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Definition
Insomnia is defined as difficulty in initiating or maintaining sleep. It is very frustrating to the patient and unfortunately health care professionals often disregard it or prescribe a sleeping pill without looking into the cause.
Etiology
Insomnia in the hospital is likely multifactorial (differential diagnosis). Aging itself is associated with lighter sleep and more arousals during the night. In the hospital is aggravated by several factors: anxiety due to the illness or the procedures planned, discomfort, inability to address pending personal matters at home and a noisy unfamiliar environment. Symptoms due to the current illness may include cough, pain, pruritus, dyspnea from cardiac or pulmonary condition, urinary frequency. Patients that have multiple chronic illnesses often have comorbid depression and its associated insomnia. Multiple medications interfere with sleep (drugs that affect sleep and wakefulness). Patients that were using alcohol or benzodiazepines at home may have withdrawal once admitted to the hospital. Finally the hospital environment is not conducive to sleep: the ward is noisy and there might be too much light at night. The patients are often awakened for medications and laboratory tests and medical assessment.
Approaches to insomnia management: The initial approach should be management of the identified problem(s) that cause insomnia and non-pharmacological measures to improve the sleep-wake cycle. Short-term use of hypnotic should be added only if the result of the non-pharmacological approach is not satisfactory. Antihistamines, tricyclic antidepressants (amitriptyline), chloral hydrate and long acting benzodiazepines should not be used for insomnia.
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