![]() ![]() any daytime sleeping, times and duration.Ī sleep log will usually help this assessment ( Fig.features that tend to add to the patient's disturbance.features (if any) that help the patient settle.what the patient does when awake in the night.habits and patterns of getting ready to go to bed.Patients may enter factors you had not considered, but which may be relevant to the sleep disturbance ( Fig. The log should be completed as each day progresses, as retrospective entries tend to minimise sleep and maximise disturbances. Asking the patient to complete a sleep log over a few days is also useful. In addition to routine clinical evaluation, it is worth asking in detail about the patient's sleep pattern (see Box 1). Taking a hypnotic during flight should generally be avoided as immobility may predispose to deep vein thrombosis. Occasionally, the brief use of a hypnotic may help adaptation to a new sleep pattern. A similar disturbance may occur when shift workers start and end work cycles. This is quicker following east to west travel than west to east. It is possible to adjust approximately one hour per day, a task which is easier when the sleep cycle is extended rather than shortened. This is aided by a regular local sleep-wake cycle and particularly by re-setting sleep rhythms with early morning light and exercise. The therapeutic key is to settle into the new time zone as quickly as possible. Many illnesses including cardiac and respiratory failure and pain syndromes may contribute to insomnia.įlying across several time zones may also result in insomnia. ![]() The assistance of a partner, other relative, or brief period of respite may address the sleeplessness. A crying baby, or a sick or restless child or other family member may disturb sleep. If a patient's bedroom is too hot, too cold, too noisy, or their bed cramped or uncomfortable, addressing those factors may resolve the problem. The patient goes to sleep in the evening when intoxicated only to wake a few hours later when their blood alcohol concentration drops. Middle insomnia is typical with alcohol abuse. Patients may present with insomnia and only acknowledge their low mood or loss of interest after enquiry. The depressive pattern may also have an associated anxiety disorder so the patient's sleep is disturbed throughout the night. With depression, it is typical to have middle insomnia (waking in the early hours of the morning) and late insomnia (waking earlier in the morning than is usual and being unable to get back to sleep). Anxiety disorders can cause early insomnia (difficulty in getting to sleep) associated with rumination over particular worries or concerns. Psychiatric disorders are typically associated with insomnia. Treating any underlying problem can help to alleviate the insomnia. Symptoms associated with insomnia may suggest an underlying medical, surgical, psychological or environmental problem. ![]()
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