One of the most common complaints reported in primary care. Unmanaged insomnia can cost over US $100 billion each year due to accidents and poor work productivity.
Associated with anxiety, depression, and physical complaints.
Diagnosis is made primarily by patient interview. Sleep diaries, actigraphy, and polysomnography may assist in confirming diagnosis.
Identification of the correct aetiology is essential, as interventions differ and may be harmful in some cases if the diagnosis is incorrect.
Education regarding sleep hygiene techniques is useful to prevent chronic insomnia.
The significant morbidity of insomnia indicates that it is a condition that warrants treatment.
As per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), insomnia is defined as difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality. The resulting sleep disturbance leads to impairment in social, occupational, educational, academic, behavioural, or other important areas of functioning, as well as causing significant distress. Patients experience insomnia even with adequate opportunity to sleep for at least 3 nights per week and for at least 3 months. Insomnia is not explained by the presence of mental disorders or medical conditions and is not associated with another sleep disorder.
History and exam
- female sex
- advanced age
- chronic medical conditions
- chronic pain (e.g., hip impairment)
- psychiatric illness
- alcohol or substance misuse
- stimulant usage
- poor sleep hygiene
- traumatic brain injury
- recent travel across time zones
- night work
- thyroid dysregulation
- participation in elite sport
- sedentary behaviour
Chief, Sleep Disorders Clinical Research Program
Department of Psychiatry
Massachusetts General Hospital
Professor of Psychiatry
Harvard Medical School
JWW has received research support from Merck, American Regent, the Restless Legs Syndrome Foundation, and the NIMH. He has acted as a consultant or received honoraria from Merck, Advance Medical, and UpToDate.
Dr John W. Winkelman would like to gratefully acknowledge Dr Teofilo Lee-Chiong and Dr Vipin Malik, previous contributors to this topic.
Sleep Disorders Center
Thomas Jefferson University Hospital
KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.
Geriatric Psychiatry and Neuropsychiatry
The Johns Hopkins Hospital
CUO declares that he has no competing interests.
Kings Harbor Multicare Center
RG declares that he has no competing interests.
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
CS declares that he has no competing interests.
Melbourne Sleep Disorders Centre
DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.
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