Sleep & Rest: Insomnia & Sleep Apnea

Chronic insomnia is trouble falling or staying asleep at least three nights a week for at least three months, and its first-line treatment is cognitive behavioral therapy for insomnia, not sleep medication. The behavioral rules: wake up at the same time every day, use the bed only for sleep, get up if sleep has not come in about twenty minutes, limit naps, and avoid caffeine in the afternoon and evening, and alcohol, large meals, and screens before bed. Obstructive sleep apnea is repeated collapse of the upper airway during sleep. Listen for loud snoring, pauses in breathing or gasping that a bed partner notices, and daytime sleepiness, especially in a patient who is obese, male, older, or has a large neck. Treatment is nightly CPAP, and the patient brings the home CPAP device to the hospital. After surgery, sleep apnea plus opioids is dangerous, so use continuous pulse oximetry and avoid the supine position. Zolpidem is taken right before bed with seven to eight hours to sleep, never with alcohol, and stopped after any sleep-driving or sleepwalking.