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Insomnia (cont.)

Insomnia Medical Therapies

Insomnia from shift changes

  • Behavioral therapy has been useful in modifying the insomnia and symptoms of sleep deprivation in shift workers.
  • A person should shift their schedules forward in a clockwise direction, from days to evening, then evenings to night shift, and allow sufficient time to adapt (at least one week) between shift changes.
  • Bright light is a potent stimulus to circadian rhythm. Bright light is being examined as a rhythm synchronizer.
  • Shift workers should stress the importance of good sleep habits with regular bedtime and awakening.
    • Supplemental naps may be necessary to ensure work time alertness.
    • Discuss the use of naps with a doctor.
    • Some people promote using short-acting sedatives in the first few days following a shift change, but not everyone agrees.

Insomnia from Acute Stresses

  • Stress may be positive or negative, and concerns about sleep may vary. Many stressors will go away with support and reassurance.
  • Education about the importance of good sleep habits is also helpful.
  • Some people may need short-term treatment with medications. A doctor will often work toward the lowest effective dose with a short-acting sedative to achieve proper sleep.

Insomnia Prevention

General recommendations for prevention of insomnia include the following:

  • Work to improve your sleep habits.
    • Learn to relax. Self-hypnosis, biofeedback and relaxation breathing are often helpful.
    • Control your environment. Avoid light, noise, and excessive temperatures. Use the bed only to sleep and avoid using it for reading and watching TV. Sexual activity is an exception.
    • Establish a bedtime routine. Have a fixed wake time.
  • Avoid large meals, excessive fluid intake, and strenuous exercise before bedtime and reduce the use of stimulants including caffeine and nicotine.
  • If you do not fall asleep within 20 to 30 minutes, try a relaxing activity such as listening to soothing music or reading.
  • Limit daytime naps to less than 15 minutes unless directed by your doctor.
    • It is generally preferable to avoid naps whenever possible to help consolidate your night's sleep.
    • There are certain sleep disorders, however, that will benefit from naps. Discuss this issue with your doctor.

Insomnia Prognosis

Recovery from insomnia can vary.

  • If you have insomnia caused by jet lag, your symptoms will generally clear up within a few days.
  • If you are depressed and have had insomnia for many months, it is unlikely that your symptoms will go away on their own. You may need further evaluation and treatment.
  • Your outcome will also depend on coexisting medical conditions, which may include congestive heart failure, chronic obstructive pulmonary disease (COPD), and chronic pain syndromes.

Medically reviewed by Peter O’Connor, MD; American Board of Otolaryngology with subspecialty in Sleep Medicine

REFERENCES: eMedicine.com. Insomnia.
<http://emedicine.medscape.com/article/1187829-overview>

FDA.gov. Medication Guide Intermezzo. <http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022328s000mg.pdf>


Medically Reviewed by a Doctor on 5/25/2016

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Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or quality of sleep that occurs despite adequate time and opportunity for sleep that results in some form of daytime impairment.

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