What insomnia is
Insomnia is difficulty falling asleep, staying asleep or waking too early, at least three nights a week, with tiredness and impairment during the day. When it lasts more than three months it is considered chronic. The psychiatrist also assesses hypersomnia (excessive sleepiness) and sleep changes linked to depression, anxiety, bipolar disorder and substance use.
Signs and symptoms
- Taking more than half an hour to fall asleep
- Waking several times or too early and not getting back to sleep
- Daytime fatigue, irritability and poor concentration
- Worry about sleep and fear of not sleeping
- Daily use of sleeping pills, sometimes for years
How it is diagnosed
The psychiatrist reviews sleep routine and schedule, screens, caffeine and alcohol, medications and conditions that disturb sleep, such as anxiety, depression, chronic pain and hormonal changes. When sleep apnea, leg movements or other specific disorders are suspected, a sleep study and specialist referral may be advised. A sleep diary helps a great deal.
Treatment
- Cognitive behavioral therapy for insomnia, the first-line treatment for chronic insomnia
- Sleep hygiene and regular schedules
- Treating associated conditions, such as anxiety and depression
- Medication, when indicated, for the shortest time needed
- Gradual tapering of long-term sleeping pills, when that is the patient’s goal
When to see a psychiatrist
When insomnia lasts weeks, affects the day, comes with anxiety or low mood, or when you rely on sleeping pills and would like to review treatment.
Follow-up at the practice
At the practice in Campinas, Dr. Petrus Raulino assesses sleep within the context of mental and physical health and follows progress in person or by video.
Staging: text awaiting medical review by Dr. Petrus before publishing.
This content is for information only and does not replace a medical consultation. Diagnosis and treatment depend on an individual assessment. In crisis or having thoughts of suicide? In Brazil call 188 (CVV, 24 hours, free) or go to the nearest emergency room. In an emergency, call 192 (SAMU).