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Suspected insomnia

Peter Wright, a 48-year-old man, tells you he is having difficulty getting to sleep. He says it takes him at least an hour to fall asleep after going to bed. This has been happening for the last four to six weeks. What do you advise?

Problem representation

Short-term insomnia in a middle-aged male.

Hypothesis generation 

Insomnia can occur at any age but the chances of having it increase with age. It is actually more common in women than men. 

Insomnia is defined as difficulty in getting to sleep, struggling to maintain sleep, waking up frequently in the night or a tendency to wake up early and be unable to go back to sleep, or the sleep is of poor quality and results in impaired daytime functioning. 

Short-term insomnia is typically described as lasting a few days to a few weeks (it is classed as chronic insomnia if present for more than three months). In short-term cases there is usually an identifiable precipitating cause or risk factor. Conditions to consider are:

Likely diagnosis 

  • Acute episodes of stress
  • Circadian rhythm disorders (e.g. shift work,jet lag)
  • Environment (e.g. noise, temperature)
  • Medical conditions
  • Medicines. 

Possible diagnosis  

  • Parasomnia
  • Periodic limb movement disorder
  • Restless legs syndrome
  • Sleep apnoea.

Critical diagnosis  

  • Narcolepsy.
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