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What is Acute Insomnia?

Characterized by: 1,2 Sudden onset Short course (duration ≤3 months) Patient may experience: Difficulty initiating sleep Sleep fragmentation Increased duration of nocturnal awakenings Short duration of sleep Poor sleep quality . What is Acute Insomnia?.

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What is Acute Insomnia?

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  1. Characterized by:1,2 • Sudden onset • Short course (duration ≤3 months) • Patient mayexperience: • Difficulty initiating sleep • Sleep fragmentation • Increased duration of nocturnal awakenings • Short duration of sleep • Poor sleep quality What is Acute Insomnia? American Academy of Sleep Medicine. ICSD-2 – International Classification of Sleep Disorders, 2nd ed: Diagnostic and coding manual. 2005. Alberta Medical Association. Toward Optimized Practice (TOP) Adult Insomnia: Diagnosis to Management Clinical Practice Guidelines. 2010.

  2. Early therapy can prevent the evolution of more complex sleep-related syndromes • Recurrent, untreated insomnia may lead to more chronic, intractable insomnia • Patient may develop psychophysiological (conditioned) insomnia over time; more difficult to resolve1 • Bidirectional link between insomnia and depression2 Why Treat Insomnia? Drake CL, Roth T. Sleep Med Clin. 2006;1:333-349. StanerL. Sleep Med Rev. 2010;14:35-46.

  3. Predisposing factors • Precipitatingfactors • Perpetuatingfactors Key Features to Assessment: 3 “P’s”

  4. Predisposing Factors to Insomnia • .

  5. Most common is emotional distress • Bereavement • Relationship difficulties • Loss of work • Financial burdens • Particular stressors (school examinations, work projects, etc.) • Changes in medication or dosing • Onset of medical or psychiatric disorder or another primary sleep disorder Precipitating Factors for Insomnia

  6. Complex interaction between behavioural, emotional, and cognitive factors • Behavioural issues are typically the easiest to address • Cognitive and emotional elements may require specialized therapies and techniques Perpetuating Factors for Insomnia

  7. Primary goals • to improve sleep quality and quantity • to improve insomnia-related daytime impairments • Reassess therapy every few weeks and/or monthly until insomnia appears stable or resolves • Follow-up every 6 months thereafter to avoid relapse1 • If a single treatment is ineffective, try other options, a combination of therapies,2 or test for comorbidities Management Strategies Schutte-Rodin S et al. J Clin Sleep Med. 2008;4(5):487-504. ZavesickaL et al. NeuroEndocrinolLett. 2008;29(6):895-901.

  8. Important first step to determine management • Engages patients in the treatment process • Provides data on severity, regularity, and compounding influences • Patient instructed to record sleep daily over 1–2 weeks • Review diary entries on follow-up appointment Sleep Diary

  9. Overcoming Maladaptive Compensatory Behavioural Responses

  10. Pharmacotherapy • Accompany with patient education • treatment goals and expectations • safety concerns • potential adverse events and drug interactions • other treatment modalities (cognitive and behavioural treatments) • potential for dosage escalation • rebound insomnia Health Canada. Authorized Sleep-Aid Medications in Canada.

  11. Cautions Related to Medications Commonly Prescribed in the Acute Management of Insomnia

  12. Short-term Therapies: Effective and Safe First- and Second-line Options * There is a moderate level of evidence and the extent of present use support the use of trazodone as a second-line agent

  13. “Natural” Agents and Over-the-counter Products Used as Sleep Aids

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