Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- queixas do parceiro de sono
- início tardio do sono
- despertares múltiplos ou longos
Other diagnostic factors
- comprometimento de função
- acidentes
- diminuição do tempo de sono
- cochilos durante o dia
- tireotoxicose
- dor crônica
- síndrome das pernas inquietas
- apneia obstrutiva do sono
Risk factors
- sexo feminino
- idade avançada
- afecções clínicas crônicas
- dor crônica
- doença psiquiátrica
- abuso de álcool ou de substâncias
- uso de estimulantes
- má higiene do sono
- lesão cerebral traumática
- doença neuropsiquiátrica
- uso de determinados medicamentos
- viagem recente em fusos horários diferentes
- trabalho noturno
- hipertireoidismo
- participação em esporte de elite
- comportamento sedentário
Diagnostic investigations
1st investigations to order
- diário do sono
- Pittsburgh Sleep Quality Index”, Índice de qualidade do sono de Pittsburgh (PSQI-BR)
- Insomnia Severity Index”, Índice de Gravidade da Insônia (IGI)
- Stanford Sleepiness Scale”, Escala de Sonolência de Stanford (ESS)
- Escala de Sonolência de Epworth (ESE)
- Escala de insônia de Atenas (EIA)
- Transtorno de Ansiedade Generalizada 7 (TAG-7)
- PHQ-9
Investigations to consider
- polissonografia (PSG)
- actigrafia
- hormônio estimulante da tireoide (TSH)
- Hemograma completo e perfil de ferro
- perfil de uso de substâncias na urina ou no sangue
Treatment algorithm
insônia aguda
insônia crônica
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
Disclosures
AER declares that he has no competing interests.
Acknowledgements
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.
Disclosures
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 apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.
Peer reviewers
Karl Doghramji, MD
Director
Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia
PA
Disclosures
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
Disclosures
CUO declares that he has no competing interests.
Roy Goldberg, MD
Medical Director
Kings Harbor Multicare Center
Bronx
NY
Disclosures
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
Disclosures
CS declares that he has no competing interests.
David Cunnington, MD
Director
Melbourne Sleep Disorders Centre
Melbourne
Victoria
Australia
Disclosures
DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.Full text
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Síndrome das pernas inquietas
- Transtorno do movimento periódico dos membros (TMPM)
- Apneia obstrutiva do sono (AOS)
More DifferentialsGuidelines
- Australasian Sleep Association 2024 guidelines for sleep studies in adults
- Manual for the scoring of sleep and associated events
More GuidelinesPatient information
Apneia do sono em adultos (obstrutiva)
Insônia
More Patient information
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