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Insufficient sleep with daytime

anergia, malaise, cognitive slowness
& irritability

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)
(Cognitive behavioural)

Do not go to bed until sleepy

Lie in bed only while attempting to
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
• 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
 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