How to Evaluate and Treat SLEEP PROBLEMS and INSOMNIA? - A Quick Guide | Psychiatrist Explains

In this video, Dr Sanil Rege, Consultant Psychiatrist, explains the evaluation of sleep difficulties using a practical algorithm.
#sleep #sleepdisorder #insomnia #obstructivesleepapnea #restlesslegs #remsleep
Insomnia is defined as an ongoing subjective dissatisfaction with the duration or quality of sleep.
Sleep difficulties do not always equate to insomnia. In order for insomnia to be diagnosed - other causes should be ruled out.
0:00 - Introduction
0:25 - Definition of insomnia
1:24 - Nature of insomnia
2:12 - Sleep habits
3:00 - Stimuli affecting sleep
3:39 - Sleep restriction
4:19 - Types of Insomnia
4:39 - Principles in the management of Insomnia - Pharmacological and Non-Pharmacological
7:26 - Specific Types of medications for Insomnia

According to the DSM-V, the following are the key criteria for insomnia:

Predominant complaints of dissatisfaction with sleep quantity or quality associated with difficulty initiating sleep, difficulty maintaining sleep and early morning awakening with an inability to return to sleep.
The sleep difficulty occurs at least three nights per week, and the difficulty is present for at least three months.

Sleep difficulties may be due to :
1. Stress
2. Travel
3. Poor sleep hygiene
4. Medications or use of substances
5. Psychiatric disorders - ADHD, PTSD, depression, agitation etc
5. Sleep disorders - Obstructive sleep apnoea, Restless Legs Syndrome (RLS), REM sleep behaviour disorder
5. Narcolepsy

Thus it is important to evaluate the causes and the associated factors in order to devise an appropriate treatment plan.
Treatment consists of treating the causes
e.g. OSA - CPAP
RLS - treating iron deficiency, MG supplement, Dopamine agonists
PTSD nightmares - clonidine or prazosin
Psychophysiological insomnia - Sleep hygiene, sleep restriction, stimulus control
CBT-insomnia

Medications
Benzodiazepines
Z drugs - Zopiclone, zolpidem
Orexin antagonists - Lemborexant or suvorexant
Treating psychiatric disorders

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👋 LET’S CONNECT!

[AndrogenReceptor]

I love fluvoxamine because it works great for anxiety, however, my sleep has been affected in a negative light. Does insomnia or sleep disturbance from SSRI’s go away with time? I plan on using fluvoxamine for life because I can’t go back to the hell that is anxiety and OCD. Thank you for all the videos you put out ❤️

[Victoria-hzgx]

Thanks. So informative I wish you could help me and my son. Love from Scotland 🏴󠁧󠁢󠁳󠁣󠁴󠁿 x

[Huero]

My sleep was fine up until around 2 months ago. I had a prescription for Remeron that was supposed to be for sleep. I had rarely used it every few months and when I did it was no more than 7.5mg. In October I started taking it consecutively for around 10 days and my life completely turned around for the worst. Severe agitation, insomnia, heart always racing etc. The psychiatrist said that's not possible, probably to cover for herself when it comes to liability. I had the same experience when I took prednisone for 5 days back in 2014, it took 6 months to recover. Psychiatrists may offer a lot of help to people, but these drugs can also wreck your life as well.

[fooqi]

Dear Dr. Sanil. I'm taking Effexor XR 150mg since last 8 years. It's no more available in my country, I don't want to switch to generic. Can I abruptly stop it and switch to Prozac ? Will I still have withdrawals ?

[petermwariri]

Great video. I have been learning a lot from Dr. Rege

[PS]

Great Video. After getting off Cymbalta have insomnia. SO bad that I have to now be on Klonopin. Why did Cymbalta create insomnia. Was on lowest 20mg dose.

[seasidepatio]

I work as a psych provider in the US and after being diagnosed with fluoroquinolone poisoning from ciprofloxacin I barely sleep even with heavy doses of eszopiclone going on for 4 months like 2-3 hours a night. It’s a nightmare. I never used to have a problem with sleep. I’ve never encountered it in practice, but it’s unreal. I’ve talked to the FDA about updating the black box warning in the US and adding to REMS. I later found out they’re NMDA agonists and GABA antagonists. Basically ruined my life and can barely practice medicine anymore. Hoping I can recover at some point.

[rovid]

This may sound stupid but it has worked for me on several occasions, but may not work for others. If you have a dream, it doesn’t matter how weird it is, try to remember it, or write it down. When you go to bed the next night, and when it’s quiet, close your eyes and think of the dream you had the night before. I don’t know what happens, but maybe the brain thinks “let’s continue on with the dream” and after a while, off you go to sleep and dream part of the same dream you had the night before and continue on sleeping. Just a suggestion you might try.

[veritasbutnotthatone]

For me it’s waking up around 3 times a night every night. It’s to the point now where I don’t even bother trying to sleep at night. And when I was younger I’d wake up at 3 o clock on the dot every single night. No idea why but it’s always happened

[entertainmenteducavlogs]

Sir
I have a urgent question
Sir I haven't slept from last 2 days
Sir I am suffering from OCD, Somatoform disorder, Schizotypal personality traits., hallucination, delusion
I am currently on Fluvoxamine and Aripiprajole.
Sir Can I take Plant based Gaba supplement with SSRI Fluvoxamine and Aripiprajole? Is plant based gaba safe to take?
I shall be very grateful to you

[anyanwustanley]

Nice video. I took Cappuccino coffee for the first time late in the night around 12am without knowing the effects. I couldn't sleep again for days, on the 4th day I took Amitriptilin 25mg for 2 days and 10mg on 3rd day. I stopped when I discovered it was not helping me to sleep. I only have insomnia and mild tremor as symptoms. Can it wear off on its own?

[anushkadnanayakkara]

Hi Dr Sanil. Very interesting and helpful all your videos. I got got few questions to ask about one of my close friends. The person got mental breakdown in April. Doctor prescribed Mitrazapine 15mg. All symptoms disappeared and was OK for about two weeks and relapse the condition in May. Then Doctor prescribed Ariprozole 10mg and Mitrazapine 30mg. June and July this person was behaving like robot. However now I can see much improvement. Now this person going to gym and cycling 3 days per week. This person always says don't feel very natural sleep (but getting enough sleep), can't laugh or no sense to do things. Something not right. Eventually will this person be normal?

[kintalivenkatarao]

Hi Sir, If i do head bath with cold water or if i sit under A.C (air conditioner) i am not gettling sleep . Max i will sleep 1 hr and later will get wakeup and not able to sleep . Even no feel to sleep . If i do head bath with hot water or no A.C then i will sleep 6 or 7 hrs . Could you please what is the problem which doctor should i consult ? is this allegric reaction . i have visited neurologist and ENT .Did CT scan and doctor told no issues in reports . Could you please suggest me which doctor should i consult .

[elodyferreiro]

My insomnia started almost 4yrs ago Unsurprisingly depression came along soon after insomnia was present. I’m a single mom of an 3, 5yrs old, my psychiatrist prescribed me mirtazapin. Starting 15mg, than 7, 5mg than just a Tipp of it, cause unfortunately it crashes me in such a deep sleep, that when waking up I feel like “drunk” as if my body was awake but my brain is still on sleep mode. So for me it turned out to be to strong. Especially while being responsible for a small child, work, and so on. Also tried Zolpidem same results.

could you suggest something that doesn’t effect being so druzzy ? That helps you sleep but able to wake up with energy? Any other solution I could talk about to my psychiatrist. I really want to get out of this loop 😔

[Idmoment]

Do you know whether the DORA-orexin antagonists are very helpful for insomnia? Are they more effective than zolpidem? Mini patients of mine have developed a tolerance to the 5 mg zolpidem and are asking for the 10 mg dosing- i’ve never prescribed the DORAs nor have I met anyone that has taken them- I’d really like to hear more about efficacy in the real world

[SABBIRK]

Hi please help

I'm 26 years old guy who gone through major depression and anxiety last year. My doctor prescribed me "Remeron 15 mg+ sertraline 50 mg+ Clopramin 25.

I'm taking these medication

Note that before take those medication also dream everynight. I have been facing this for 1.5 years everything okay except Sleep. Cause i have meaningless dream every night which made me tired and effect my temper.
And day time if i feel sleepy i go to bed but i can not sleep. I get shivering in my body and wake up.

How to solve this please help.

[pritamshil]

Sir, where does the human brain store visual long term memory of shapes ?

[fallon]

I have PTSD from a serious fall and traumatic event of falling down several flights of stairs. Does CBD help 🤔

[Amritpalsingh-mckx]

I've struggled with insomnia for years, and Planet Ayurveda's insomnia care pack has been such a relief. Highly recommend!"

[johnmitchell]

What about people suffering chronic pain or any kind of pain🤫🤔 if you were any kind of a specialist in sleep issues I would think you would have at least mention it🤣😴