Insomnia – Practical advice

The ‘ Insomnia is the most common sleep disorder in the world, suffers from one third to one fourth of the world population.

Despite this, insomnia remains poorly recognized, diagnosed and treated correctly. It is estimated that around 60% of insomniacs have never discussed sleep disorders with their doctor.

Failure to recognize and treat insomnia determines important medical and social repercussions, significantly reducing the patient’s occupational performance and, more generally, the quality of life.

The ‘ Insomnia is defined as the experience of inadequate sleep or poor quality described by one or more of these symptoms:

  • difficulty in initiating or maintaining sleep
    • early morning awakening
    • unrefreshing sleep.

L ‘ insomnia is manifested by the appearance of one night or more indicators, which mean that it can qualify as a first-level insomnia. These indicators are associated with some daytime symptoms, which define insomnia as second-level insomnia.

Depending on the duration of the symptoms, insomnia can be acute if it lasts a few days or a few weeks, or chronic if the symptoms have persisted for at least a month.

The possibility of early detection of insomnia results in the practical relapse of avoiding the chronicity of the disorder and significantly improving the quality of life and health in general of patients.

For the correct management of insomnia in clinical practice, it may be useful to refer to some indications, validated in the context of general medicine.

  • Insomnia should always be diagnosed if the patient complains spontaneously and treated even if not expressly requested by the patient himself
    • Insomnia should always be sought and treated in conjunction with psychiatric and internal pathologies
    • For diagnostic and therapeutic management it should always the cause of insomnia be sought
    • It is preferable to use a hypnotic with a short half-life
    • It is preferable to use non-benzodiazepine hypnotics for their ease of handling
    • The evolution of insomnia and its therapy must be re-evaluated over time
    • The self-management of therapy should be discouraged and avoided
    • In case of ineffectiveness of hypnotic drug, the recommended dose should not be increased, but the treatment must be modified, re-evaluated the diagnosis or better undertaken an adequate psychotherapy
    • A patient sharing to their “process of care” is a positive element for success. For example, the adoption of a hypnotic drug in a formulation in drops allows on the one hand fine adjustments of the dosage, on the other hand an “active ritual” of the person, who feels even more involved in solving his problem

In addition, it is useful to propose to patients some practical rules of sleep hygiene :

The appropriate management of insomnia does not end with the setting of drug therapy and sleep hygiene but often requires a valid psychotherapeutic intervention. The doctor’s first task is to ensure that the patient becomes aware of the need to verify the progress of his disorder and psychological support, as for any other problem of this nature.


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