Sleep Disorders and Fatigue
B. H&P
Distinguish sleepiness that stems from insomnia or sleep deprivation from fatigue from meds or illness. Ask about sleep latency, daytime sleeping, medications, snoring, scratchy throat in AM, cataplexy, sleep paralysis, trouble with initiating vs. maintaining sleep, movements in bed.
C. Insomnia
1. DDx: Pain, anxiety, depression, bad sleep hygiene, alcohol or tranquilizer dependence, medications (steroids, β-blockers, etc.), nocturnal movement disorders, occasionally sleep apnea or midbrain damage.
2. Acute rx: In the elderly, use the lowest, shortest acting dose.
a. Nonbenzodiazepine GABA receptor drugs: E.g., zolpidem 5-10 mg. Little addiction, short half-life.
b. Benzodiazepines: Good for comorbid anxiety, but rapid tolerance. Avoid these, esp. in elderly pts.
c. Melatonin agonists: Melatonin itself soon habituates. Ramelteon 8 mg is nonaddictive; effects last ∼8 h.
d. Sedating antidepressantsRelated posts:
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