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Chapter 028. Sleep Disorders (Part 6)

Evaluation of Insomnia Insomnia is the complaint of inadequate sleep; it can be classified according to the nature of sleep disruption and the duration of the complaint. Insomnia is subdivided into difficulty falling asleep (sleep onset insomnia), frequent or sustained awakenings (sleep maintenance insomnia), early morning awakenings (sleep offset insomnia), or persistent sleepiness/fatigue despite sleep of adequate duration (nonrestorative sleep). Similarly, the duration of the symptom influences diagnostic and therapeutic considerations. An insomnia complaint lasting one to several nights (within a single episode) is termed transient insomnia and is typically the result of situational stress or a change in sleep. | Chapter 028. Sleep Disorders Part 6 Evaluation of Insomnia Insomnia is the complaint of inadequate sleep it can be classified according to the nature of sleep disruption and the duration of the complaint. Insomnia is subdivided into difficulty falling asleep sleep onset insomnia frequent or sustained awakenings sleep maintenance insomnia early morning awakenings sleep offset insomnia or persistent sleepiness fatigue despite sleep of adequate duration nonrestorative sleep . Similarly the duration of the symptom influences diagnostic and therapeutic considerations. An insomnia complaint lasting one to several nights within a single episode is termed transient insomnia and is typically the result of situational stress or a change in sleep schedule or environment e.g. jet lag disorder . Short-term insomnia lasts from a few days to 3 weeks. Disruption of this duration is usually associated with more protracted stress such as recovery from surgery or short-term illness. Longterm insomnia or chronic insomnia lasts for months or years and in contrast with short-term insomnia requires a thorough evaluation of underlying causes see below . Chronic insomnia is often a waxing and waning disorder with spontaneous or stressor-induced exacerbations. An occasional night of poor sleep typically in the setting of stress or excitement about external events is both common and without lasting consequences. However persistent insomnia can lead to impaired daytime function injury due to accidents and the development of major depression. In addition there is emerging evidence that individuals with chronic insomnia have increased utilization of health care resources even after controlling for co-morbid medical and psychiatric disorders. All insomnias can be exacerbated and perpetuated by behaviors that are not conducive to initiating or maintaining sleep. Inadequate sleep hygiene is characterized by a behavior pattern prior to sleep or a bedroom environment that is not conducive to sleep.