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Management of sleep complaints in correctional settings 

Management of sleep complaints in correctional settings
Chapter:
Management of sleep complaints in correctional settings
Author(s):

Bernice S. Elger

DOI:
10.1093/med/9780199360574.003.0016
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date: 17 April 2021

Inmates of correctional settings often seek health care for sleep and drug problems. Studies on insomnia in correctional institutions are scarce. Sleep problems among detainees are frequent. Appropriate evaluation and treatment remains a challenge in correctional settings. Correctional health professionals need appropriate education regarding insomnia evaluation and management. Guidelines should be based on the principle of equivalence of care and take into account all evidence from research in the community and in correctional settings. Priority should be given to assessing modifiable causes and contributions to disturbed sleep and to non-pharmacological treatment such as targeted cognitive behavior therapy. Pharmacologically, there is no evidence-based justification to replace short-term pharmacologic management using benzodiazepines with antipsychotics or antidepressants. In correctional settings, prescriptions of antipsychotics and antidepressants for sleep problems can increase risk due to polypharmacy and higher suicide risks. Correctional physicians should monitor and document the evaluation and treatment practice concerning insomnia complaints in order to improve safe, evidence-based treatment. This chapter outlines treatment guidelines for insomnia that apply in community settings and then presents an overview of the clinical and ethical issues of insomnia management in correctional institutions and provides evidence-based recommendations.

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