STUDY - Technical - New Dacian's Medicine
Insomnia
(Classical / Allopathic Medicine)
Insomnia is the
inability to fall asleep, remain asleep, or feel refreshed by
sleep. Acute and transient during periods of stress, insomnia
may become chronic, causing constant fatigue, extreme anxiety
as bedtime approaches, and even psychiatric disorders. This
common complaint is experienced occasionally by about 25% of
Americans, and chronically by another 10%.
Physiologic causes
of insomnia include jet lag, stress, and lack of exercise.
Pathophysiologic causes range from medical and psychiatric
disorders to pain, adverse drug effects, and idiopathic
factors. Complaints of insomnia are subjective and require
close investigation; the patient may mistakenly attribute his
insomnia to fatigue from an organic cause such as anemia.
Tips for relieving
insomnia
Common problems: Acroparesthesia
Intervention:
Teach the patient to assume a comfortable position in bed,
with his limbs unrestricted. If he tends to awaken with a numb
leg or arm, tell him to massage and move it until the
sensation returns completely and then assume an unrestricted
position.
Common problems:
Anxiety
Intervention:
Encourage the patient to discuss his fears and concerns and
teach him relaxation techniques, such as guided imagery and
deep breathing. If ordered, administer a mild sedative, such
as diazepam, before bedtime.
Common problems:
Dyspnea
Intervention:
Elevate the head of the bed or provide at least two pillows or
a reclining chair to help the patient sleep. Suction him when
he awakens, and encourage deep breathing every 2 to 4 hours.
Also, provide supplementary oxygen by nasal cannula.
Common problems:
Pain
Intervention:
Administer pain medication, as ordered, 20 minutes before
bedtime, and teach deep, even, slow breathing to promote
relaxation. Help the patient with back pain lie on his side
with his legs flexed. Encourage the patient with epigastric
pain to take an antacid before bedtime and to sleep with the
head of the bed elevated.
Common problems:
Pruritus
Intervention: Wash
the patient's skin with mild soap and water and dry the skin
thoroughly. Apply moisturizing lotion on the dry, unbroken
skin and an antipruritic, such as calamine lotion, on pruritic
areas.
Common problems:
Restless leg
Intervention: Help
the patient exercise his legs gently by slowly walking with
him around the room and down the hall. If ordered, administer
a muscle relaxant such as diazepam.
HISTORY:
Ask the patient when his insomnia began and the attending circumstances. Is he trying to stop using sedatives? Does he use central nervous system stimulants, such as amphetamines, pseudoephedrine, theophylline derivatives, phenylpropanolamine, cocaine, and caffeine-containing drugs or beverages? Does he use herbal remedies?
Review the patient's medical history for a chronic or acute condition that may be disturbing his sleep, particularly a cardiac or respiratory disease or a painful or pruritic condition. Also, check for a history of endocrine or neurologic disorders and drug or alcohol abuse.
Ask the patient if he's a frequent traveler who suffers from jet lag.
Ask the patient if he uses his legs a lot during the day only to feel restless at night.
Ask the patient about daytime fatigue and regular exercise. Also, ask if he experiences periods of gasping for air or apnea and frequent body repositioning. If possible, consult the patient's spouse or sleep partner because the patient may not be aware of his own behavior.
Assess the patient's emotional status, and try to estimate his level of self-esteem. Ask about personal and professional problems and psychological stress.
Ask the patient if he has had hallucinations, and note behavior that may indicate alcohol withdrawal.
HISTORY:
Ask the patient when his insomnia began and the attending circumstances. Is he trying to stop using sedatives? Does he use central nervous system stimulants, such as amphetamines, pseudoephedrine, theophylline derivatives, phenylpropanolamine, cocaine, and caffeine-containing drugs or beverages? Does he use herbal remedies?
Review the patient's medical history for a chronic or acute condition that may be disturbing his sleep, particularly a cardiac or respiratory disease or a painful or pruritic condition. Also, check for a history of endocrine or neurologic disorders and drug or alcohol abuse.
Ask the patient if he's a frequent traveler who suffers from jet lag.
Ask the patient if he uses his legs a lot during the day only to feel restless at night.
Ask the patient about daytime fatigue and regular exercise. Also, ask if he experiences periods of gasping for air or apnea and frequent body repositioning. If possible, consult the patient's spouse or sleep partner because the patient may not be aware of his own behavior.
Assess the patient's emotional status, and try to estimate his level of self-esteem. Ask about personal and professional problems and psychological stress.
Ask the patient if he has had hallucinations, and note behavior that may indicate alcohol withdrawal.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Perform a complete physical assessment. Note skin abnormalities, and observe for areas of pain or tenderness.
Closely assess the patient's heart and thyroid gland for abnormalities.
Take the patient's vital signs.
Perform a complete physical assessment. Note skin abnormalities, and observe for areas of pain or tenderness.
Closely assess the patient's heart and thyroid gland for abnormalities.
SPECIAL
CONSIDERATIONS:
Herbal remedies, such as ginseng and green tea, can cause adverse effects, including insomnia.
Herbal remedies, such as ginseng and green tea, can cause adverse effects, including insomnia.
PEDIATRIC
POINTERS:
Insomnia in early childhood may develop along with separation anxiety between ages 2 and 3, after a stressful or tiring day, or during illness or teething.
In children ages 6 to 11, insomnia usually reflects residual excitement from the day's activities; a few children continue to have bedtime fears.
Insomnia in early childhood may develop along with separation anxiety between ages 2 and 3, after a stressful or tiring day, or during illness or teething.
In children ages 6 to 11, insomnia usually reflects residual excitement from the day's activities; a few children continue to have bedtime fears.
PATIENT
COUNSELING:
Teach the patient comfort and relaxation techniques to promote natural sleep. (See Tips for relieving insomnia.)
Teach the patient comfort and relaxation techniques to promote natural sleep. (See Tips for relieving insomnia.)
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)