Sleep onset Insomnia

Park, Hwan Seok; Joo, Eun Yeon; Hong, Seung Bong

doi:2009.6.2.74

J Korean Sleep Res Soc > Volume 6(2); 2009 > Article

REVIEW ARTICLE

J Korean Sleep Res Soc. 2009;6(2):74-85. doi: https://doi.org/10.13078/jksrs09015

수면 개시 불면증

¹인제대학교 의과대학 부산백병원 신경과학교실
²성균관대학교 의과대학 삼성서울병원 신경과

Sleep onset Insomnia

Hwan Seok Park¹, Eun Yeon Joo², Seung Bong Hong²

¹Department of Neurology, Inje University College of Medicine, Busan, Korea
²Department of Neurology, Sleep Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding Author: Seung Bong Hong ,Tel: +82-2-3410-3592, Fax: +82-2-3410-0052, Email: sbhong@skku.edu

Received: December 13, 2009 Accepted: December 23, 2009 Published online: December 31, 2009

ABSTRACT

Sleep onset insomnia, defined as difficulty initiating asleep, is a common disorder with associated impairment or significant distress and is associated with daytime consequences. Although these sleep onset insomnia has generally been attributed to psychological or psychiatric causes, it can also be secondary to a medical, circardian, or sleep disorder. Usually, many patients have various causes or conditions such as psychophysiological insomnia (PPI), periodic limb movements in sleep (PLMS), restless legs syndrome (RLS), obstructive sleep apnea-hypopnea syndrome (OSAS), congestive heart failure (CHF), delayed sleep phase syndrome (DSPS), etc. These patients are characterized by frequent arousals or failing to get to sleep in the early sleep stage and don’t feel refreshed in the morning. They result in complaints of insomnia or sleep state misperception and have significant decreased daily activities and impaired cognitive functions. For more accurate evaluation, polysomnography (PSG), multiple sleep latency test (MSLT), neuropsychological test (NP test), and suggested Immobilization Test (SIT) can be necessary to these patients. After these studies, the most appropriate treatments are adjusted including sleep hygiene education, cognitive behavior therapy, pharmacologic therapy, continuous positive airway pressure titration, and surgery, etc. These article introduces the clinical approach to the diagnosis and management of the sleep onset insomnia that can be caused by the various possibilities, such as PPI, SSM, PLMS, RLS, DSPS, OSAS, and CHF.