Lowering the dose and administering the medication earlier in the day may attenuate the sleep disturbance. Glucocorticoids – Oral or inhaled glucocorticoids commonly produce insomnia. Sometimes, the sleep disruptive effects of antidepressants are transient, and temporary use of a sedating medication may be indicated to address this side effect. While morning dosing is commonly recommended to mitigate sleep disturbances, it is not clear that this reduces the risk of incident insomnia. Antidepressants – Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with treatment-induced insomnia in approximately 20 percent of patients.Lowering the dose, choosing a shorter-acting agent, and administering the medication earlier in the day may attenuate the sleep disturbance. Many stimulants have effective half-lives greater than 10 hours and can therefore interfere with both sleep onset and sleep maintenance. Stimulants – The major determinants of whether stimulants such as methylphenidate or modafinil will interfere with sleep are dose and effective half-life.Use of medications with the potential to disrupt sleep has been associated with an increased risk of insomnia on a population level and is commonly overlooked as a contributing factor. Medication side effects - Medications used to treat a comorbid condition may themselves precipitate insomnia through stimulation of arousal centers or other central nervous system effects (eg, stimulants, glucocorticoids, some antidepressants), nocturia (eg, diuretics), or respiratory suppression (eg, opioids) ( table 2). Awareness of this history is valuable as it may shed light on etiology and help identify targets of cognitive therapy. A history of childhood trauma or chaotic home environment at night (even in the absence of posttraumatic stress disorder ) may increase vulnerability to sleeplessness as an adult.(See 'Patients with comorbid psychiatric disorders' below.) Psychiatric disorders and insomnia have a bidirectional relationship, and concomitant treatment for both disorders is often necessary to hasten recovery and increase the likelihood of sustained response of both disorders.(See 'Patients with comorbid sleep disorders' below and "Clinical presentation and diagnosis of obstructive sleep apnea in adults", section on 'Diagnostic evaluation'.) Suspected OSA is an indication for in-laboratory polysomnography or home sleep apnea testing.
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