![]() Sleep logs/diaries are reliable and cost-effective ways to assess the sleep-wake cycle in an individual. The most widely used ones are Epworth Sleepiness Scale (from 0 to 24 with a score of more than 15 indicating severe daytime sleepiness) and Pittsburgh Sleep Quality Index (poor sleep score of greater than 5). Self-evaluating questionnaires and assessment scales are helpful to document sleep disturbances and the quality of sleep. The initial laboratory workup should include thyroid function tests, glycosylated hemoglobin, complete blood count, serum iron studies, liver function tests, and renal function tests. The laboratory test can provide a supportive data to evaluate the underlying medical conditions that can be associated with insomnia. Other sleep-related disorders like restless leg syndrome (RLS), sleep apnea, periodic limb movements, nocturnal leg cramps can contribute to seep fragmentation and should be evaluated during the clinical encounter. Inquiring about the sleep hygiene practices (activities performed just before bedtime including nighttime consumption of alcohol and caffeinated beverages, use of electronic gadgets at bedtime and frequency of daytime naps) can also be helpful to determine the ways to mitigate the sleep disturbances. ![]() ![]() Patients with underlying depression may have symptoms of waking up too early in the morning (early morning insomnia) and should be screened for the same. The clinician should be able to identify if the sleep disturbances are from difficulty in initiating sleep or maintaining sleep or both. The management plan for chronic insomnia should involve comprehensive evaluation that includes a history of sleep-related disturbances, associated underlying medical and/or psychiatric problems, medications or other sleep-related disorders.Ī detailed sleep history is essential for the evaluation of insomnia. The sleep disturbances have been present for over a period of 3 months.ĭifficulty in initiating or maintaining sleep that does not meet the criteria of chronic insomnia or short-term insomnia disorder. The sleep disturbances occur at least three times a week and have been present for the last 3 months. Insomnia is also considered a contributing risk factor for medical problems like cardiovascular diseases, chronic pain syndrome, depression, anxiety, diabetes, obesity, and asthma.Īccording to the third edition of the International Classification of Sleep Disorder, insomnia is classified as: Chronic insomnia can adversely affect the health, quality of life, academic performance, increase the risk of motor vehicle accidents, decrease the productivity at work, irritability and increase daytime sleepiness. These symptoms occur despite the presence of adequate opportunity and circumstance for sleep and result in daytime dysfunction. According to the third edition of the International Classification of Sleep Disorders (ICSD-3), insomnia is characterized by difficulty in either initiating sleep, maintaining sleep continuity, or poor sleep quality. Insomnia is the most common sleep disorder in the United States affecting about one-third of the general population.
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