Summary of Insomnia Treatment & Recommendations from the Text
This text provides a extensive overview of insomnia treatment, ranging from medication to non-drug therapies, and highlights when neurological consultation is necessary.Here’s a breakdown of the key points:
1. Acute vs. Chronic Insomnia:
Acute Insomnia: Treat aggressively with sleeping pills to quickly reduce anxiety and prevent it from becoming chronic.Medication is considered meaningful in these cases.
Chronic Insomnia: The text focuses more on long-term management strategies.
2. Non-Drug treatments (CBT-I Alternatives):
Treat Underlying sleep Disorders: If insomnia co-occurs with other sleep disorders (like sleep apnea), address those frist. Positive airway pressure (PAP) therapy for sleep apnea can substantially improve sleep.
Light Exposure: Block light in the evening, maximize bright light exposure during the day.
Sleep Diary (2 weeks): Track bedtime, wake-up time, time in bed, estimated sleep time, and sleep onset latency (time to fall asleep). This helps identify patterns.
Stimulus Control:
If unable to sleep after a reasonable time, get out of bed.
Engage in relaxing activities until feeling sleepy, then return to bed.
Goal: Reduce awake time in bed. Sleep Hygiene: Crucially, reduce caffeine intake (including hidden sources like cola and energy drinks). Sleep Restriction:
Based on sleep diary analysis,reduce time in bed to 85% of actual sleep time (but never below 5 hours).
Requires consistent effort and weekly diary adjustments.
caution: Not suitable for patients with epilepsy or manic depression.
Digital CBT-I: Smartphone apps offering CBT-I principles. Becoming increasingly recognized and researched in Korea.
3. When to Refer to Neurology:
Comorbidity: If insomnia is accompanied by another neurological or psychiatric disorder. (The text specifically highlights needing a neurology request in this situation). Medical History: Patients with a history of:
Arrhythmia
Coronary artery disease
Heart failure
Cerebral infarction
Concerning Symptoms: Insomnia plus any of the following:
orthostatic hypotension
Nighttime sleep behavior disturbances (suggesting potential degenerative brain disease)
4. risks of Untreated Insomnia:
Cardiovascular Disease & Dementia: Sleep less than 5 hours is linked to increased risk.
Excessive Sleep: Sleeping more than 9 hours is also associated with increased risk of cardiovascular disease, dementia, and mortality.(Highlights the importance of sleep quality).
Underreporting: Many patients with insomnia underestimate thier actual sleep time.
In essence,the text advocates for a multi-faceted approach to insomnia,prioritizing non-drug therapies like CBT-I techniques and careful sleep hygiene,while recognizing the importance of medical evaluation and potential neurological referral in specific cases. It emphasizes that simply focusing on quantity of sleep isn’t enough; quality* is crucial.
