Insomnia
Insomnia is a topic covered in the 5-Minute Clinical Consult.
To view the entire topic, please log in or purchase a subscription.
Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
- Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep
- Causes at least one of the following forms of daytime impairment related to nighttime sleep difficulty:
- Fatigue or malaise
- Attention, concentration, or memory impairment
- Social or vocational dysfunction or poor school performance
- Mood disturbance or irritability
- Daytime sleepiness
- Motivation, energy, or initiative reduction
- Proneness for errors or accidents at work or while driving
- Tension, headaches, or GI symptoms in response to sleep loss
- Concerns or worries about sleep
Epidemiology
- Predominant age: increases with age
- Predominant sex: female > male (5:1)
Prevalence
- Most common sleep disorder
- Insomnia (transient and chronic): 5–35% of the population; 10–15% associated with daytime impairment
- Chronic insomnia: 10% middle-aged adults; 1/3 of people >65 years
Etiology and Pathophysiology
- Transient/intermittent (<30 days) and short-term (<3 months)
- Usually caused by an identifiable stressor
- Stress/excitement/bereavement
- Shift work
- Medical illness
- High altitude
- Can lead to chronic insomnia
- Usually caused by an identifiable stressor
- Chronic (>3 months)
- Usually not due to one single cause
- Medical: gastroesophageal reflux disease, sleep apnea, chronic pain, congestive heart failure, Alzheimer disease, Parkinson disease, chronic fatigue syndrome, irritable bowel syndrome
- Psychiatric: mood, anxiety, psychotic disorders
- Primary sleep disorder: idiopathic, psychophysiologic (heightened arousal and learned sleep-preventing associations), paradoxical (sleep state misperception)
- Circadian rhythm disorder: irregular pattern, jet lag, delayed/advanced sleep phase, shift work
- Environmental: light (liquid crystal display [LCD] clocks), noise (snoring, household, traffic), movements (partner/young children/pets)
- Behavioral: poor sleep hygiene, adjustment sleep disorder
- Substance induced
- Medications: antihypertensives, antidepressants, corticosteroids, levodopa-carbidopa, phenytoin, quinidine, theophylline, thyroid hormones
Risk Factors
- Age
- Female gender
- Medical comorbidities
- Unemployment
- Psychiatric illness
- Impaired social relationships
- Lower socioeconomic status
- Shift work
- Separation from spouse or partner
- Drug and substance abuse
- Family or personal history of insomnia
General Prevention
- Practice consistent sleep hygiene:
- Fixed wake-up times and bedtimes regardless of amount of sleep obtained (weekdays and weekends)
- Go to bed only when sleepy.
- Avoid naps.
- Sleep in a cool, dark, quiet environment.
- No activities or stimuli in bedroom associated with anything but sleep or sex
- 30-minute wind-down time before sleep
- If unable to sleep within 20 minutes, move to another environment and engage in quiet activity until sleepy.
- Limit caffeine intake to mornings.
- No alcohol after 4 PM
- Fixed eating times
- Avoid medications that interfere with sleep.
- Regular moderate exercise (>4 hours prior to bedtime)
Commonly Associated Conditions
- Psychiatric disorders
- Painful musculoskeletal conditions
- Obstructive sleep apnea
- Restless leg syndrome
- Drug or alcohol addiction/dependence
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep
- Causes at least one of the following forms of daytime impairment related to nighttime sleep difficulty:
- Fatigue or malaise
- Attention, concentration, or memory impairment
- Social or vocational dysfunction or poor school performance
- Mood disturbance or irritability
- Daytime sleepiness
- Motivation, energy, or initiative reduction
- Proneness for errors or accidents at work or while driving
- Tension, headaches, or GI symptoms in response to sleep loss
- Concerns or worries about sleep
Epidemiology
- Predominant age: increases with age
- Predominant sex: female > male (5:1)
Prevalence
- Most common sleep disorder
- Insomnia (transient and chronic): 5–35% of the population; 10–15% associated with daytime impairment
- Chronic insomnia: 10% middle-aged adults; 1/3 of people >65 years
Etiology and Pathophysiology
- Transient/intermittent (<30 days) and short-term (<3 months)
- Usually caused by an identifiable stressor
- Stress/excitement/bereavement
- Shift work
- Medical illness
- High altitude
- Can lead to chronic insomnia
- Usually caused by an identifiable stressor
- Chronic (>3 months)
- Usually not due to one single cause
- Medical: gastroesophageal reflux disease, sleep apnea, chronic pain, congestive heart failure, Alzheimer disease, Parkinson disease, chronic fatigue syndrome, irritable bowel syndrome
- Psychiatric: mood, anxiety, psychotic disorders
- Primary sleep disorder: idiopathic, psychophysiologic (heightened arousal and learned sleep-preventing associations), paradoxical (sleep state misperception)
- Circadian rhythm disorder: irregular pattern, jet lag, delayed/advanced sleep phase, shift work
- Environmental: light (liquid crystal display [LCD] clocks), noise (snoring, household, traffic), movements (partner/young children/pets)
- Behavioral: poor sleep hygiene, adjustment sleep disorder
- Substance induced
- Medications: antihypertensives, antidepressants, corticosteroids, levodopa-carbidopa, phenytoin, quinidine, theophylline, thyroid hormones
Risk Factors
- Age
- Female gender
- Medical comorbidities
- Unemployment
- Psychiatric illness
- Impaired social relationships
- Lower socioeconomic status
- Shift work
- Separation from spouse or partner
- Drug and substance abuse
- Family or personal history of insomnia
General Prevention
- Practice consistent sleep hygiene:
- Fixed wake-up times and bedtimes regardless of amount of sleep obtained (weekdays and weekends)
- Go to bed only when sleepy.
- Avoid naps.
- Sleep in a cool, dark, quiet environment.
- No activities or stimuli in bedroom associated with anything but sleep or sex
- 30-minute wind-down time before sleep
- If unable to sleep within 20 minutes, move to another environment and engage in quiet activity until sleepy.
- Limit caffeine intake to mornings.
- No alcohol after 4 PM
- Fixed eating times
- Avoid medications that interfere with sleep.
- Regular moderate exercise (>4 hours prior to bedtime)
Commonly Associated Conditions
- Psychiatric disorders
- Painful musculoskeletal conditions
- Obstructive sleep apnea
- Restless leg syndrome
- Drug or alcohol addiction/dependence
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Domino, Frank J., et al., editors. "Insomnia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia.
Insomnia. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia. Accessed April 2, 2023.
Insomnia. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia
Insomnia [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 April 02]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Insomnia
ID - 816561
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -