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Chronic Insomnia / Insomnia Disorder

Symptoms & Clinical Presentation

Insomnia disorder is characterised by self-reported so-called ‘Difficulties Initiating and/or Maintaining Sleep’ (DIMS).

Insomnia disorder includes:

  • Difficulty initiating sleep defined by sleep latency (time taken to fall asleep >30 min)
  • Difficulty maintaining sleep (wake periods >30 min) and unable to fall back to sleep
  • Early waking (termination of sleep >30 minutes before desired wake time) and unable to fall back to sleep

The insomnia disorder’s difficulty falling and/or staying asleep including waking too early is:

  • Present for at least 3 nights per week for 3 months or more
  • Occurs despite adequate opportunity for sleep
  • Causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of daytime functioning (see daytime symptoms below)

The clinical presentation of insomnia disorder includes night-time and daytime symptoms which are present for at least 3 nights per week for 3 months.

Night-time symptoms

  • Self-reported frequent difficulties falling asleep at the start of the night
  • Awakenings during the night with difficulties returning to sleep
  • Early morning awakenings with difficulties returning to sleep

Daytime symptoms

  • Fatigue
  • Irritability
  • Anxiety
  • Stress
  • Concerns and worries
  • Impaired attention, concentration and memory
  • Mood disturbance
  • Headaches
  • Pervasive malaise
  • Gastrointestinal symptoms
  • Deterioration in work performance
  • Low libido

Clinical presentation:

  • Impaired daytime functioning and feeling symptoms motivate many patients to seek treatment for insomnia
  • Presenting symptoms may include self-reported tiredness, fatigue, sleepiness, or general sleeping difficulties
  • Patients requesting sleeping pills, or those with previous sedative-hypnotic prescriptions could be investigated for insomnia

AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset