A. Situational stress concerning job loss or problems, or an illness in the family often disrupt sleep. Patients under stress may experience interference with sleep onset and early morning awakening. Attempting to sleep in a new place, changes in time zones, or changing bedtimes due to shift work may interfere with sleep. Exercise or overstimulation late in the day may cause insomnia.
B. Drugs associated with insomnia include antihypertensives, caffeine, diuretics, oral contraceptives, phenytoin, selective serotonin reuptake inhibitors, protriptyline, corticosteroids, stimulants, theophylline, and thyroid hormone.
C. Psychiatric disorders. Depression is a common cause of poor sleep, often characterized by early morning awakening. Associated findings include hopelessness, sadness, loss of appetite, and reduced enjoyment of formerly pleasurable activities. Anxiety disorders and substance abuse may cause insomnia.
D. Medical disorders. Prostatism, peptic ulcer, congestive heart failure, and chronic obstructive pulmonary disease may cause insomnia. Pain, nausea, dyspnea, cough, and gastroesophageal reflux may interfere with sleep.
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