Insomnia

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Diagnosis

Because insomnia is a condition qualified by other subsidiary disorders, it is usually diagnosed as a result of one or more of these. Varied conditions that lead to insomnia include delayed sleep-phase syndrome (DSPS) and stress. Assessment begins with the documentation of a complete sleep history and an evaluation of the patient's sleep hygiene. A medical history is obtained and an examination performed to determine if underlying medical or psychiatric conditions are present. Formal testing for sleep disorder is noninvasive and includes overnight polysomnography and multiple sleep latency testing (MSLT).

Insomnia as a Side Effect of Medications

There are numerous medications for which insomnia is a predictable side effect. The most common ones are listed below.

• Decongestants (pseudoephedrine)
• Bronchodilators (beta-2 agonists, theophylline)

• Antihypertensives (hydrochlorothiazide, nifedipine, methyldopa, propranolol)
• Antidepressants (fluoxetine, bupropion, sertraline)
• Antidepressants that may cause daytime drowsiness (desipramine, imipramine, nortriptyline)
• Diuretics (furosemide)
• Antiepileptics (phenytoin)
• Antiarrhythmic agents (quinidine, propranolol, verapamil)
• Histamine H2 inhibitors (cimetidine -for gastrointestinal conditions)
• Thyroid medications
• Alcohol, caffeine, nicotine

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