These article introduces the clinical approach to the diagnosis and management of the sleep onset insomnia that can be caused by the various possibilities, such as PPI, SSM, PLMS, RLS, DSPS, OSAS, and CHF. After these studies, the most appropriate treatments are adjusted including sleep hygiene education, cognitive behavior therapy, pharmacologic therapy, continuous positive airway pressure titration, and surgery, etc. For more accurate evaluation, polysomnography (PSG), multiple sleep latency test (MSLT), neuropsychological test (NP test), and suggested Immobilization Test (SIT) can be necessary to these patients. They result in complaints of insomnia or sleep state misperception and have significant decreased daily activities and impaired cognitive functions. These patients are characterized by frequent arousals or failing to get to sleep in the early sleep stage and don’t feel refreshed in the morning. Symptoms of this condition can include: difficulty staying asleep. Insomnia can get in the way of your daily activities and may make you feel sleepy during the day. Middle insomnia can cause not only sleep-related symptoms but also difficulty with day-to-day tasks due to lack of sleep. This happens even if you have the time and the right environment to sleep well. With insomnia, you may have trouble falling asleep, staying asleep, or getting good quality sleep. Usually, many patients have various causes or conditions such as psychophysiological insomnia (PPI), periodic limb movements in sleep (PLMS), restless legs syndrome (RLS), obstructive sleep apnea-hypopnea syndrome (OSAS), congestive heart failure (CHF), delayed sleep phase syndrome (DSPS), etc. Espaol Insomnia is a common sleep disorder. Although these sleep onset insomnia has generally been attributed to psychological or psychiatric causes, it can also be secondary to a medical, circardian, or sleep disorder. Definition As per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR), insomnia disorder is defined as difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality. Sleep onset insomnia, defined as difficulty initiating asleep, is a common disorder with associated impairment or significant distress and is associated with daytime consequences. (ICSD-2 definition) Evaluation: Insomnia is primarily diagnosed by clinical evaluation through a thorough sleep history and detailed medical, sub-stance, and psychiatric history. In patients presenting with an acute onset insomnia. Seung Bong Hong ,Tel: +82-2-3410-3592, Fax: +82-2-3410-0052, Email: DecemAccepted: DecemPublished online: December 31, 2009 Insomnia disorder is defined as difficulty in falling asleep, maintaining sleep, and early morning. Hwan Seok Park 1, Eun Yeon Joo 2, Seung Bong Hong 2ġDepartment of Neurology, Inje University College of Medicine, Busan, Korea 2Department of Neurology, Sleep Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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