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Chapter 94. Insomnia: Assessment and Management of Sleep Disorders

Kimberly A. Hardin, MD, MS, FAASM; Kristina Antonson, MD, PhD; Anne B. McBride, MD; Julie S. Young, MD, MS

  1. Why is it important to understand the regulation of normal sleep?

  2. What are the most common causes of disrupted sleep in hospitalized patients?

  3. What are the consequences of sleep deprivation?

  4. What are the key questions that an examiner should ask when approaching a patient with impaired sleep?

  5. What are nonpharmacologic and pharmacologic modalities for preventing and treating sleep problems in hospitalized patients?

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Case 94-1

A 59-year-old retired school teacher with a history of advanced ovarian cancer has been admitted for community-acquired pneumonia, responding well to appropriate antibiotic treatment. She has lost 10 pounds since her last clinic visit, and she reveals that she is having a difficult time sleeping during the night. Her husband is concerned that she has been “pretty down” recently. How should this problem be addressed?

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Case 94-2

A 48-year-old woman with obesity, hypertension, depression, and asthma, was admitted to the hospital for treatment of an exacerbation of her multiple sclerosis. Her physicians continued her home medications including lisinopril, hydrochlorothiazide, bupropion, and interferon beta. After 48 hours, her weakness improved in response to intravenous high-dose methylprednisolone, but the doctor on call has been called every night for a “sleeper.” The patient stated: “I cannot sleep at all! I feel worse than when I came in! I just feel so anxious; this happens every time I have a flare.” She has also been having trouble staying asleep because she needs to get up multiple times each night to urinate, a nurse interrupted her sleep at 2 am every night to take her blood pressure, and her roommate has been watching TV all night. Although she uses continuous positive airway pressure (CPAP) at home, she forgot to bring the machine to the hospital. What adjustments can be made to improve the sleep of patients like her?

Sleep disruption is a common problem among hospitalized patients. Patients frequently report disturbed sleep not only during their hospital stay but also prior to and after discharge. Approximately one-third of hospitalized patients have insomnia at the time of admission. Additionally, up to 69% of postsurgical patients continue to complain of prolonged sleep problems after hospital discharge. The high prevalence of sleep disturbance among this population warrants clinicians to incorporate the evaluation and treatment of sleep problems as part of routine hospital care. In order to effectively treat sleep complaints, one has to understand the regulation of normal sleep and how various disorders may influence or impair this process. Early recognition and treatment of sleep complaints can improve recovery among hospitalized patients.

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Practice Point
  • Sleep deprivation is associated with physiologic and psychological sequelae that may impair recovery from acute illness. Screening patients for sleep problems is the “new” sixth vital sign.

Even in healthy individuals, partial ...

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