Sleep onset Insomnia

Abstract

Sleep onset insomnia, defined as difficulty initiating asleep, is a common disorder with associated impairment or significant distress and is associated with daytime consequences. Although these sleep onset insomnia has generally been attributed to psychological or psychiatric causes, it can also be secondary to a medical, circardian, or sleep disorder. Usually, many patients have various causes or conditions such as psychophysiological insomnia (PPI), periodic limb movements in sleep (PLMS), restless legs syndrome (RLS), obstructive sleep apnea-hypopnea syndrome (OSAS), congestive heart failure (CHF), delayed sleep phase syndrome (DSPS), etc. These patients are characterized by frequent arousals or failing to get to sleep in the early sleep stage and don’t feel refreshed in the morning. They result in complaints of insomnia or sleep state misperception and have significant decreased daily activities and impaired cognitive functions. For more accurate evaluation, polysomnography (PSG), multiple sleep latency test (MSLT), neuropsychological test (NP test), and suggested Immobilization Test (SIT) can be necessary to these patients. After these studies, the most appropriate treatments are adjusted including sleep hygiene education, cognitive behavior therapy, pharmacologic therapy, continuous positive airway pressure titration, and surgery, etc. These article introduces the clinical approach to the diagnosis and management of the sleep onset insomnia that can be caused by the various possibilities, such as PPI, SSM, PLMS, RLS, DSPS, OSAS, and CHF.