HOW TO TREAT NON-ORGANIC INSOMNIA 2025

HOW TO TREAT NON-ORGANIC INSOMNIA 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 27

NON-ORGANIC INSOMNIA

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 27

NON-ORGANIC INSOMNIA

I. DEFINITION  

Sleep is a natural physiological state recurring on a 24-hour cycle, during which the body rests, perception and consciousness are suspended, muscles relax, and respiratory and circulatory activities slow. A good sleep ensures sufficient quantity, quality, and duration, leaving one refreshed and comfortable physically and mentally upon waking, while restoring bodily functions. Non-organic insomnia is a sleep disorder tied to psychogenic factors, characterized by predominant complaints about inadequate sleep quantity, quality, or duration compared to a normal sleep pattern.

II. ETIOLOGY  

– Primarily linked to psychosocial factors, with emotional causes being the foremost and foundational trigger.

III. DIAGNOSIS  

1. Definitive Diagnosis (ICD-10)  

1.1. Clinical Features  

– Complaints of difficulty falling asleep, maintaining sleep, or non-restorative sleep.  

– Sleep disturbance occurs at least three times per week for at least one month.  

– Significant distress or impairment in daily personal functioning due to sleep disruption.  

– No organic cause (e.g., neurological or medical condition), substance use disorder, or medication effect identified.

1.2. Ancillary Testing  

– Basic Labs:  

  – Blood: Hematology, biochemistry, microbiology (HIV, HBV, HCV).  

  – Thyroid, sex, and growth hormone levels (to assess consequences).  

  – Urine: General analysis, drug screening, syphilis serology.  

– Imaging/Functional Tests:  

  – Chest X-ray, abdominal ultrasound, transcranial Doppler, thyroid ultrasound.  

  – EEG, ECG, cerebral blood flow, polysomnography, CT/MRI brain (select cases).  

– Psychological Assessments:  

  – Depression scales: Beck, Hamilton, GDS, PHQ-9.  

  – Personality: MMPI, EPI.  

  – Pittsburgh Sleep Quality Index (PSQI).  

  – Anxiety scales: Zung, Hamilton, DASS.  

– Monitoring Tests:  

  – Metabolic effects: Blood glucose, lipids (cholesterol, triglycerides, LDL, HDL) every 3 months.  

  – Leukopenia: Complete blood count monthly.  

  – Liver, kidney function, ECG every 3 months.  

– Collaboration: Coordinate with other specialties for additional differential testing if needed.

2. Differential Diagnosis  

– Distinguish from insomnia due to organic causes (e.g., neurological or medical conditions) or substance/medication-related disorders.

IV. TREATMENT  

1. Treatment Principles  

– Non-organic insomnia is predominantly psychogenic, with emotional disturbances as the primary factor. Treatment thus comprises two main approaches—psychological (cognitive-behavioral) and pharmacological—which can be combined.  

– Drug Selection Principles:  

  – Prefer monotherapy; combine an antidepressant and antipsychotic if ineffective.  

  – Start with low doses, titrate gradually to efficacy.  

  – Limit use of addictive anxiolytics.

2. Treatment Framework  

– Combine pharmacotherapy with psychotherapy.  

– Treat until symptoms improve, then maintain for at least 6 months for stability.  

– Some patients may require longer or lifelong treatment to prevent relapse.

3. Specific Treatments  

3.1. Psychotherapy  

– Focus on educating patients about good sleep hygiene:  

  – Go to bed only when sleepy.  

  – Maintain consistent sleep and wake times.  

  – Wake up at the same time every morning, regardless of prior sleep duration.  

  – Avoid coffee and tobacco, especially in the evening.  

  – Establish a daily exercise routine.  

  – Avoid alcohol, as it disrupts sleep-wake rhythms.  

  – Practice relaxation techniques.

3.2. Pharmacotherapy  

– Tailor drug choice and dosage to the individual.  

– Use sedatives, anxiolytics, and antidepressants, given insomnia’s close ties to anxiety and depression.  

– Antidepressants: 1-3 agents:  

  – TCAs: Amitriptyline (25-200 mg/day), Clomipramine (50-100 mg/day), Imipramine (150-300 mg/day).  

  – SSRIs: Sertraline (50-300 mg/day), Fluoxetine (20-60 mg/day), Fluvoxamine (50-100 mg/day), Citalopram (20-60 mg/day), Escitalopram (10-20 mg/day), Paroxetine (20-80 mg/day).  

  – SNRIs: Venlafaxine (37.5-225 mg/day), Duloxetine (40-120 mg/day).  

  – NaSSAs: Mirtazapine (15-60 mg/day).  

  – Dopamine-Norepinephrine Reuptake Inhibitors: Bupropion (75-450 mg/day).  

  – Other: Tianeptine (variable efficacy).  

– Antipsychotics: 1-3 agents:  

  – Haloperidol (5-30 mg/day), Chlorpromazine (25-500 mg/day), Levomepromazine (25-500 mg/day), Sulpiride (25-200 mg/day), Risperidone (1-10 mg/day), Olanzapine (5-30 mg/day), Quetiapine (50-800 mg/day), Clozapine (25-900 mg/day), Aripiprazole (5-30 mg/day).  

– Benzodiazepines: 1 agent (rapid anxiety relief but risk dependence):  

  – Diazepam (5-30 mg/day), Lorazepam (1-4 mg/day), Clonazepam (1-8 mg/day), Bromazepam (3-6 mg/day).  

– Other Anxiolytics/Sedatives: Etifoxine, Grandaxin, Zopiclone, Eszopiclone, Melatonin, Hydroxyzine (10-300 mg/day), Propranolol (start 10 mg twice daily, max 80-160 mg/day).  

– Adjunctive: Neuroprotectants (piracetam, citicoline, ginkgo biloba, vinpocetine, choline alfoscerate, cinnarizine, nicergoline), vitamins/minerals, digestible diet (soft, high-fiber, fruits), hydration, IV nutrition if needed.

V. PROGNOSIS AND COMPLICATIONS  

– Complications to Prevent:  

  – Delayed detection/treatment may lead to anxiety and depression.  

  – Anxiolytic misuse causing dependence.

VI. PREVENTION  

– Avoid intense psychological stress in daily life.  

– Proactively address personal psychological traumas that could trigger emotional, anxiety, depressive, or stress-related disorders.  

– Detect and treat psychogenic causes of sleep disruption early.  

– Establish a balanced, scientific routine for work, rest, and exercise.  

– Avoid overwork and use of central nervous system stimulants or medications.

REFERENCES

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English

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