How do you sequence pharmacologic treatments for primary insomnia?
Answer from: at Academic Institution
First, be sure you have already addressed deficiencies in sleep hygiene:
Room at 65 degrees F
Wearing earplugs
Complete darkness (no visible hand in front of face)
No clock
Golden hour before bed
ETOH, nicotine, and caffeine reduction with cessation of 4 hours before bed
Writing a list of w...
Comments
at Michigan Institute for Neurological Disorders (MIND) Thank you! Very helpful!
at Kaiser Permanente I appreciate the long list of suggestions, as well...
at Monument Health Rapid City Hospital Is there published evidence on magnesium for insom...
I very seldom recommend medications. There is both physical dependency and psychological dependency (patients feeling they need to take something to sleep). I use sleep logs and establish sleep restrictions, e.g., 5 hours only in bed with no naps in the day. Dealing with cognitive distortions where ...
Sleep diary
Sleep hygiene reinforcement
GAD/Depression Screening
Discuss actigraphy, irregular sleep wake cycles, and sleep state misperception
Trial of melatonin
Sleep study (HST/Lab)
Treat OSAS if present
Trial of somnolence agent therapies
I had a good experience with prescribing orexin inhibitors Dayvigo as well as the new upcoming Quviviq as they block wakefulness and do not induce drowsiness. They may also have a good effect on reducing daytime sleepiness.
I would love to hear how others address the trackers such as Oura rings, Apple watches, etc. I've found that they have dramatically increased my patients' anxiety about sleep and hence, their perceived insomnia.
The best way I've found is to suggest that they speak with their partners who provide s...
Thank you! Very helpful!
I appreciate the long list of suggestions, as well...
Is there published evidence on magnesium for insom...