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→ Primary/psychophysiologic vs. comorbid
→ Depression or anxiety
→ Long term conditions: pain, respiratory, cancer, neurodegenerative
→ Drugs: hypnotic-dependent, other medication/drugs
→ Specific sleep disorders
→ Sleep apnoea: snoring, excessive daytime sleepiness, 50% are obese and/or collar size 17+
Individuals who have difficulty initiating and maintaining sleep can be classified as having either primary or cormorbid insomnia. Primary insomnia is sleeplessness that is not associated with another medical or psychological condition. This could arise as a result of prolonged periods of stress, abnormality in the neurological control of sleep-wake cycle involving areas of the brain responsible for wakefulness and sleep or due to the individual complaining of insomnia without any objective evidence of any sleep disturbance. For comorbid insomnia, the individual’s sleep problems are associated with other health conditions (depression, cancer, arthritis), chronic pain, medication or a substance abuse e.g. alcohol.
Primary insomnia may not necessarily require drug treatment and could be managed by patient focused therapy involving careful assessment and cognitive behavioural therapy for insomnia. Comorbid insomnia may require treatment of the associated condition, e.g. pain or depression, but there is good evidence that these will also respond to psychological therapy. Treatment of comorbid insomnia therefore involves treating the underlying health condition that is causing the insomnia but also using CBTi.