Treatment

Treatment goals vary among different sleep disorders but generally include restoration of normal sleep patterns, elimination of daytime sequelae, improved quality of life, and prevention of complications and adverse effects from therapy. All patients presenting with sleep complaints should have a thorough inventory of their sleep habits and sleep hygiene investigated during the interview and history taking. Nonpharmacologic interventions for insomnia are outlined in Table 41-1. Sleep hygiene should be reinforced in all patients, and behavioral, cognitive, and stimulus-control in terventions are used mainly for patients with insomnia-type complaints. Both pharma-cologic and nonpharmacologic therapies are effective at improving sleep and reducing insomnia complaints. An algorithm for the initial assessment and first treatment step of EDS is provided in Figure 41-1.

Table 41-1 Nonpharmacologic Therapies for Insomnia

Sleep Hygiene

• Keep a regular sleep schedule

• Exercise frequently but not immediately before bedtime

• Avoid alcohol and stimulants (caffeine, nicotine) in the late afternoon and evening

• Maintain a comfortable sleeping environment that is dark, quiet, and free of intrusions

• Avoid consuming large quantities of food or liquids immediately before bedtime

Stimulus Control

• Go to bed only when sleepy

• Avoid daytime naps

• If you cannot sleep, get out of bed and go to another room—only return to your bed when you feel the need to sleep

• Bed is for sleep and intimacy only (no eating or watching TV in bed)

• Always wake up at the same time each day Relaxation Training

• Reduce somatic arousal (muscle relaxation)

• Reduce mental arousal (attention focusing procedures, imagery training, meditation, etc.)

Biofeedback (use of visual or auditory feedback to reduce tension)

Cognitive Therapy

• Alter beliefs, attitudes, and expectations about sleep

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