MANAGEMENT OF INSOMNIA / SHIFT WORK SLEEP DISORDER
Panelists: David Atwell, MD, D’ABSM; Joel Kestenbaum, PhD; Michael Neeb, PhD, D’
ABSM (from right to left)
- Insomnia is common problem; can be very debilitating
- Obtaining a thorough sleep history is very important; Consultation with sleep
psychologist can be very beneficial - Safety and efficacy of newer hypnotics enables long term use of hypnotics if
needed although try to use hypnotics fro least possible duration - Consider using wakefulness promoting agent along with hypnotic for
management of shift work sleep disorder - Circadian rhythm disorders (advanced and delayed phase syndromes) are likely
to present with a chief complaint of insomnia. A thorough history is essential,
particularly determining the patient’s preferred sleep/wake schedule when not
dictated by school or work. When allowed to sleep on their own preferred
schedule, patients with these rhythm disorders do not generally report
symptoms of insomnia.
- Pay close attention to environmental factors and principles of good sleep
hygiene when treating patients with shift work sleep disorders. Many patients
underestimate the impact of light, noise, and temperature on the continuity of
their daytime sleep, and many overload of caffeine during the night which will
impair their ability to fall asleep during the morning hours.
- Depression can cause insomnia, and prolonged insomnia can cause
depression. Patients with insomnia will often require a thorough assessment for
depression and other psychiatric disorders in order to determine the best
course of treatment.