Insomnia Questions & Answers

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Questions & Answers

Overview

How is insomnia defined?

What are the AASM guidelines for evaluation of insomnia?

What should be the focus of patient history in the evaluation of insomnia?

Which medications commonly cause insomnia?

What should be included in the physical exam for insomnia?

How is insomnia diagnosed?

What are the treatment goals for insomnia?

What is the role of cognitive-behavioral therapy (CBT) in the treatment of insomnia?

Which sedative-hypnotics are used in the treatment of insomnia?

What are precautions for use of sedative-hypnotics to treat insomnia?

Which sedating antidepressants are used in the treatment of insomnia?

Which nonpharmacologic therapies may be helpful for the treatment of insomnia?

What are concerns regarding a patient's report of insomnia?

What is insomnia?

How prevalent is insomnia?

What are the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for insomnia?

What is acute insomnia?

What is chronic insomnia?

Which disorders are associated insomnia?

What is comorbid insomnia?

What is included in the evaluation of insomnia?

What is the role of a sleep diary in the evaluation of insomnia?

What is the role of actigraphy in the evaluation of insomnia?

What must be present for a diagnosis of insomnia?

What is the definition of primary insomnia?

What is the focus of treatment for insomnia?

How does the brain regulate sleep?

How does the brain promote wakefulness?

How does the brain promote sleep?

What are the homeostatic and circadian processes regulating sleep?

How is melatonin synthesized during sleep?

What is the flip-flop switch model of sleep regulation?

What are the mechanisms of action of benzodiazepines and benzodiazepine receptor agonists for insomnia?

What are the mechanisms of action of melatonin receptor agonists for insomnia?

What are the mechanisms of action of sedating antidepressants for insomnia?

What are the mechanisms of action of antihistamines for insomnia?

What is the pathophysiology of insomnia?

What is the role of hyperarousal in the pathophysiology of insomnia?

What is the Spielman model of chronic insomnia?

What is the role of genetics in the pathophysiology of insomnia?

What is the pathophysiology of fatal familial insomnia (FFI)?

What are the precipitating factors of insomnia?

What are the perpetuating factors of insomnia?

What causes insomnia?

What is inadequate sleep hygiene in insomnia?

What are the behavioral insomnias of childhood?

How is insomnia classified in the International Classification of Sleep Disorders, 2nd Edition (ICSD-2)?

What causes adjustment insomnia (acute insomnia)?

What causes primary insomnia?

What is paradoxical insomnia?

What must be observed for a diagnosis of paradoxical insomnia?

Which medical disorders have and etiologic role in insomnia?

Which medical conditions are common in people with insomnia?

Which mental disorders have an etiologic role in insomnia?

What is the role of drug or substance abuse in the etiology of insomnia?

How is insomnia not due to substance or known physiologic condition diagnosed?

What is idiopathic insomnia?

What primary sleep disorders cause insomnia?

What is the role of restless legs syndrome (RLS) in the etiology of insomnia?

What is the role of obstructive sleep apnea or hypopnea syndrome in the etiology of insomnia?

What are Circadian rhythm disorders in insomnia?

What is the prevalence of insomnia?

What are risk factors for insomnia?

How does the prevalence of insomnia vary by sex?

What are the racial predilections of insomnia?

How does the prevalence of insomnia vary by age?

What are the consequences of untreated insomnia?

What is the prognosis of insomnia?

What is the association of insomnia with depression and anxiety?

What is included in patient education about insomnia?

Presentation

What should be included in the patient history for insomnia?

What must be determined in a sleep history for insomnia?

What are questions to ask in the sleep history for insomnia?

What are common daytime effects of insomnia?

What should be the focus of the medical and psychiatric history in the evaluation of insomnia?

How are patients with insomnia screened for depression?

What is the role of family history in the evaluation of insomnia?

What is the role of social history in the evaluation of insomnia?

Which medications commonly cause insomnia?

What is the role of a physical exam for insomnia?

Which physical findings are significant in the evaluation of insomnia?

DDX

Which disorders should be considered in the differential diagnoses of insomnia?

Which medications are associated with insomnia?

What are the differential diagnoses for Insomnia?

Workup

What is the role of a sleep log in the diagnosis and management of insomnia?

What studies are indicated for patients with chronic obstructive pulmonary disease (COPD) and insomnia?

What is the role of polysomnography in the workup of insomnia?

What is the role of actigraphy in the workup of insomnia?

When is a sleep diary indicated in the workup of insomnia?

What is the role of genetic testing in the workup of insomnia?

Treatment

What are the American Association of Sleep Medicine (AASM) treatment guidelines for insomnia?

What is the role of cognitive-behavioral therapy (CBT) for insomnia?

What is the efficacy of cognitive-behavioral therapy (CBT) for insomnia?

What are the components of cognitive-behavioral therapy (CBT) for insomnia?

What is cognitive-behavioral therapy for insomnia (CBT-I)?

What are the AASM recommendations for initial treatment of insomnia?

What is included in sleep hygiene education for the treatment of insomnia?

What is the focus of cognitive therapy for insomnia?

What is relaxation therapy for insomnia?

What is stimulus-control therapy for insomnia?

What is sleep-restriction therapy for insomnia?

What is the efficacy of cognitive-behavioral therapy (CBT) compared to sedative hypnotics for treatment of insomnia?

What is the efficacy of combined cognitive-behavioral therapy (CBT) and sedative hypnotics for insomnia?

What is the role of medications in the treatment of insomnia?

What is the role of sedative-hypnotic drugs in the treatment of insomnia?

What is the efficacy of sedative-hypnotic drugs for the treatment of insomnia?

What is the recommended dosage for sedative-hypnotic drugs in the treatment of insomnia?

What are general precautions regarding the use of sedative-hypnotics for insomnia?

What is the role of long-term hypnotic drug treatment for insomnia?

What are risks associated with the use of sedative-hypnotics for insomnia?

What is the role of suvorexant (Belsomra) in the treatment of insomnia?

What is the role of ramelteon (Rozerem) in the treatment of insomnia?

What is the role of sedating antidepressants in the treatment of insomnia?

What is the role of antihistamines in the treatment of insomnia?

What is the role of melatonin in the treatment of insomnia?

What is the role of alternative and herbal medications in the treatment of insomnia?

What is the role of acupressure for insomnia?

What is the Cerêve Sleep System for the treatment of insomnia?

Which dietary modifications are used in the treatment of insomnia?

What are treatment options for insomnia in elderly patients?

When is referral to a sleep specialist indicated for the treatment of insomnia?

Guidelines

What are the AASM Choosing Wisely® recommendations regarding insomnia?

What are the AASM guidelines for the evaluation of insomnia?

What are the American Thoracic Society (ATS) guidelines for managing insomnia?

Medications

Which medications are used in the treatment of insomnia?

Which medications in the drug class Antidepressants, Other are used in the treatment of Insomnia?

Which medications in the drug class Antidepressants, TCAs are used in the treatment of Insomnia?

Which medications in the drug class Sedative-Hypnotics are used in the treatment of Insomnia?