Insomnia

Insomnia is a common sleep disorder that affects up to around 90% of human beings during their
lifetime. Insomnia is defined as repeated difficulty with sleep involving trouble in initiating
sleep, maintenance of sleep, consolidation, or problems with the quality of sleep. Insomnia
occurs despite the patients having adequate time and opportunity for sleep and that can result in
impairment of their day-to-day and daytime activities.
Insomnia

Insomnia presents as decreased sleep efficiency or a decrease in the total number of hours spent
on sleep. There is a strong association between insomnia and elderly patients whereby elderly
patients are frequent victims of insomnia, especially those living with several underlying
comorbidities- in this case, the patient was diagnosed with coronary artery disease,
hyperlipidemia, hypertension, benign prostatic hypertrophy, and major depressive disorder.
Patients taking several medications for different diseases are also prone to sleep disturbances-
some of the medications can induce insomnia like beta-blockers- metoprolol, antidepressants-
Fluoxetine, and some stimulants. It is vital to do a comprehensive medical history to rule out
psychiatric disorders like anxiety and depression, history of fatal familial insomnia, and restless
leg syndrome. This are some of the secondary causes of insomnia.
The phases of insomnia include initial, middle, or terminal insomnia whereby initial insomnia is
characterized by difficulty falling asleep, increased sleep latency, and is associated with anxiety
disorders. Middle insomnia is the second phase that is characterized by difficulty in maintaining
sleep, decreased sleep efficiency, and frequent episodes of awakening during the night while

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terminal insomnia is characterized by consistent awakening of the patients that occur relatively
earlier than normal (Sweetman et al, 2017)

Management of Insomnia

Management of insomnia involves the use of both pharmacological and non-pharmacological
interventions. Non-pharmacological interventions include cognitive-behavioral therapy like
relaxation therapy and sleep hygiene education. Pharmacological interventions include the use of
sedative-hypnotics like Eszopiclone, benzodiazepines like triazolam, Zolpidem, and Orexin
antagonists like suvorexant (Riemann et al, 2017). The patients are also advised to stop taking
alcohol – alcohol has drug interaction reactions with most sedatives and hypnotics. Patient KJ
should be prescribed with either Zolpidem as it safe for the elderly age groups and is ideal for
short term usage or Eszopiclone for severe and chronic insomnia.

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References

Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … &
Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of
insomnia. Journal of sleep research, 26(6), 675-700.
Sweetman, A. M., Lack, L. C., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Smith, S. S.,
… & McEvoy, R. D. (2017). Developing a successful treatment for co-morbid insomnia
and sleep apnoea. Sleep Medicine Reviews, 33, 28-38.