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omnia

Insomnia

C om p la ints m a y be : d iffic ulty fa lling or r e m a ining a s le e p , w a king up too e a r ly in the
m or ning, nightm a r e s , or d a ytim e fa tigue .

Management

If the ins om nia is r e la te d to a n or ga nic c a us e , tr e a t the c a us e (e .g., a d m inis te r
a na lge s ic s
for p a in).
If the ins om nia is r e la te d to the us e of a lc ohol, d r ugs or a m e d ic a tion , m a na ge m

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d e p e nd s on th e s ubs ta nc e r e s p ons ible .
I f th e ins om n ia is r e la te d to a p a r tic ula r life e v e n t ( e .g. be r e a v e m e n t) , a s h or t
te r m
tr e a tm e nt w ith a s e d a ting a ntihis ta m ine ( promethazine P O : 2 5 m g onc e d a ily a t
be d tim e
for 8 to 1 0 d a ys ) m a y be us e ful.
I f t h e in s om n ia p e r s is ts , r e - e v a lua te t h e p a t ie n t . I n s om n ia is a c om m on
fe a tur e in
d e p r e s s ion (p a ge 2 9 7 ), p os t-tr a um a tic s tr e s s d is or d e r (p a ge 2 9 5 ) a nd a nxie ty
d is or d e r s
(p a ge 2 9 1 ). I n s uc h c a s e s , the und e r lying d is or d e r s hould be a d d r e s s e d .

The main drugs known to cause sleep problems are corticosteroids, beta blockers, levodopa/carbidopa,

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levothyroxin (if overdosage), phenytoin, fluoxetine and clomipramine.