She does not snore and has no usual limb movements during sleep (history from husband). Suraya, also experiences daytime fatigue and is unable to concentrate in her work. She experiences about 3-5 awakenings every night and with each awakening requires about 30 minutes to fall asleep again. She regularly goes to bed at 10 pm but is unable to sleep until 1 am. Puan Suraya, a 40 year old schoolteacher complains of inability to sleep well for more than 2 years. Puan Suraya, a 40 -year-old lady with difficulty falling asleep. Patients with sleep-disordered breathing, sleep-related motor disorders and those with severe, chronic insomnia for which an obvious cause cannot be found may require referral for sleep laboratory evaluation. A sleep diary that the patient maintains in which sleep-relevant behaviours such as bedtime and waking times, awakenings, total sleep time, napping, medications, alcohol and mood on waking often provides valuable information for the patient and physician. The diagnosis of sleep disorders is often based on obtaining a detailed sleep history, a neuropsychiatric evaluation, a physical examination looking for medical and other disorders, mental status examination and relevant investigations. 6, 7 Secondary causes of insomnia include conditions where another disorder contributing to or aggravating the insomnia can be diagnosed ( Table1). Primary insomnia refers to insomnia that appears to be unrelated to any identifiable underlying medical or psychiatric disorder. Insomnia can be due to primary or secondary causes. An important consideration is whether the presence of one or more of these symptoms causes significant impairment to the patient’s social, occupational or other important areas of functioning. 1 Insomnia is a common encounter in primary care consultations 2 and constitutes the commonest sleep problem 3, 4 that presents to the general practitioner.īased on the National Center for Sleep Disorders Research Classification, 5 insomnia symptoms can be defined as subjective complaints of difficulty falling asleep, difficulty maintaining sleep, early awakening and non refreshing sleep despite an adequate opportunity to sleep. pregnancy and menstrual related sleep disorders). Sleep disorders can be broadly classified into: (a) insomnia, (b) parasomnia, (c) sleep disorders associated with psychiatric, neurologic and other medical disorders, and (d) proposed sleep disorders (e.g.
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