Insomnia
Description General Measures Medicine Treatment Referral ICD-10 code: G47.0/G47.9 Description Insomnia may be an independent disorder or associated with comorbid conditions. Insomnia may persist despite successful treatment of the comorbidity and may necessitate separate treatment. Patients presenting with insomnia may complain of difficulty falling asleep, frequent waking during the night, early
ICD-10 code: G47.0/G47.9
Description
- Insomnia may be an independent disorder or associated with comorbid conditions.
- Insomnia may persist despite successful treatment of the comorbidity and may necessitate separate treatment.
- Patients presenting with insomnia may complain of difficulty falling asleep, frequent waking during the night, early-morning wakening, and daytime sleepiness.
General Measures
- Treat the medical condition, psychiatric illness, substance use disorder or sleep disorder that may be precipitating or exacerbating the insomnia, if present.
- Provide basic behavioural counselling about sleep hygiene and stimulus control as first step of treatment.
- Cognitive behavioural therapy is the treatment of choice.
Medicine Treatment
If medication is needed:
- Use the lowest effective dose.
- Use intermittent dosing if possible (alternate night or less).
Sleep hygiene and stimulus control:
- Maintain a regular sleep cycle (same time wake up in the morning, including week-ends).
- Stimulus control:
- Keep the room quiet, dark, and at a comfortable temperature.
- Use the bed and bedroom only for sleeping and partner intimacy.
- Limit intake of caffeine, nicotine, and alcohol, especially before bedtime.
- Eat a light snack before bedtime and avoid eating large meals late at night.
- Sleep restriction: avoid daytime naps.
- Increase daily exercise (not late in the evening).
- Practise anxiety management or relaxation techniques.
- Go to bed only when tired. Sleep as much as needed to feel refreshed, not longer.
- If unable to sleep despite attempting for more than 15–20 minutes, get out of bed and engage in a non-stimulating activity until tired (e.g. listen to soft music, read).
If medication is needed to treat the insomnia:
- Short-acting benzodiazepines, e.g.:
- Oxazepam, oral 7.5–30 mg at night.
Short-term use of benzodiazepines of 14 days is recommended, as long-term use is often associated with dependence.
Referral
Patients with chronic insomnia.
Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital level_Chapter 15: Mental Health Conditions and Substance Misuse_NEMLC Recommendations for Medicine Amendments 2020_2023