Insomia: case studies in family practice
Sleep disorders can be broadly classified into: (a) insomnia, (b) parasomnia, (c) sleep disorders associated with psychiatric, neurologic and other medical disorders, and (d) proposed sleep disorders (e.g. pregnancy and menstrual related sleep disorders).1 Insomnia is a common encounter in primary care consultations2 and constitutes the commonest sleep problem3,4 that presents to the general practitioner.
Based on the National Center for Sleep Disorders Research Classification,5 insomnia symptoms can be defined as subjective complaints of difficulty falling asleep, difficulty maintaining sleep, early awakening and non refreshing sleep despite an adequate opportunity to sleep. An important consideration is whether the presence of one or more of these symptoms causes significant impairment to the patient’s social, occupational or other important areas of functioning.
Insomnia can be due to primary or secondary causes. Primary insomnia refers to insomnia that appears to be unrelated to any identifiable underlying medical or psychiatric disorder.6,7 Secondary causes of insomnia include conditions where another disorder contributing to or aggravating the insomnia can be diagnosed (Table1). The diagnosis of sleep disorders is often based on obtaining a detailed sleep history, a neuropsychiatric evaluation, a physical examination looking for medical and other disorders, mental status examination and relevant investigations. A sleep diary that the patient maintains in which sleep-relevant behaviours such as bedtime and waking times, awakenings, total sleep time, napping, medications, alcohol and mood on waking often provides valuable information for the patient and physician. Patients with sleep-disordered breathing, sleep-related motor disorders and those with severe, chronic insomnia for which an obvious cause cannot be found may require referral for sleep laboratory evaluation. (copied from article)
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