Insomnia

Last updated: November 2021


Complaints may be: difficulty falling or remaining asleep, waking up too early in the morning, nightmares, or fatigue. Symptoms occur at least three times a week for at least one month.

Management

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

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

If insomnia is related to a particular life event (e.g. bereavement), a short term treatment with a sedative may be useful:
promethazine PO: 25 mg once daily at bedtime for 7 to 10 days
or, if promethazine is not available, hydroxyzine PO: 25 mg once daily at bedtime for 7 to 10 days
or, as a last resort (risk of addiction), diazepam PO: 2 to 5 mg once daily at bedtime for 7 days max.

If insomnia persists, re-evaluate the patient. Insomnia is a common feature in depression (Depression), post-traumatic stress disorder (Post-traumatic stress disorder) and anxiety disorders (Anxiety). 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, levothyroxine, etc.