Insomnia

Complaints may be: difficulty falling or remaining asleep, waking up too early in the morning, nightmares, or fatigue.

Management

If the insomnia is related to an organic cause, treat the cause (e.g., administer analgesics for pain).

If the insomnia is related to the use of alcohol, drugs or a medication1 , management depends on the substance responsible.

If the insomnia is related to a particular life event (e.g. bereavement), a short term treatment with a sedating antihistamine may be useful:
promethazine PO: 25 mg once daily at bedtime for 7 to 10 days
or diazepam PO: 2 to 5 mg once daily at bedtime for 7 days max.

If the insomnia persists, re-evaluate the patient. Insomnia is a common feature in depressionpost-traumatic stress disorder and anxiety disorders. In such cases, the underlying disorder should be addressed.



Footnotes
Ref Notes
1 The main drugs known to cause sleep problems are corticosteroids, beta blockers, levodopa/carbidopa, fluoxetine, levothyroxin, etc.