In this video, Dr Sanil Rege, Consultant Psychiatrist, explains the evaluation of sleep difficulties using a practical algorithm.
#sleep #sleepdisorder #insomnia #obstructivesleepapnea #restlesslegs #remsleep
Insomnia is defined as an ongoing subjective dissatisfaction with the duration or quality of sleep.
Sleep difficulties do not always equate to insomnia. In order for insomnia to be diagnosed - other causes should be ruled out.
0:00 - Introduction
0:25 - Definition of insomnia
1:24 - Nature of insomnia
2:12 - Sleep habits
3:00 - Stimuli affecting sleep
3:39 - Sleep restriction
4:19 - Types of Insomnia
4:39 - Principles in the management of Insomnia - Pharmacological and Non-Pharmacological
7:26 - Specific Types of medications for Insomnia

According to the DSM-V, the following are the key criteria for insomnia:

Predominant complaints of dissatisfaction with sleep quantity or quality associated with difficulty initiating sleep, difficulty maintaining sleep and early morning awakening with an inability to return to sleep.
The sleep difficulty occurs at least three nights per week, and the difficulty is present for at least three months.

Sleep difficulties may be due to :
1. Stress
2. Travel
3. Poor sleep hygiene
4. Medications or use of substances
5. Psychiatric disorders - ADHD, PTSD, depression, agitation etc
5. Sleep disorders - Obstructive sleep apnoea, Restless Legs Syndrome (RLS), REM sleep behaviour disorder
5. Narcolepsy

Thus it is important to evaluate the causes and the associated factors in order to devise an appropriate treatment plan.
Treatment consists of treating the causes
e.g. OSA - CPAP
RLS - treating iron deficiency, MG supplement, Dopamine agonists
PTSD nightmares - clonidine or prazosin
Psychophysiological insomnia - Sleep hygiene, sleep restriction, stimulus control
CBT-insomnia

Medications
Benzodiazepines
Z drugs - Zopiclone, zolpidem
Orexin antagonists - Lemborexant or suvorexant
Treating psychiatric disorders

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