Insomnia - Revision history

Arowther: /* Differential Diagnosis */

2024-06-12T03:22:10Z

Differential Diagnosis

← Older revision		Revision as of 03:22, 12 June 2024
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	* Sleep-disruptive environmental circumstances		* Sleep-disruptive environmental circumstances
	* Restless legs syndrome		* Restless legs syndrome
	* ~~Sleep~~ apnea		* [[Obstructive sleep apnea]]
	* Short duration sleep circadian rhythm disorders		* Short duration sleep circadian rhythm disorders
	* Chronic sleep restriction		* Chronic sleep restriction

ClaireLewis: /* Differential Diagnosis */

2019-10-03T03:29:41Z

Differential Diagnosis

← Older revision		Revision as of 03:29, 3 October 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	* [[Alcohol Abuse]]		* [[Alcohol Abuse]], [[alcohol withdrawal\|alcohol]], [[benzodiazepine withdrawal\|benzo]], or [[opioid withdrawal]]
	* [[Depression]]/[[anxiety]]		* [[Depression]]/[[anxiety]]
	*[[Bipolar disorder]]		*[[Bipolar disorder]], [[schizophrenia]]
			*[[Hepatic encephalopathy]]
			*[[TBI]]
			*[[Acute mountain sickness]]
			*[[Delirium]]
			*[[Hyperphosphatemia]]
			*Medications (many!)
			*Excess [[caffeine]]
	* Sleep-disruptive environmental circumstances		* Sleep-disruptive environmental circumstances
	* Restless legs syndrome		* Restless legs syndrome

ClaireLewis: /* References */

2019-10-03T03:25:13Z

References

← Older revision		Revision as of 03:25, 3 October 2019
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	[[Category:Neurology]] [[Category:Psychiatry]]		[[Category:Neurology]] [[Category:Psychiatry]]
			[[Category:Symptoms]]

ClaireLewis at 16:12, 17 September 2019

2019-09-17T16:12:00Z

← Older revision		Revision as of 16:12, 17 September 2019
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	==Management==		==Management==
	* Sleep hygiene education, relaxation, and stimulus control		* Sleep hygiene education, relaxation, and stimulus control
	* [[Zaleplon]] for sleep onset insomnia, [[Zolpidem]] (Ambien) or [[Eszopiclone]] for sleep maintenance insomnia<ref>Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([https://www.uptodate.com/contents/treatment-of-insomnia-in-adults?source=see_link])</ref>		* Zaleplon for sleep onset insomnia, [[Zolpidem]] (Ambien) or Eszopiclone for sleep maintenance insomnia<ref>Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([https://www.uptodate.com/contents/treatment-of-insomnia-in-adults?source=see_link])</ref>
	* [[Trazodone]], [[gabapentin]], and melatonin agonists		* [[Trazodone]], [[gabapentin]], and melatonin/melatonin agonists
	** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)		** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)

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	<references/>		<references/>

	[[Category:Neurology]]		[[Category:Neurology]] [[Category:Psychiatry]]

ClaireLewis at 18:20, 27 September 2017

2017-09-27T18:20:34Z

← Older revision		Revision as of 18:20, 27 September 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
	* [[Alcohol ~~use disorder~~]]		* [[Alcohol Abuse]]
	* [[Depression]]/[[anxiety]]		* [[Depression]]/[[anxiety]]
	* ~~Undifferentiated bipolar~~		*[[Bipolar disorder]]
	* Sleep-disruptive environmental circumstances		* Sleep-disruptive environmental circumstances
	* Restless legs syndrome		* Restless legs syndrome

Rossdonaldson1: /* References */

2017-09-24T12:39:11Z

References

← Older revision		Revision as of 12:39, 24 September 2017
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	==References==		==References==
	~~Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([https:~~/~~/www.uptodate.com/contents/treatment-of-insomnia-in-adults?source=see_link])~~		<references/>

	[[Category:Neurology]]		[[Category:Neurology]]

Rossdonaldson1: /* Management */

2017-09-24T12:38:58Z

Management

← Older revision		Revision as of 12:38, 24 September 2017
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	==Management==		==Management==
	* Sleep hygiene education, relaxation, and stimulus control		* Sleep hygiene education, relaxation, and stimulus control
	* [[Zaleplon]] for sleep onset insomnia, [[Zolpidem]] (Ambien) or [[Eszopiclone]] for sleep maintenance insomnia		* [[Zaleplon]] for sleep onset insomnia, [[Zolpidem]] (Ambien) or [[Eszopiclone]] for sleep maintenance insomnia<ref>Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([https://www.uptodate.com/contents/treatment-of-insomnia-in-adults?source=see_link])</ref>
	* [[Trazodone]], [[gabapentin]], and melatonin agonists		* [[Trazodone]], [[gabapentin]], and melatonin agonists
	** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)		** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)

Eklesick: /* Evaluation */

2017-09-22T15:48:34Z

Evaluation

← Older revision		Revision as of 15:48, 22 September 2017
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	* Sleep-disruptive environmental circumstances		* Sleep-disruptive environmental circumstances
	* Restless legs syndrome		* Restless legs syndrome
			* Sleep apnea
	* Short duration sleep circadian rhythm disorders		* Short duration sleep circadian rhythm disorders
	* Chronic sleep restriction		* Chronic sleep restriction
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	==Evaluation==		==Evaluation==
	*A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia		*A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia
	*~~Insomnia can be associated with another conditions~~, ~~medications~~, ~~or substances~~		*Screen for mood disorders, PTSD, substance use disorders
	*A sleep history and review of sleep and wake diaries can be helpful in determining the cause.		*A sleep history and review of sleep and wake diaries can be helpful in determining the cause

	==Management==		==Management==
	* Sleep hygiene education, relaxation, and stimulus control		* Sleep hygiene education, relaxation, and stimulus control
			* [[Zaleplon]] for sleep onset insomnia, [[Zolpidem]] (Ambien) or [[Eszopiclone]] for sleep maintenance insomnia
	* [[Trazodone]], [[gabapentin]], and melatonin agonists		* [[Trazodone]], [[gabapentin]], and melatonin agonists
	** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)		** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)
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	==References==		==References==
	~~<references~~/>		Bonnet, MH and DL Arand. Treatment of insomnia in adults. In: UpToDate, Benca, R (Ed), UpToDate, Waltham, MA, 2017. ([https://www.uptodate.com/contents/treatment-of-insomnia-in-adults?source=see_link])

	[[Category:Neurology]]		[[Category:Neurology]]

Rossdonaldson1 at 11:25, 19 September 2017

2017-09-19T11:25:10Z

← Older revision		Revision as of 11:25, 19 September 2017
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	==Background==		==Background==
	*Daytime dysfunction due to difficulty initiating sleep or lack of good sleep. ~~Insomnia in the~~ emergency department ~~is a common~~ complaint among patients in recovery from a substance use disorder or a psychiatric disorder. Most substances of abuse affect sleep during active use, acute withdrawal, and with sustained abstinence. Specific medications for insomnia should be avoided in patients with history of substance abuse.		*Daytime dysfunction due to difficulty initiating sleep or lack of good sleep.
			*A common emergency department complaint among patients in recovery from a substance use disorder or a psychiatric disorder
			**Most substances of abuse affect sleep during active use, acute withdrawal, and with sustained abstinence
			*Specific medications for insomnia should be avoided in patients with history of substance abuse.

	==Clinical Features==		==Clinical Features==
	*~~Patients with insomnia typically complain about difficulty~~ falling asleep and staying asleep. Impaired daytime function must also be reported for a diagnosis of an insomnia disorder. Simultaneous psychiatric, medications/substances, are usually present.		*Difficulty falling asleep and staying asleep
			*Impaired daytime function (must also be reported for a diagnosis of an insomnia disorder)
			*Simultaneous psychiatric, medications/substances, are usually present

	==Differential Diagnosis==		==Differential Diagnosis==
	* ~~alcohol~~ use disorder		* [[Alcohol use disorder]]
	* Depression/anxiety		* [[Depression]]/[[anxiety]]
	* ~~undifferentiated Bipolar~~		* Undifferentiated bipolar
	* ~~sleep~~-disruptive environmental circumstances		* Sleep-disruptive environmental circumstances
	* Restless legs syndrome		* Restless legs syndrome
	* ~~short~~ duration sleep circadian rhythm disorders		* Short duration sleep circadian rhythm disorders
	* ~~chronic~~ sleep restriction		* Chronic sleep restriction
	* ~~psychosis~~		* [[Psychosis]]

	==Evaluation==		==Evaluation==
	A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia. Insomnia can be associated with another conditions, medications, or substances. A sleep history and review of sleep and wake diaries can be helpful in determining the cause.		*A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia
			*Insomnia can be associated with another conditions, medications, or substances
			*A sleep history and review of sleep and wake diaries can be helpful in determining the cause.

	==Management==		==Management==
	* ~~sleep~~ hygiene education, relaxation and stimulus control		* Sleep hygiene education, relaxation, and stimulus control
	* Trazodone, gabapentin, and melatonin agonists		* [[Trazodone]], [[gabapentin]], and melatonin agonists
	* Benzodiazepines should be avoided due to risks of overdose when mixed with alcohol or other substances.		** [[Benzodiazepines]] should be avoided (due to risks of overdose when mixed with alcohol or other substances)

	==Disposition==		==Disposition==
	* ~~discharge~~ home unless patient acutely psychotic		* Discharge home unless patient acutely [[psychotic]]
	* ~~follow~~ up with primary care doctor		* Follow up with primary care doctor
	* ~~Polysomnography~~-sleep study		* Consider outpatient polysomnography-sleep study

	==See Also==		==See Also==

Mholtz at 05:45, 7 September 2017

2017-09-07T05:45:02Z

← Older revision		Revision as of 05:45, 7 September 2017
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	~~<big>~~Background~~-</big>~~ Daytime dysfunction due to difficulty initiating sleep or lack of good sleep. Insomnia in the emergency department is a common complaint among patients in recovery from a substance use disorder or a psychiatric disorder. Most substances of abuse affect sleep during active use, acute withdrawal, and with sustained abstinence. Specific medications for insomnia should be avoided in patients with history of substance abuse.		==Background==
			*Daytime dysfunction due to difficulty initiating sleep or lack of good sleep. Insomnia in the emergency department is a common complaint among patients in recovery from a substance use disorder or a psychiatric disorder. Most substances of abuse affect sleep during active use, acute withdrawal, and with sustained abstinence. Specific medications for insomnia should be avoided in patients with history of substance abuse.

	~~<big>~~Clinical Features~~-</big>~~		==Clinical Features==
	Patients with insomnia typically complain about difficulty falling asleep and staying asleep. Impaired daytime function must also be reported for a diagnosis of an insomnia disorder. Simultaneous psychiatric, medications/substances, are usually present.		*Patients with insomnia typically complain about difficulty falling asleep and staying asleep. Impaired daytime function must also be reported for a diagnosis of an insomnia disorder. Simultaneous psychiatric, medications/substances, are usually present.

	~~<big>~~Differential Diagnosis~~-</big>~~		==Differential Diagnosis==
	* alcohol use disorder		* alcohol use disorder
	* Depression/anxiety		* Depression/anxiety
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	* psychosis		* psychosis

	~~<big>~~Evaluation~~</big>~~		==Evaluation==
	A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia. Insomnia can be associated with another conditions, medications, or substances. A sleep history and review of sleep and wake diaries can be helpful in determining the cause.		A personal medical history considering any medical conditions, any medications being taken, and any stressful life events/changes that could be causing insomnia. Insomnia can be associated with another conditions, medications, or substances. A sleep history and review of sleep and wake diaries can be helpful in determining the cause.

	~~<big>~~Management~~</big>~~		==Management==
	* sleep hygiene education, relaxation and stimulus control		* sleep hygiene education, relaxation and stimulus control
	* Trazodone, gabapentin, and melatonin agonists		* Trazodone, gabapentin, and melatonin agonists
	* Benzodiazepines should be avoided due to risks of overdose when mixed with alcohol or other substances.		* Benzodiazepines should be avoided due to risks of overdose when mixed with alcohol or other substances.

	~~<big>~~Disposition~~</big>~~		==Disposition==
	* discharge home unless patient acutely psychotic		* discharge home unless patient acutely psychotic
	* follow up with primary care doctor		* follow up with primary care doctor
	* Polysomnography-sleep study		* Polysomnography-sleep study

	~~<big>~~See Also~~</big>~~		==See Also==

	~~<big>External Links</big>~~

	~~<big>~~References </~~big~~>		==External Links==
	~~Brower KJ, Perron BE. Prevalence and correlates of withdrawal-related insomnia among adults with alcohol dependence: results from a national survey. Am J Addict 2010; 19:238.~~
	~~Gavin DR, Ross HE, Skinner HA. Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. Br J Addict 1989; 84~~:~~301.~~
			==References==
			<references/>

			[[Category:Neurology]]