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  • Q&A with Australian Health Practitioners

    What investigations should be done to find a possible underlying cause of my insomnia?

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    Insomnia Sleep Medicine
    Good Afternoon

    I have Insomnia, and it started last novemeber I dont know why as I am a happy person whith a job that i love and great relationship with freinds and family.

    I previous had epigastric issues last Aug 2012, with no resolve, however I sleeped perfectly with no. My Doctor put me on diferent types of medication. one irritated my insomnia and made it worse. I just dont have problems I dont sleep all. When I tried my first drug, It made me fall a sleep but made me wake up 10 times a night which did increase my stress.

    I am now on endep and I had being on it as I am part from this stress free and I dont want to be on medicaltion for ever and I get no clarity from my Doctor, what else can I do investigation wise to make sure there is no nevous or sleep disporder involved.

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    Dr David Cunnington

    Respiratory & Sleep Medicine Physician

    Specialist sleep physician delivering a high standard of clinical care to clients with complex sleep problems and promoting sleep health through research, education and advocacy. … View Profile

    Insomnia can often be triggered by acute illness or change in medication. However, once the illness settles or we are no longer on the same medication, poor sleep can persist. This often occurs as we develop a fear of not sleeping which is what makes us continue to sleep poorly. This generally responds well to the psychological treatment - cognitive behavioural therapy (CBT) - of which there is a specific type for insomnia that is very effective. 

    Rather than doing tests or investigations, I would suggest either seeing a psychologist experienced in the management of sleep disorders for CBT, or being assessed clinically at a sleep disorders clinic by either a sleep physician (doctor) or psychologist. 

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    Dr Dick Beatty

    GP (General Practitioner)

    Dr Dick Beatty is a Full Time Vasectomist - operating across locations in South East Queensland, including Greenslopes Private Hospital. View Profile

    That is a good question because often people think of insomnia as just something in its own right (primary insomnia) whereas insomnia often has a cause (secondary insomnia). From the question, you are probably thinking of physical causes but also remember that insomnia may be a reflection of extreme stress, and can be associated with depression, anxiety, hypomania (excessive energy) and other psychological problems. It may not be easy to know which came first - the mood disorder or the insomnia as both are inter-related.

    An “easy” one is too much caffeine. It is surprising how much better people sleep without lots of caffeine, and the less the better; as a coffee drinker, though, I would be realistic and suggest 2 cups of fresh coffee per morning (last cup by 1-2pm) is OK. Alcohol also lessens sleep quality.

    Medications can contribute to insomnia.

    Physical causes may be obvious such as pain from arthritis, getting up at night to pass urine more than a couple of times, hot flushes or night sweats and coughing. Although these seem obvious enough, it's suprising how often people do not associate their arthritis pain or urinary frequency with insomnia.

    Two important and common causes of insomnia are sleep apnoea and movement disorders. Sleep apnoea is something most people have heard of nowadays, and often people have large neck diameters, snore, their partner may notice they stop breathing at night for a few seconds, and people affected are excessively tired in the day time. This is diagnosed by sleep studies.

    An important and commonly overlooked cause is restless legs syndrome and periodic limb movement disorder; despite the fancy names, these are amazingly common and often go hand in hand. Restless legs syndrome often is not felt as restless legs, though, and can feel very different in different people (such as discomfort) but the main feature is that the symptoms in the legs are worse at rest in the evening and relieved by moving around so people may not get off to sleep easily. Periodic limb movement disorder also disrupts sleep and the main feature is involuntary leg movements during sleep, and daytime sleepiness. Both can be treated with medication that is not addictive.

    Finally, reading about sleep hygiene can really help, as poor sleep hygiene can easily be sorted out.

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Adding a bit to what Dr Beatty wrote, "sleep hygiene" is essentially learning good habits in preparation for a good night's sleep - it has certainly helped me. These links might help you:

    http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_hygiene

    http://sleepfoundation.org/ask-the-expert/sleep-hygiene

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