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Insomnia

Insufficient sleep with daytime


anergia, malaise, cognitive slowness
& irritability

Assessment
&
Management
Insomnia
10-30% adult population; 15% are primary

Causes Parasomnias
• Painful organic conditions
• Nightmares
• Depressive disorder
Anxiety disorder
• Night terrors

• Psychosocial stresors • Sleep walking

Perpetuating factors
• Alcohol
• Tobacco Hypersomnias
• Caffeine • Narcolepsy
• Sleep apnoea
• Primary (ideopathic)
Management
(Cognitive behavioural)

Do not go to bed until sleepy


Lie in bed only while attempting to
sleep
If unable to sleep, get out of bed
Use relaxation techniques
• Progressive muscular relaxation
• Visualization
• Correct negative thoughts: I did not sleep
last night, cannot sleep tonight
• Avoid catastrophic thoughts: I’ll die if do
not get good sleep tonight
• Insert positive thoughts
Good sleep hygiene
Quiet comfortable environment
Avoid
• Stimulants
• Alcohol
• Heavy meals
• Vigorous exercise within 4 hours
Moderate exercise earlier than 4 hours before bed time
No daytime naps
Regular wake time
Reinforce waking hours with exposure to light and
physical activity
Address life stressors
Avoid obsession concerns regarding sleep difficulty
Objectives
 Establish rapport
 Take chronological account
 Determine sleep timings, any day time naps
 Ask about quality of sleep (feeling after waking up)
 Inquire about
• Effect of insomnia on daytime activities/job/family
• Painful physical conditions
• Alcohol, stimulants, tobacco, caffeine
• Psychosocial stressors
 Invite questions
 Reassure