Summary
Definition
History and exam
Key diagnostic factors
- sleep partner complaints
- delayed sleep onset
- multiple or long awakenings
Other diagnostic factors
- impairment of functioning
- accidents
- decreased sleep time
- daytime napping
- thyrotoxicosis
- chronic pain
- restless legs syndrome
- obstructive sleep apnea
Risk factors
- female sex
- advanced age
- chronic medical conditions
- chronic pain
- psychiatric illness
- alcohol or substance misuse
- stimulant use
- poor sleep hygiene
- traumatic brain injury
- neuropsychiatric illness
- use of certain medications
- recent travel across time zones
- night work
- hyperthyroidism
- participation in elite sport
- sedentary behavior
Diagnostic tests
1st tests to order
- sleep diary
- Pittsburgh Sleep Quality Index (PSQI)
- Insomnia Severity Index (ISI)
- Stanford Sleepiness Scale (SSS)
- Epworth Sleepiness Scale (ESS)
- Athens Insomnia Scale (AIS)
- Generalized Anxiety Disorder-7 (GAD-7)
- Patient Health Questionnaire-9 (PHQ-9)
Tests to consider
- polysomnography (PSG)
- actigraphy
- thyroid-stimulating hormone (TSH)
- CBC and iron studies
- urine or blood substance use panel
Treatment algorithm
acute insomnia
chronic insomnia
Contributors
Authors
Joshua Hyong-Jin Cho, MD, PhD
Health Sciences Clinical Professor
Director, UCLA Insomnia Clinic
Cousins Center for Psychoneuroimmunology
Department of Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
JHC is an author of a reference cited in this topic.
Paul Barkopoulos, MD, MPH
Clinical Professor
Department of Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
PB is an author of a reference cited in this topic.
Anthony E. Reading, MPhil, PhD
Clinical Professor
Department of Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles
CA
Declarações
AER declares that he has no competing interests.
Agradecimentos
Dr Joshua Hyong-Jin Cho, Dr Paul Barkopoulos, and Dr Anthony E. Reading would like to gratefully acknowledge Dr John W. Winkelman, Dr Teofilo Lee-Chiong, and Dr Vipin Malik, previous contributors to this topic.
Declarações
JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation. TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.
Revisores
Karl Doghramji, MD
Director
Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia
PA
Declarações
KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.
Chiadi U. Onyike, MD, MHS
Assistant Professor
Geriatric Psychiatry and Neuropsychiatry
The Johns Hopkins Hospital
Baltimore
MD
Declarações
CUO declares that he has no competing interests.
Roy Goldberg, MD
Medical Director
Kings Harbor Multicare Center
Bronx
NY
Declarações
RG declares that he has no competing interests.
Craig Sawchuk, MD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
Seattle
WA
Declarações
CS declares that he has no competing interests.
David Cunnington, MD
Director
Melbourne Sleep Disorders Centre
Melbourne
Victoria
Australia
Declarações
DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.Texto completo
Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Feb 15;13(2):307-49.Texto completo Resumo
Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33.Texto completo Resumo
Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb 1;17(2):255-62.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Restless legs syndrome
- Periodic limb movement disorder (PLMD)
- Obstructive sleep apnea (OSA)
Mais Diagnósticos diferenciaisDiretrizes
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- Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults
Mais DiretrizesFolhetos informativos para os pacientes
Insomnia
Sleep apnea in adults (obstructive)
Mais Folhetos informativos para os pacientes
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