Overcoming Difficulties in the Care Paradigm for Insomnia: Ashgan Elshinawy, DO

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"This drug, even though it works for so many of my patients, may not work for you, so don’t get frustrated—there are other medications we can try. It’s their impatience, their eagerness, their anxiety [which drives that frustration].”

Insomnia is a sleep disorder characterized by persistent difficulty with sleep onset, maintenance, consolidation, or quality. Treating insomnia typically involves sleep-inducing medication, cognitive behavioral therapy for insomnia (CBT-I), or a combination of both methods. Although there is no gold standard treatment for insomnia, positive lifestyle changes such as changing sleep area or schedule, avoiding big meals and alcohol before bed, and staying active, may alleviate symptoms.

If approaches such as stimulus control, relaxation techniques, and other CBT-I methods are ineffective, patients can turn to therapeutic options such as benzodiazepines, nonbenzodiazepines, melatonin agonists, orexin receptor antagonists, off-label treatments such as antidepressants and antipsychotics, and over-the counter medications. Ashgan A. Elshinawy, DO, a pulmonologist at Penn Medicine, believes the most important aspect of care is patience, from both the clinician and patient perspectives.

In an interview with NeurologyLive^®, Elshinawy discussed some of the challenging aspects to caring for patients with insomnia, as well as the biggest priorities with improving the paradigm for the future. She stressed the need to treat patients holistically and cater their sleeping plans to what they feel can provides them with enough functional ability.