G47.0/G47.9
DESCRIPTION
Insomnia may be an independent disorder, or associated with comorbid conditions. Insomnia may persist despite successful treatment of the comorbidity, and may necessitate separate treatment.
Patients presenting with insomnia may complain of difficulty falling asleep, frequent waking during the night, early-morning wakening and daytime sleepiness.
GENERAL MEASURES
- Treat the medical condition, psychiatric illness, substance use disorder or sleep disorder that may be precipitating or exacerbating the insomnia, if present.
- All patients should receive basic behavioural counselling about sleep hygiene and stimulus control as first step of treatment.
- Cognitive behavioural therapy is the treatment of choice.
MEDICINE TREATMENT
If medication is needed:
- Use the lowest effective dose.
- Use intermittent dosing if possible (alternate night or less).
Sleep hygiene and stimulus control:
- Maintain a regular sleep cycle (same time wake up in the morning, including week-ends).
- Stimulus control:
- Keeping the room quiet, dark and at a comfortable temperature.
- Using the bed and bedroom only for sleeping (and sex).
- Limit intake of caffeine, nicotine and alcohol, especially before bedtime.
- Eating a light snack before bedtime, but not a large meal late at night.
- Sleep restriction: avoiding daytime naps.
- Increasing daily exercise (not late in the evening).
- Using anxiety management or relaxation techniques.
- Go to bed only when tired. Sleep as much as needed to feel refresh, not longer.
- If unable to sleep for more than 15–20 minutes, get out of bed and engage in a non-stimulating activity until tired (e.g. listen to soft music, read).
If medication is needed to treat the insomnia:
- Short-acting benzodiazepines, e.g.:
- Oxazepam, oral 15–30 mg at night.
Short-term use of benzodiazepines of 14 days is recommended as long-term use is often associated with dependence.
REFERRAL
Patients with chronic insomnia.