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Insomnia

Insomnia is the term used to describe inadequate or poor-quality sleep which may be due to one or more of the following: difficulty falling asleep; difficulty staying asleep; waking up too early in the morning and non-refreshing sleep.

How does insomnia affect daytime function?

Insomnia results in unrefreshing sleep and can lead to daytime problems of tiredness, lack of energy, difficulty concentrating and irritability.

Are there different types of insomnia?

Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute (short-term) insomnia.

Chronic insomnia refers to sleep difficulty at least three nights a week for one month or more. Most people with chronic insomnia will NOT be excessively sleepy.

  1. Sleep-onset insomnia is most commonly associated with anxiety. Ensure that a severe delayed sleep phase syndrome (DSPS) is excluded, see Circadian Rhythm Disorders – RefHelp opens a new window Also ensure that sleep hygiene is enforced.
  2. Middle insomnia is generally related to medical issues and illness, including pain, alcohol withdrawal etc.
  3. Late insomnia (sometimes also early morning wakening) is often related to depression.

The Department of Sleep Medicine is not funded to manage insomnia.

If specialist advice is called for, please write a short referral letter to the department via sci-gateway (see under whom to refer)

Please ensure underlying or co-morbid conditions are identified, treated and referred on where necessary.

Who can refer:

Any healthcare professional seeking advice only where the guidelines cited below have been exhausted.

Whom to refer:

For advice only, for extreme cases, advice can be sought by sending a referral letter via Sci-Gateway

Refer to appropriate service depending on what is causing the insomnia if it is not easily managed in primary care, e.g. psychiatric services for severe anxiety/depression, cognitive behavioural therapy, pain service.

Who not to refer:

Do not refer insomnia to the Department of Sleep Medicine.

If a circadian rhythm disorder is suspected e.g. extreme phase delay, then you are welcome to seek further advice on management after the patient has completed a sleep diary for at least one month.  

How to refer:

RIE > Respiratory Sleep > LI Sleep Referral.

A sleep diary opens a new window for a month is essential to include with the referral.

Blood test as per excessive daytime sleepiness guidelines Excessive Daytime Sleepiness – RefHelp opens a new window must be taken, and addressed, if necessary, prior to referral. If referring from out with NHS Lothian the results should be attached to the referral.