INSOMNIA

INSOMNIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there dyspnea? If there is a history of dyspnea, heart disease or lung disease should be suspected.
2. Is there a history of drug or alcohol ingestion? There are many drugs that may cause insomnia, including the amphetamines, theophylline, caffeine, anticonvulsants, nicotine, thyroid hormones, and the sympathomimetics. Alcohol may induce sleep, but patients complain of early morning wakening.
3. Is there a history of a painful condition? Abscessed teeth, arthritis, sciatica, bone metastasis, hiatal hernia, and esophagitis are just a few of the conditions that may keep a patient awake because of pain.
4. Are there other psychiatric symptoms? Anxiety, loss of libido, loss of appetite, and depression may be associated with hyperthyroidism, general paresis, organic brain syndrome, chronic anxiety, and endogenous depression.

DIAGNOSTIC WORKUP

Routine studies include a CBC, sedimentation rate, urinalysis and drug screen, chemistry panel, thyroid profile, VDRL test, EKG, and chest x-ray. Arterial blood gases and pulmonary function testing should be done to rule out pulmonary disease. A venous pressure and circulation time will help rule out early congestive heart failure. Blood pressure monitoring can be used to rule out paroxysmal hypertension. If an organic brain syndrome is suspected, a CT scan or MRI of the brain should be done. If psychiatric symptoms are present, the patient should be referred to a psychiatrist. Alternatively, a therapeutic trial of psychotherapeutic agents may be initiated if the patient is not suicidal. When all of the above diagnostic tests are negative, a sleep study must be done. However, home monitors for apnea and oxygen desaturation are available and may be an inexpensive alternative to rule out obstructive sleep apnea.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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