Better understanding needed on differentiating, managing different forms of insomnia

PHILADELPHIA — Insomnia is a poorly understood medical condition, meaning it is often not diagnosed or appropriately treated, according to a presenter here at the annual meeting of the American Association of Nurse Practitioners.

“Insomnia is a sleep disorder that is often underrecognized and undertreated in outpatient settings,” Veronica Wilbur, PhD, APRN-FNP, CNE, FAANP, assistant professor, West Chester University of Pennsylvania, wrote in her poster. “Primary care nurse practitioners may lack the knowledge to ask appropriate questions to guide diagnosis and management of insomnia.”

According to the Sleep Management Institute, an estimated 30% to 50% of the general U.S. population is affected by insomnia, while 10% of this group have chronic insomnia. The condition generally affects women more often than men, tends to increase as a person gets older and is typically more common in chronic alcoholics, lower income groups, and patients with mental health disorders.

Wilbur defined short-term insomnia as occurring for less than 3 months, having a precipitating cause and causing daytime impairment. Chronic insomnia occurs at least three times a week and more than three times a month, causes daytime impairment and happens in spite of what she called adequate environmental factors.

“It is critical to assess sleep hygiene, [things like] bedroom environment, use of electronic devices close to bedtime and caffeine intake,” Wilbur wrote. “Evidence is weak overall for the use of drugs; however, treatment considerations should be individualized for each patient.”

The medications Wilbur recommended were Ambien (zolpidem, Sanofi-aventis) Belsomra (suvorexant, Merck), doxepin, Lunesta (eszopiclone, Sunovion), Rozerem (ramelteon, Takeda), triazolam and zaleplon, she did not encourage the use of trazadone, and the over-the-counter medications diphenhydramine, l-tryptophan, melatonin and, valerian. – by Janel Miller

References :

Sleep Management Institute Webpage on Insomnia (accessed 06-22-17)

Wilbur, V. “How to approach the challenges of insomnia disorder in primary care: Applying the 2014 International Classification of Sleep Disorders Guidelines.” Presented at: American Association of Nurse Practitioners National Conference; Jun. 20-25, 2017; Philadelphia.

Disclosure: Healio Family Medicine was unable to confirm relevant financial disclosures prior to publication.