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Insomnia: Diagnosis and TreatmentDiagnosis- A
medical history and a physical examination, including a detailed sleep
history, is an essential part of the evaluation. It should assess sleep
habits, sleep environment, drug and alcohol use, medical and medication
history, and family medical history. It is often helpful for the
physician to interview the patient's bed partner and to ask the patient
to keep a sleep log.
- Laboratory testing may identify medical disorders (such as thyroid disease) that can contribute to sleep difficulties.
- Sleep testing is often helpful. The most common sleep test is polysomnography, which is used to evaluate for sleep apnea.
Treatment- Underlying medical, surgical, or psychiatric disorders should be treated as appropriate.
- Proper
sleep hygiene is important. Individuals should exercise regularly (but
not before bedtime), avoid caffeine, and limit alcohol, particularly
near bedtime.
- Exercise has been shown to improve sleep
quality, but timing is important. Physical activity early in the day is
generally not associated with improved sleep, and aerobic exercise
taken shortly before bedtime can make it more difficult to fall asleep.
- Other
beneficial practices include sleeping only as much as necessary to feel
rested, keeping a regular sleep schedule, avoiding smoking, and
adjusting the bedroom environment as needed.
- Warm baths in the evening may improve insomnia in some cases.
- Psychiatric therapy can be useful in patients who do not respond to the above suggestions.
- Several
medications have been used as treatment, including antidepressants,
benzodiazepines, and diphenhydramine (Benadryl). In most cases,
however, these drugs do not improve the quality of sleep.
- Ramelteon has recently been approved by the Food and Drug Administration for insomnia treatment.
- Supplemental use of melatonin and valerian may also be effective for sleep disorders (see Nutritional Considerations).
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