Insomnia Insomnia

48 Attarian
Fig. 4. Algorithm. (Used with permission. Courtesy of Primary Care Reports/American
Health Consultants [41].) Abbreviations: PSG, plysomnograph; MSLT, Multiple Sleep Latency
Tests.
and a list of medication the patient is taking is also important because many chemicals,
either pharmaceutical or toxic, can affect sleep and cause insomnia. If the
diagnosis of persistent primary insomnia is made, then sleep diaries are essential in
tailoring treatment to the individual patient’s needs. An actigraph is an essential
tool in primary insomnia; both in providing an objective measure of the true extent
of the insomnia and for gauging response to treatment. In patients with intermittent
situational insomnia, such as Sunday night insomnia, the use of hypnotic medication
as the sole method of treatment is encouraged. This is to prevent the intermittent
insomnia from perpetuating itself through conditioning and poor sleep hygiene
to become persistent and more difficult to treat (Fig. 4 presents an algorithm).