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sleep:2-insomnia-disorder [on April 5, 2020] |
sleep:2-insomnia-disorder [on January 4, 2024] psychdb |
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| {{INLINETOC}} | {{INLINETOC}} | ||
| ===== Primer ===== | ===== Primer ===== | ||
| - | **Insomnia Disorder** is the dissatisfaction with sleep quantity or quality, with complaints of difficulty initiating or maintaining sleep. These sleep complaints cause clinically significant distress and/or impairment in social, occupational, or other areas of functioning. The sleep disturbance can occur during the course of an other mental disorder or medical condition, or it may occur independently. | + | **Insomnia Disorder** is the dissatisfaction with sleep quantity or quality, with complaints of difficulty initiating or maintaining sleep. Put simply, insomnia is defined as difficulty falling asleep or staying asleep, //even when a person has the chance to do so//. Insomnia also involves daytime impairments (fatigue and daytime sleepiness). Other changes include cognitive impairment (impacts on attention, concentration, and memory), and mood changes (irritability, mood lability). Insomnia disorder often causes clinically significant distress and/or impairment in social, occupational, or other areas of functioning. It can occur during the course of another mental disorder or medical condition, or it may occur independently. |
| - | <WRAP group> | + | |
| - | <WRAP third column> | + | |
| - | == Symptoms == | + | |
| - | * Insomnia disorder involves daytime impairments (fatigue and daytime sleepiness) as well as nighttime sleep difficulties (this is more common among older individuals, chronic pain, and sleep apnea) | + | |
| - | * Cognitive impairment includes difficulties with attention, concentration, and memory (even with performing simple tasks) | + | |
| - | * Mood changes include irritability, mood lability, and less commonly as depressive or anxiety symptoms | + | |
| - | </WRAP> | ||
| - | <WRAP third column> | ||
| == Prevalence == | == Prevalence == | ||
| * Insomnia disorder is the most prevalent of all sleep disorders | * Insomnia disorder is the most prevalent of all sleep disorders | ||
| * About 30% of the general population have insomnia symptoms and 10% have an associated functional daytime impairment | * About 30% of the general population have insomnia symptoms and 10% have an associated functional daytime impairment | ||
| * Up to 10% have symptoms that meet criteria for insomnia disorder. | * Up to 10% have symptoms that meet criteria for insomnia disorder. | ||
| - | </WRAP> | + | |
| - | <WRAP third column> | + | |
| == Risk Factors == | == Risk Factors == | ||
| - | * Older age, women (more prevalent among females than males), widowed, lower socioeconomic status, smokers, drinkers, and with co-morbid psychiatric and medical conditions. Disrupted sleep and insomnia also have a familial disposition. Insomnia is higher in monozygotic twins compared to dizygotic twins; it is also higher in first-degree family members. | + | * Older age, women (more prevalent among females than males), widowed, lower socioeconomic status, smokers, drinkers, and with co-morbid psychiatric and medical conditions. Close to 50% of individuals with psychosis experience insomnia, and this is predictive of the onset of psychotic experiences.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327507/|Waite, F., Sheaves, B., Isham, L., Reeve, S., & Freeman, D. (2020). Sleep and schizophrenia: From epiphenomenon to treatable causal target. Schizophrenia research, 221, 44-56.]])] |
| + | * Disrupted sleep and insomnia also have a familial disposition. Insomnia is higher in monozygotic twins compared to dizygotic twins; it is also higher in first-degree family members. | ||
| * Poor sleep hygiene, irregular sleep scheduling, and the fear of not sleeping also exacerbate symptoms | * Poor sleep hygiene, irregular sleep scheduling, and the fear of not sleeping also exacerbate symptoms | ||
| * Noise, light, uncomfortably high or low temperature, and high altitude may also increase vulnerability to insomnia. | * Noise, light, uncomfortably high or low temperature, and high altitude may also increase vulnerability to insomnia. | ||
| - | </WRAP></WRAP> | + | ===== DSM-5 Diagnostic Criteria ===== |
| - | ===== Diagnostic Criteria ===== | + | |
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| Line 83: | Line 74: | ||
| ==== Behavioural Insomnia ==== | ==== Behavioural Insomnia ==== | ||
| - | **Behavioural insomnia** is the most common type of insomnia in the pediatric population (i.e. - bedtime problems and/or awakenings). Children may refuse to sleep, want to be rocked, or sleep in their parents’ bed. This "flocking" behaviour is common in all mammals and a natural protective instinct. Popular methods that demand that children "cry it out" can actually impede development of healthy self-regulation.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218792/|Vriend, J., & Corkum, P. (2011). Clinical management of behavioural insomnia of childhood. Psychology research and behaviour management, 4, 69.]])] Soothing with an aim toward //learning// self-soothing provides better long-term results for emotional growth and resilience. Behavioural insomnia should not be treated pharmacologically! | + | **Behavioural insomnia** is the most common type of insomnia in the pediatric population (i.e. - bedtime problems and/or awakenings, or "bed time resistance"). Children may refuse to sleep, want to be rocked, or sleep in their parents’ bed. This "flocking" behaviour is common in all mammals and a natural protective instinct. Popular methods that demand that children "cry it out" can actually impede development of healthy self-regulation.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218792/|Vriend, J., & Corkum, P. (2011). Clinical management of behavioural insomnia of childhood. Psychology research and behaviour management, 4, 69.]])] Soothing with an aim toward //learning// self-soothing provides better long-term results for emotional growth and resilience. Behavioural insomnia should not be treated pharmacologically! |
| + | |||
| + | The 3 principles to treating bedtime resistance are: | ||
| + | - Creating an emotional state of calmness and safety | ||
| + | - Consistent limit setting | ||
| + | - Establishing good bedtime habits (i.e. - have a wind-down period and a sequence of activities that begin 30 to 60 minutes before bedtime, and promote sleep hygiene). | ||
| Line 95: | Line 92: | ||
| * Normal sleep variations | * Normal sleep variations | ||
| * Situational/acute insomnia | * Situational/acute insomnia | ||
| - | * [[sleep:5-circadian-rhythm-sleep-wake-disorders|Delayed sleep phase and shift work types of circadian rhythm sleep-wake disorders]] | + | * [[sleep:5-circadian-rhythm-sleep-wake-disorders:home|Delayed sleep phase and shift work types of circadian rhythm sleep-wake disorders]] |
| - | * [[sleep:parasomnias:rls|Restless legs syndrome]] | + | * [[sleep:movement:rls|Restless legs syndrome]] |
| * [[sleep:breathing:|Breathing-related sleep disorders]], including sleep apnea | * [[sleep:breathing:|Breathing-related sleep disorders]], including sleep apnea | ||
| * Sleep disorder-related: narcolepsy, parasomnias | * Sleep disorder-related: narcolepsy, parasomnias | ||
| Line 106: | Line 103: | ||
| * Up to 70% of GAD patients have insomnia | * Up to 70% of GAD patients have insomnia | ||
| * Medical: Chronic pain, neurological disorders, **menopause** | * Medical: Chronic pain, neurological disorders, **menopause** | ||
| - | * [[sleep:parasomnias:substance-sleep|Substance/medication-induced sleep disorder]] | + | * [[sleep:substance-medication|Substance/medication-induced sleep disorder]] |
| + | * Postural tachycardia syndrome (PoTS)[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083342/|Mallien, J., Isenmann, S., Mrazek, A., & Haensch, C. A. (2014). Sleep disturbances and autonomic dysfunction in patients with postural orthostatic tachycardia syndrome. Frontiers in neurology, 5, 118.]])] | ||
| ===== Investigations ===== | ===== Investigations ===== | ||
| Line 123: | Line 121: | ||
| <panel title="Measurement Scales for Sleep Quality" no-body="true"> | <panel title="Measurement Scales for Sleep Quality" no-body="true"> | ||
| - | !^! Name ^ Rater ^ Description ^ Download ^ | + | <mobiletable 1> |
| + | ^ Name ^ Rater ^ Description ^ Download ^ | ||
| ^ Epworth Sleepiness Scale (ESS) | Patient | The ESS is a self-administered questionnaire with 8 questions. | [[http://epworthsleepinessscale.com/about-the-ess/|ESS Information]] | | ^ Epworth Sleepiness Scale (ESS) | Patient | The ESS is a self-administered questionnaire with 8 questions. | [[http://epworthsleepinessscale.com/about-the-ess/|ESS Information]] | | ||
| - | ^ Insomnia Severity Index (ISI) | Patient | The ISI has seven questions rated on a scale of 0 to 4.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079939/|Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601-608.]])] | {{ :sleep:2-insomnia-disorder:the_pittsburgh_sleep_quality_index_psqi.pdf |ISI Download}} | | + | ^ Insomnia Severity Index (ISI) | Patient | The ISI has seven questions rated on a scale of 0 to 4.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079939/|Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601-608.]])] | {{ :sleep:2-insomnia-disorder:insomnia-severity-index_isi.pdf |ISI Download}} | |
| - | ^ Pittsburgh Sleep Quality Index (PSQI) | Patient | The PSQI is an effective instrument used to measure the quality and patterns of sleep in adults. It differentiates “poor” from “good” sleep quality by measuring 7 components. | {{ :sleep:2-insomnia-disorder:insomnia-severity-index_isi.pdf |PSQI Download}} | | + | ^ Pittsburgh Sleep Quality Index (PSQI) | Patient | The PSQI is an effective instrument used to measure the quality and patterns of sleep in adults. It differentiates “poor” from “good” sleep quality by measuring 7 components. | {{ :sleep:2-insomnia-disorder:the_pittsburgh_sleep_quality_index_psqi.pdf |PSQI Download}} | |
| + | </mobiletable> | ||
| </panel> | </panel> | ||
| Line 139: | Line 139: | ||
| ===== Treatment ===== | ===== Treatment ===== | ||
| ==== Sleep Hygiene ==== | ==== Sleep Hygiene ==== | ||
| - | Sleep hygiene implementation and sleep education should //always// be the first step for patients reporting insomnia. There is much evidence to suggest that these strategies can provide long-term resolution to sleep problems in ways that medications do not (and should not!).[([[https://www.ncbi.nlm.nih.gov/pubmed/25454674|Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews, 22, 23-36.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/12927121|Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep medicine reviews, 7(3), 215-225.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/12244643|Brown, F. C., Buboltz Jr, W. C., & Soper, B. (2002). Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral medicine, 28(1), 33-38.]])] It is important to keep at these habits for at least 2-3 weeks before giving up and trying more aggressive interventions. Key sleep hygiene practices include: | + | Sleep hygiene implementation and sleep education should be a first step for patients reporting insomnia. Basic sleep hygiene alone has not been shown to be effective in treating chronic insomnia, but is important for patient education.[([[https://www.ncbi.nlm.nih.gov/pubmed/25454674|Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews, 22, 23-36.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/12927121|Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep medicine reviews, 7(3), 215-225.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/12244643|Brown, F. C., Buboltz Jr, W. C., & Soper, B. (2002). Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral medicine, 28(1), 33-38.]])] It is important to keep at these habits for at least 2 to 3 weeks before giving up and trying more aggressive interventions such as CBT-I and/or hypnotics. Key sleep hygiene practices include: |
| <WRAP col2> | <WRAP col2> | ||
| - **Keep Your Bedroom Cool, and Dark**: A dark room reminds your brain it is nighttime, and a cool room temperature allows your body thermoregulate during sleep. | - **Keep Your Bedroom Cool, and Dark**: A dark room reminds your brain it is nighttime, and a cool room temperature allows your body thermoregulate during sleep. | ||
| Line 160: | Line 160: | ||
| ==== Psychotherapy ==== | ==== Psychotherapy ==== | ||
| - | Psychological treatment of insomnia disorder includes [[https://sleepfoundation.org/sleep-topics/sleep-hygiene|sleep hygiene]], cognitive behavioural therapy, stimulus control, bed restriction, and relaxation techniques. CBT for Insomnia (CBT-I) is being an effective and cost-effective treatment for insomnia disorder and should be offered as a first-line treatment.[([[https://www.ncbi.nlm.nih.gov/pubmed/30264137|Espie, C. A., Emsley, R., Kyle, S. D., Gordon, C., Drake, C. L., Siriwardena, A. N., ... & Freeman, D. (2019). Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: a randomized clinical trial. JAMA psychiatry, 76(1), 21-30.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/27902836|Ritterband, L. M., Thorndike, F. P., Ingersoll, K. S., Lord, H. R., Gonder-Frederick, L., Frederick, C., ... & Morin, C. M. (2017).ed cognitive behavio Effect of a web-basr therapy for insomnia intervention with 1-year follow-up: a randomized clinical trial. JAMA psychiatry, 74(1), 68-75.]])] Research evidence has also shown that I-CBT should be a first-line treatment for insomnia in mid-life women experiencing menopause with hot flashes.[([[https://www.ncbi.nlm.nih.gov/pubmed/29165623|Guthrie, K. A., Larson, J. C., Ensrud, K. E., Anderson, G. L., Carpenter, J. S., Freeman, E. W., ... & Newton, K. M. (2018). Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials. Sleep, 41(1)]])] With the advent of the internet, many of these therapies have become widely accessible online (see table below). | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See main article: **[[psychotherapy:cbt-insomnia|]]**</alert> |
| + | <WRAP group> | ||
| + | <WRAP half column> | ||
| + | * **CBT for Insomnia (CBT-I)** is an effective and cost-effective treatment for insomnia disorder and should be offered as a first-line treatment.[([[https://www.ncbi.nlm.nih.gov/pubmed/30264137|Espie, C. A., Emsley, R., Kyle, S. D., Gordon, C., Drake, C. L., Siriwardena, A. N., ... & Freeman, D. (2019). Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: a randomized clinical trial. JAMA psychiatry, 76(1), 21-30.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/27902836|Ritterband, L. M., Thorndike, F. P., Ingersoll, K. S., Lord, H. R., Gonder-Frederick, L., Frederick, C., ... & Morin, C. M. (2017). Effect of a web-based therapy for insomnia intervention with 1-year follow-up: a randomized clinical trial. JAMA psychiatry, 74(1), 68-75.]])] | ||
| + | * Components of CBT-I include: sleep hygiene education, sleep restriction, stimulus control therapy, relaxation-based interventions (e.g. - progressive muscle relaxation), and cognitive restructuring. | ||
| + | * Research evidence has also shown that CBT-I should be a first-line treatment for insomnia in mid-life women experiencing menopause with hot flashes.[([[https://www.ncbi.nlm.nih.gov/pubmed/29165623|Guthrie, K. A., Larson, J. C., Ensrud, K. E., Anderson, G. L., Carpenter, J. S., Freeman, E. W., ... & Newton, K. M. (2018). Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials. Sleep, 41(1)]])] With the advent of the internet, CBT-I has become widely accessible online (see table below). | ||
| + | * There is strong and robust evidence that shows the effectiveness of CBT-I for insomnia.[([[https://pubmed.ncbi.nlm.nih.gov/11752485/|Espie, C. A. (2002). Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual review of psychology, 53(1), 215-243.]])] | ||
| + | * Importantly, there is comparable treatment effect with hypnotics, and the effects from CBT-I are more durable than medications.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481424/|Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice, 13(1), 1-11.]])] | ||
| + | * CBT-I can also reduce and eliminate the need for hypnotic use. | ||
| + | * CBT-I can also significantly reduce depression symptoms.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2279754/|Manber, R., Edinger, J. D., Gress, J. L., Pedro-Salcedo, M. G. S., Kuo, T. F., & Kalista, T. (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep, 31(4), 489-495.]])] | ||
| + | </WRAP> | ||
| + | <WRAP half column> | ||
| + | <HTML> | ||
| + | <div id="amazon"> | ||
| + | <div class="ribbon"><i class="fa fa-star"></i> Recommended Reading</div> | ||
| + | <a href="https://www.amazon.com/Gregg-D-Jacobs/dp/0805089586/ref=as_li_ss_il?crid=A7RL1MF9IFOY&dchild=1&keywords=cbt+insomnia&qid=1599594365&sprefix=cbt+insomnia,aps,164&sr=8-3&linkCode=li3&tag=psychdb030f-20&linkId=ced55764a10cb402d7dabedf0ec246b1&language=en_US" target="_blank"><img style="max-width: 50%" border="0" src="//ws-na.amazon-adsystem.com/widgets/q?_encoding=UTF8&ASIN=0805089586&Format=_SL250_&ID=AsinImage&MarketPlace=US&ServiceVersion=20070822&WS=1&tag=psychdb030f-20&language=en_US" ></a> | ||
| + | <p> | ||
| + | <span class="bs-wrap bs-wrap-button" data-btn-type="default" data-btn-size="lg" data-btn-icon="fa fa-amazon"><a href="https://amzn.to/2F49DfQ" rel="nofollow" role="button">Buy on Amazon</a></span> | ||
| + | </p> | ||
| + | <small> | ||
| + | PsychDB is an Amazon Associate and earns from qualifying purchases. Thank you for supporting our site! | ||
| + | </small> | ||
| + | </div> | ||
| + | </HTML> | ||
| + | |||
| + | </WRAP> | ||
| + | </WRAP> | ||
| <panel title="Online Insomnia Therapies" no-body="true"> | <panel title="Online Insomnia Therapies" no-body="true"> | ||
| + | <mobiletable 1> | ||
| ^ Name ^ Description ^ Cost ^ | ^ Name ^ Description ^ Cost ^ | ||
| ^ [[http://www.cbtforinsomnia.com|CBT for Insomnia]] | 5-session on-line cognitive behavioural therapy (CBT) program for insomnia. | $24.95 US to $49.95 US | | ^ [[http://www.cbtforinsomnia.com|CBT for Insomnia]] | 5-session on-line cognitive behavioural therapy (CBT) program for insomnia. | $24.95 US to $49.95 US | | ||
| Line 172: | Line 199: | ||
| ^ [[http://restore.cbtprogram.com/|Restore CBT-I]] | A 6-week CBT-I program evaluated in a randomized trial | £99 to £199 | | ^ [[http://restore.cbtprogram.com/|Restore CBT-I]] | A 6-week CBT-I program evaluated in a randomized trial | £99 to £199 | | ||
| ^ [[http://www.sleeptrainingsystem.com/index.php|Sleep Training System]] | 6-week on-line CBT-I program with money-back guarantee and personalized feedback | $29.95 US | | ^ [[http://www.sleeptrainingsystem.com/index.php|Sleep Training System]] | 6-week on-line CBT-I program with money-back guarantee and personalized feedback | $29.95 US | | ||
| - | </panel> | + | </mobiletable></panel> |
| ==== Medications==== | ==== Medications==== | ||
| - | Based on American Academy of Sleep Medicine Guidelines[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576317/|Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 4(5), 487.]])] and College of Physicians and Surgeons of Alberta Guidlines.[([[http://www.topalbertadoctors.org/download/439/insomnia_management_guideline.pdf|Toward Optimized Practice (TOP) Program 2010 Guideline for adult insomnia. Edmonton, Alberta (2010).]])] | + | Based on |
| + | American Academy of Sleep Medicine Guidelines[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576317/|Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 4(5), 487.]])] and College of Physicians and Surgeons of Alberta Guidlines.[([[http://www.topalbertadoctors.org/download/439/insomnia_management_guideline.pdf|Toward Optimized Practice (TOP) Program 2010 Guideline for adult insomnia. Edmonton, Alberta (2010).]])] | ||
| <panel type="info" title="Pharmacological Treatment of Insomnia" no-body="true"> | <panel type="info" title="Pharmacological Treatment of Insomnia" no-body="true"> | ||
| Line 183: | Line 211: | ||
| </panel> | </panel> | ||
| - | <callout type="danger" title="Benzodiazapine as sleep aids" icon="true">Although triazolam is FDA-approved for insomnia disorder, it should really not be used given its short half-life and therefore high potential for addiction, misuse, and withdrawal symptoms. Tamazepam or clonazepam would be better choices if you absolutely have to use a benzodiazapine.</callout> | + | * When taking melatonin, it is recommended to take it 6 hours before the **middle of sleep** (i.e. - if you sleep 8 hours, then take melatonin 2 hours before your typical sleep time). |
| + | |||
| + | <callout type="danger" title="Benzodiazapine as sleep aids" icon="true"> | ||
| + | Although triazolam is FDA-approved for insomnia disorder, it should really not be used given its short half-life and therefore high potential for addiction, misuse, and withdrawal symptoms. Tamazepam or clonazepam would be better choices if you absolutely have to use a benzodiazapine. | ||
| + | </callout> | ||
| - | <callout type="danger" title="Don't forget!" icon="true">Short-term hypnotic treatment should always be supplemented with behavioural and cognitive therapies if possible.</callout> | + | <callout type="danger" title="Don't forget!" icon="true">Short-term hypnotic treatment should always be supplemented with behavioural and cognitive therapies if possible. |
| + | </callout> | ||
| ==== Clinical Pearls ==== | ==== Clinical Pearls ==== | ||
| - | * If you are at all considering antipsychotics (which you really should not), you must consider the following: weight gain and therefore worsening of sleep apnea, increased leg restlessness, hyperlipidemia, glucose dysregulation, and QT prolongation. All these reasons should make you think twice about prescribing antipsychotics for sleep. For this reason alone, the NIH Chronic insomnia panel states: "all (antipsychotics) agents have significant risks, and thus their use in the treatment of chronic insomnia cannot be recommended." | + | If |
| + | you are at all considering antipsychotics (which you really should not), you must consider the following: weight gain and therefore worsening of sleep apnea, increased leg restlessness, hyperlipidemia, glucose dysregulation, and QT prolongation. All these reasons should make you think twice about prescribing antipsychotics for sleep. For this reason alone, the NIH Chronic insomnia panel states: "all (antipsychotics) agents have significant risks, and thus their use in the treatment of chronic insomnia cannot be recommended." | ||
| Line 195: | Line 229: | ||
| <WRAP group> | <WRAP group> | ||
| <WRAP quarter column> | <WRAP quarter column> | ||
| - | ==== For Patients ==== | + | == For Patients == |
| * [[https://mysleepwell.ca/|SleepWell]] | * [[https://mysleepwell.ca/|SleepWell]] | ||
| * [[https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Sleep|Centre for Clinical Interventions (CCI) - Sleep Information Sheets]] | * [[https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Sleep|Centre for Clinical Interventions (CCI) - Sleep Information Sheets]] | ||
| * [[https://www.anxietybc.com/sites/default/files/SleepHygiene.pdf|Sleep Hygiene Tips (PDF)]] | * [[https://www.anxietybc.com/sites/default/files/SleepHygiene.pdf|Sleep Hygiene Tips (PDF)]] | ||
| - | * [[https://www.amazon.ca/Quiet-Your-Mind-Get-Sleep/dp/1572246278/ref=sr_1_1?ie=UTF8&qid=1511840644&sr=8-1&keywords=quiet+your+mind+and+get+to+sleep|Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety or Chronic Pain]] | ||
| </WRAP> | </WRAP> | ||
| <WRAP quarter column> | <WRAP quarter column> | ||
| - | ==== For Providers ==== | + | == For Providers == |
| *[[https://pro.psychcentral.com/this-months-expert-john-w-winkelman-m-d-ph-d-on-treating-sleep-disorders/|PsychCentral: John W. Winkelman, M.D., Ph.D. On Treating Sleep Disorders]] | *[[https://pro.psychcentral.com/this-months-expert-john-w-winkelman-m-d-ph-d-on-treating-sleep-disorders/|PsychCentral: John W. Winkelman, M.D., Ph.D. On Treating Sleep Disorders]] | ||
| *[[http://www.cpsa.ca/i-cant-sleep-managing-insomnia-in-the-older-adult/|CPSA: "I Can't Sleep." - Managing Insomnia in the Older Adult]] | *[[http://www.cpsa.ca/i-cant-sleep-managing-insomnia-in-the-older-adult/|CPSA: "I Can't Sleep." - Managing Insomnia in the Older Adult]] | ||