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CPD: Key questions on insomnia

Dr Roger Henderson on diagnosis in primary care and management in the elderly

Learning Objectives

This module will take you through the diagnosis and management of insomnia, including: 

  • Assessing sleep quality
  • How to treat the condition in older populations
  • Using benzodiazepines and Z-drugs safely
  • The role of melatonin in pharmacological management

Author

Dr Roger Henderson is a GP in Shropshire

1. What are some of the associated risks of persistent insomnia?

It is very important to realise that insomnia is not a benign condition. It is associated with a range of mental and physical health problems, higher rates of healthcare resource utilisation and reduced quality of life. Sleep disturbance, and the resulting daytime fatigue, cause distress and impair daytime functioning, both social and occupational, which have been associated with reduced quality of life. People with insomnia have been shown to have higher rates of mental health problems, drug and alcohol abuse, cardiac morbidity and healthcare resource utilisation, and to be at increased risk of accidents, falls and overall mortality.1,2

Several large studies have demonstrated reduced quality of life, increased functional impairment and increased healthcare costs in patients with insomnia. Impairments in the areas of vitality, energy, emotional and mental health have been the most widely reported. One study shows that severe insomnia is independently associated with worsened health-related quality of life to almost the same extent as chronic conditions such as congestive heart failure and major depression.3

Far from being a minor irritation, insomnia puts sufferers at significantly greater risks of poor mental and physical health ranging from depression, anxiety, immune deficiency and metabolic and cardiovascular disease. Insomniacs report frequent medical problems and have twice as many doctors’ visits yearly and a higher hospitalisation rate compared with good sleepers.4

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