Feature Article

Breaking the cycle of insomnia

Feature Article

Breaking the cycle of insomnia

Delwyn Bartlett, Catherina L Chang

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Abstract

Insomnia can be exacerbated by anxiety and anxiety can cause insomnia. Cognitive behavioural therapy and pharmacological therapy are important tools in breaking the cycle of insomnia.

Key Points

  • Insomnia is a disorder in itself but is frequently dismissed as being a symptom of a mood disorder or another medical condition. A bidirectional relation exists where untreated insomnia can lead to depression or anxiety and untreated depression or anxiety can result in insomnia.
  • Important factors that contribute to insomnia development can be assessed using the three ‘Ps’: predisposing factors, precipitating factors and perpetuating factors.
  • Excessive sleepiness (as opposed to fatigue) is uncommon in primary insomnia and, if present, other causes of sleep disruption (such as obstructive sleep apnoea and restless legs syndrome), medical and psychiatric conditions and substance abuse should be considered.
  • Cognitive behavioural therapy (CBT) is the most efficacious treatment for patients with insomnia and can be successfully used in general practice. Important elements of CBT include stimulus control, bed restriction, relaxation, cognitive therapy and healthy sleep practices. Pharmacotherapy is also efficacious but may be associated with significant side effects and should be used with caution.