | [[Insomnia physical examination|Physical Examination]] | [[Insomnia laboratory findings|Laboratory Findings]] | [[Insomnia electrocardiogram|Electrocardiogram]] | [[Insomnia x ray|X-ray]] | [[Insomnia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Insomnia CT scan|CT scan]] | [[Insomnia MRI|MRI]] | [[Insomnia other imaging findings|Other Imaging Findings]] | [[Insomnia other diagnostic studies|Other Diagnostic Studies]] |
| ===History and Symptoms===
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| [[DSM-5 diagnostic criteria]] for insomnia includes<ref name="urlEvaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population | Read by QxMD">{{cite web |url=https://read.qxmd.com/read/29394962/evaluating-dsm-5-insomnia-disorder-and-the-treatment-of-sleep-problems-in-a-psychiatric-population |title=Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population | Read by QxMD |format= |work= |accessdate=}}</ref>: | |
| *Symptoms occur ≥ 3 days/week for ≥ 3 months
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| *Symptoms cause functional impairment or distress
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| *Problems initiating or maintaining sleep, or awakening early in the morning and being unable to return to sleep
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| *Symptoms occur despite having enough time to sleep
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| *Symptoms are not caused by an underlying substance or medication use
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| *No underlying or coexisting psychiatric or medical disorder that explains symptoms
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| ===Laboratory Findings===
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| *Blood tests: Medical conditions can also cause/exacerbate sleep. Based on the [[questionnaire]] and physical exam, the doctor may recommend blood tests to check for other pre-existing conditions.<ref name="urlDiagnosing Insomnia | Sleep Foundation">{{cite web |url=https://www.sleepfoundation.org/insomnia/diagnosis |title=Diagnosing Insomnia | Sleep Foundation |format= |work= |accessdate=}}</ref>.
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| ===Diagnostic Studies===
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| The doctor won’t be able to confirm an insomnia diagnosis in some cases without further testing. Following are the tests one might have to undergo
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| *[[Sleep study]]: Overnight sleep stud or the [[polysomnogram]] test.In this study, one has to spend the night at a sleep center with sensors on the face, scalp, eyelids, one finger, chest and limbs. The sensors then monitor brain wave activity, oxygen level, heart rate, respiratory rate and muscle movement that occur prior, during, and post sleep. Also, some daytime tests monitor sleep latency during a series of naps, evaluate abilities to stay awake and alert after a night of normal sleep. However, irrespective of home-based monitoring kits or the procedures mentioned above, they will be non-invasive and pain-free.
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| *[[Actigraphy]]: Actigraphy tests, similar to [[overnight sleep studies]], but most are conducted at home. In this one has to wear a sensor on the wrist or ankle to monitor their sleep and wakefulness pattern. Recommended Duration for wearing the sensors is three to 14 consecutive days. The test is safe for children and adults but the sensor may cause some light albeit temporary irritation.
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| If the diagnostic criteria for chronic or short-term insomnia based on the sleep disorder test are met, then we may advance to insomnia treatment.
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| ==Treatment== | | ==Treatment== |
| [[Insomnia medical therapy|Medical Therapy]] | [[Insomnia non-pharmacological therapy|Non-pharmacological therapy]] | [[Insomnia primary prevention|Primary Prevention]] | [[Insomnia secondary prevention|Secondary Prevention]] | [[Insomnia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Insomnia future or investigational therapies|Future or Investigational Therapies]] | | [[Insomnia medical therapy|Medical Therapy]] | [[Insomnia non-pharmacological therapy|Non-pharmacological therapy]] | [[Insomnia surgery|Surgery]] | [[Insomnia primary prevention|Primary Prevention]] | [[Insomnia secondary prevention|Secondary Prevention]] | [[Insomnia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Insomnia future or investigational therapies|Future or Investigational Therapies]] |
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| Management is guided by available [[clinical practice guideline]]s<ref name="pmid32066145">{{cite journal| author=Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C | display-authors=etal| title=The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. | journal=Ann Intern Med | year= 2020 | volume= | issue= | pages= | pmid=32066145 | doi=10.7326/M19-3575 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32066145 }} </ref>.
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| ==Case Studies== | | ==Case Studies== |