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Drugs (e.g. caffeine, alcohol, β-blockers)
Anxiety, stress
Depression
Restless legs syndrome
Sleep apnoea
Nightmares
Physical disorders (e.g. CCF, arthritis)
Bedwetting
Reflux disease
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Management: Non-drug treatments are first line.
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Give explanation and reassurance (treat cause if known)
Try to recognise what helps patient to settle best (e.g. warm bath, listening to music)
Establish a routine before going to bed and turn off electronic devices in advance
Avoid alcohol and drinks containing caffeine in evening
Regular time of arising
Organise a comfortable, quiet sleep setting with right temperature
Avoid naps during the day
Remove pets from the bedroom
Try relaxation therapy, meditation, stress management
Consider hypnosis
If all conservative means fail, try temazepam 10 mg (o) first line or zopiclone (Imovane) 3.75–7.5 mg or zolpidem tartrate (Stilnox) 5 mg (o) at night (limit to 2 wks); consider melatonin CR 2 mg (ο) 1–2 hrs before bedtime (best >55 yrs)
Consider referral to a specialist in sleep disorders
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DELAYED SLEEP PHASE SYNDROME
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This circadian rhythm disorder is a DD for common insomnia. Sufferers struggle to fall asleep with delays of 2+ hours. Diagnosis by sleep studies. People should factor in extra time for sleep cycle.