Insomnia Tool Kit

HKC Bottom Line

• Start with good sleep hygiene. A sleep diary helps the patient personalize their sleep strategy. Most people seem to have a specific issue (anxiety, sedentary, caffeine, poor schedule, depression, etc.) that you can make a priority. Medications are helpful, but mostly in the short term. Non-benzodiazepines should be the first choice.

HKC Recommended Article

• CMAJ Review. The Diagnosis and Management of Insomnia in Clinical Practice, a Practical Evidence-Based Approach (2000).

Disease Overview

• CMAJ Review. The Diagnosis and Management of Insomnia in Clinical Practice, a Practical Evidence-Based Approach (2000).

Management and Prescribing Advice

  General

• ICES Informed. Are You Getting Enough zzz's? The Management of Insomnia in Adults (June 2001).
  Excellent overview of managing insomnia
  
  
• ICES. Indications for Referral for Sleep Study (June 2001).
  A quick 1-page reference.
  
  
• AFP. Insomnia: Assessment and Management in Primary Care (June 1999).
  A paper discussing diagnosing, managing and treating insomnia.
  
  
• AAFP. Chronic Insomnia: A Practical Review (1999).
  Good for a comprehensive review although a little more outdated than the ICES or CMAJ review.

  Drug Specific

• Rx Files. Sedative Comparison Chart (Sept 2005).
  Complete with generic & trade name, dose/class, peak levels/onset of action, average half-life, comments, initial and max dose, usual sedative dose, and cost.
  
  
• Rx Files. Benzodiazepine Comparison Chart (Sept 2005).
  Complete with generic & trade name, dose/class, peak level/absorption rate, average half life, active metabolites, comments, initial and max does, usual dose range, and cost.

  Evidence – Based Articles

• American Journal of Psychiatry Online. Comparative Meta-Analysis of Pharmacotherapy and Behavior Therapy for Persistent Insomnia (Jan 2002).
  Drugs or CBT? This meta-analysis would suggest either as similar outcomes were demonstrated in this evaluation. However, since long-term sedative use is not ideal, CBT may be the way to go.
  
  
• AFP. Behavior Therapy compared with Drug Therapy for Insomnia (Sept 1999).
  Additional supporting evidence for non-drug therapy.

Algorithms

• Mental Health Information Center.
  
  
• Best Practice. Sleep Disorders (Apr 2002)

Guidelines

• Prodigy. Insomnia (Jul 2006).
  A very comprehensive website that provides disease assessment and management. Weakness is that British names and prices are used for drugs.

Patient Resources

  Tools

• ICES. Sleep Diary.
  Can be used to identify nature of sleep disturbance, guide treatment and assess the patient's response to therapy.

  Printable Patient Handouts

• Canadian Family Physician. Insomnia, How to Get a Good Night's Sleep.
  Printable, Canadian 1-page brochure on Insomnia.
  
  
• Healthy Ontario. Insomnia.
  Printable, Canadian patient information on insomnia.
  
  
• National Institute of Health. Facts About Insomnia.
  Good, extensive, and printable resource to give your patients.
  
  
• AAFP. Insomia: What to do when you can't sleep. Quick, printable 1-page handout for patients.
  
  
• Getting a Good Night's Sleep (Wellness Module 6)

  Web Based Resources

• National Sleep Foundation
  Helping yourself get a good night's sleep. Web-based resource on non-pharmaceutical tips for sleep.
  
  
• Can't Sleep? Learn About Insomnia. Tips on non-pharmaceutical options.
  
  
• ABC's of Sleep.Web-based information on sleep.

  Drug SpecificIinformation

• AAFP. Melatonin.
  Printable 1-page drug specific information for your patient.
  
  
• NIH. Q & A about Valerian for Insomnia and other sleep disorders.
  Printable, drug specific information for your patient. Quite extensive.
  
  
• National Sleep Foundations. Sleep aids.
  Web-based information on insomnia, hypnotics and other sleep aids.