Co-morbidities and their treatments should also inform the insomnia diagnosis and its management. Medication associated with increased likelihood of insomnia includes:3,7,13,14,15

·       some antidepressants, especially SSRIs and SNRIs, (although sedation is possible, too)

·       anti-epileptics

·       antihypertensives such as clonidine, beta-blockers or diuretics and some anti-arrhythmics

·       asthma medicines such as salbutamol, salmeterol, terbutaline, theophylline

·       cold remedies such as pseudoephedrine, phenylephrine, phenylpropanolamine

·       stimulants used for narcolepsy or attention deficit hyperactivity disorder

·       corticosteroids.

Alcohol, especially on three or more days a week, caffeine and nicotine can all disturb sleep. The likelihood of insomnia increases with age, but drinking high volumes of alcohol throughout adult life can increase the risk further, especially in older men.3,4,5,16

The possibility of other sleep disorders needs to be considered as well, including:3

·       restless legs syndrome

·       obstructive sleep apnoea

·       narcolepsy

·       circadian rhythm disorders (including jet lag or shift working effects)

·       parasomnias – including nightmares, night terrors, walking or talking during sleep or sleep paralysis.