![]() ![]() Several herbal agents have been promoted for their effect on sleep, but there are only limited studies to date to support or recommend rejecting their use. Side effect profiles of the drugs, their potential interactions with alcohol, and the patient's specific responses to drug therapy should be carefully discussed and monitored to achieve the best balance of risk and benefit with each agent. Daytime drowsiness (drug hangover), alterations in memory, an increased risk of accidents, dry mouth, blurred vision, or constipation are potential side effects of some of these medications. Drug therapies include the use of sedative and hypnotic drugs (including antihistamines such as diphenhydramine benzodiazepines such as temazepam benzodiazepine receptor antagonists antidepressants such as doxepin melatonin or melatonin receptor agonists such as ramelteon). Proven treatments for insomnia include CBTs and hypnotic drugs: both are effective and acceptable to patients. For these patients, sleep hygiene is an effective intervention. Other patients sleep poorly because they do not have an established sleep routine. Cognitive behavioral therapies (CBTs) may help them to set these thoughts aside until daytime. Many patients with sleep disturbances experience troublesome or intrusive thoughts at night that keep them from resting at night (“My mind is racing.”). PSG is usually employed only in those patients in whom sleep apnea is suspected. Technologies that are occasionally used to aid the diagnosis include wrist actigraphy, in which a monitor is worn by the patient and used to track motor activity during sleep and polysomnography (PSG). sleep apnea) and their treatments and the consumption of stimulants, alcohol, or other drugs are additional important elements that should be included in a sleep diary by the patient. The regularity or irregularity of sleep habits the patient's comorbid illnesses (esp. Important elements in a sleep diary include factors that interfere with sleep onset or sleep maintenance: how long it takes to fall asleep the number of nighttime arousals (and the reason for the arousal (such as for nursing mothers, the care they provide for their newborns or for mature men, the number of times they awaken to urinate). The patient's history, including a carefully documented diary that details sleep behaviors (and their daytime consequences) can help both to diagnose insomnia and to guide therapeutic approaches. Insomniacs also experience alterations in their daytime attention or focus, in their moods, e.g., reporting increased irritability, or their decreased ability to carry out normal daytime functions effectively. Insomnia is characterized more by the subjective sense that sleep is impaired rather than by objectively measured short sleep duration. Others awaken in the middle of the night or early in the morning and have difficulty returning to sleep after waking up. Some people have trouble falling asleep even when given adequate time and a comfortable place to do so. Insomnia more often occurs secondary to a problem, e.g., alcohol or drug dependence, mood disorders, restless legs syndrome, sleep apnea, or travel across time zones. Insomnia is primary when it occurs in the absence of underlying diseases or conditions. Ten to 20% of the population experience chronic insomnia. Roughly half of all people experience some measure of insomnia, however briefly, each year. ![]() SYN: SEE: difficulty initiating and maintaining sleepSEE: sleep disorder SEE TABLE: Natural and Artificial Stimulants That May Contribute to Insomnia The subjective experience of insufficient sleep or of sleep that is not refreshing. A disruption in the amount and quality of sleep that impairs functioning.Ģ. To hear audio pronunciation of this topic, purchase a subscription or log in.ġ. ![]()
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