[Patient suffers from insomnia. Proscribing bed rest]. / Patient leidet unter Schlaflosigkeit. Erteilen Sie ihm Bettverbot!

ABSTRACT

Roughly every fifth patient attending the doctor's office complains of insomnia. The first thing that needs to be done is to determine whether a particular patient has primary insomnia of pathological significance, or a temporary disturbance of his/her sense of well-being, or whether the sleep disorder is a secondary consequence of some other somatic or psychiatric condition. For the treatment of insomnia in the doctor's office, a number of basic rules derived from behavioral medicine can be recommended, for example systematic self-observation and record-keeping in a sleep diary, reassurance as to the harmlessness of a temporary sleep problem, practicing relaxation to reduce the general level of activity, reduction of the time spent in bed, and sleep-deprivation treatment. For all of these forms of treatment, a good doctor-patient relationship is mandatory, in particular when--as is to be expected--setbacks occur, which should not be dramatized. A diagnosis-treatment diagram is presented, in which proposals for medication should also be integrated.