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Methodology
The Team
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Adult Insomnia, Acute
Adult Insomnia, Acute
Diagnosis
Medication
Recommendation
Does insomnia result from physiologic or psychologic stress, recent onset?
Yes
No
Is there concern for sleep apnea or nocturnal hypoxia due to cardiopulmonary disease?
Yes
No
Does patient have comorbid psychiatric disorder(s)?
Yes
No
Does the patient suffer from sleep-onset insomnia or sleep-maintenance insomnia?
Sleep-onset insomnia
Sleep-maintenance insomnia
X
No
Yes
Yes
No
Yes
No
Yes
No
Yes
No
Acute Insomnia
Does insomnia
result from physiologic
or psychologic stress,
recent onset?
Expand differential diagnosis;
see chronic insomnia decision support
Is there concern for sleep apnea
or nocturnal hypoxia due
to cardiopulmonary disease?
Refer for
polysomnography
Does patient have comorbid
psychiatric disorder(s)?
Treat psychiatric disorder and
insomnia concurrently
(see appropriate decision support)
Review sleep hygiene and
stimulus control along with
other, appropriate non
pharmacologic treatments
SOR A
Insomnia resolved?
Monitor for recurrence
Sleep-maintenance insomnia
Treat 2-4 weeks then
follow up
Insomnia resolved?
Reevaluate diagnosis and
refer to chronic insomnia
decision support if symptoms
persist beyond three months
Discuss tenets of CBT-I;
taper medication
Eszopiclone
Doxepin
Trazodone
Zolpidem ER
Sleep-onset insomnia
Eszopiclone
Zolpidem
Trazodone
Pharmacologic treatment based
on phase of sleep affected
SOR B