Fast Five Quiz: Insomnia Types and Causes

Stephen Soreff, MD

Disclosures

July 15, 2020

Patient history is the most important part of the evaluation for insomnia. It must include a complete sleep history, medical history, psychiatric history, social and family history, a review of abused substance use, a survey of one's social and vocational environment, and medication review. Some medications associated with disturbed sleep include alpha-blockers, corticosteroids, cholinesterase inhibitors, glucosamine, chondroitin, and statins. Furthermore, drugs that can be abused, such as amphetamines, can cause insomnia, and individuals recovering from abuse of these drugs might experience sleep disruption.

In 2014, as part of the Choosing Wisely® initiative from the American Board of Internal Medicine Foundation, the American Academy of Sleep Medicine recommended that physicians avoid polysomnography in patients with chronic insomnia unless symptoms suggest a comorbid sleep disorder.

Excessive daytime sleepiness is uncommon in insomnia. If a patient complains of excessive daytime sleepiness (ie, Epworth Sleepiness Scale Score > 10), another sleep disorder should also be considered.

FFI is a rare disorder that should only be considered if first-degree relatives are affected, because this disorder is inherited in an autosomal dominant pattern. So while a family history should be obtained in all patients with insomnia, the National Institutes of Health recommends that genetic testing for FFI should only be performed in those with a family history of FFI or abnormal sleep study or PET scan.

Learn more about the clinical presentation of insomnia.

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