Assessment: Insomnia Plan: [comment memo="Sleep hygiene, stimulus and temporal control"][checklist value="Lie down to sleep only when feeling sleepy|Avoid wakeful activities at bedtime (watching television, talking on the phone, eating)|Leave the bed if unable to fall asleep within 20 minutes and return when sleepy|Maintain a consistent sleep-wake cycle (e.g., set the alarm for the same time each morning regardless of how much sleep occurs during the night)|Avoid daytime naps|Exercise regularly (not within 4 hours of bedtime)|Avoid large meals and limit fluid intake in the evenings|Limit caffeine, tobacco, and alcohol intake|Use the bedroom for sleep and sex only|Avoid distracting stimuli at bedtime, such as loud noises, bright lights when not being used therapeutically, and extreme temperature variations|Ear-plugs can be used if noise is a problem"] [textarea] [comment memo="Sleep restriction"][checklist value="Limit time in bed to the number of hours actually spent sleeping (not less than 5 hours), sleep time gradually increases as sleep efficiency improves"] [textarea] [comment memo="Paradoxical intention"][checklist value="Advise patient to remain awake to help alleviate the anxiety associated with the pressure to fall asleep"] [textarea] [comment memo="Relaxation training"][checklist value="Autogenic training - imagine a calm environment with comforting body perceptions such as warmth and heaviness of the limbs|Imagery training - focus on pleasant images|Repetitive focus - focus on a word, sound, prayer, phrase, or muscle activity|Hypnosis|Meditation|Yoga|Abdominal breathing|Progressive muscle relaxation (from the feet up to the facial muscles)|Paced respirations: Take a deep breath and hold for five seconds, repeat several times; focus on the sound of the breath"] [textarea] [checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"] References: [link url="http://www.ncbi.nlm.nih.gov/pubmed/19178064" memo="#1"] Harsora P, Kessmann J. Nonpharmacologic management of chronic insomnia. Am Fam Physician. 2009 Jan 15;79(2):125-30. [link url="https://www.ncbi.nlm.nih.gov/pubmed/18853708" memo="#2"] Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504. [link url="https://www.ncbi.nlm.nih.gov/pubmed/17162987" memo="#3"] Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, Coleman J, Kapur V, Lee-Chiong T, Owens J, Pancer J, Swick T; American Academy of Sleep Medicine. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep. 2006 Nov;29(11):1415-9. [link url="https://www.ncbi.nlm.nih.gov/pubmed/19454639" memo="#4"] Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, Bastien C, Baillargeon L. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009 May 20;301(19):2005-15. [/conditional]
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