Insomnia

Insomnia is one of the most common complaints reported in primary care.

Diagnosis is made primarily by patient interview. Sleep diaries, actigraphy, and polysomnography may assist in confirming diagnosis.

Identification of the correct etiology is essential, as interventions differ and may be harmful in some cases if the diagnosis is incorrect.

The significant morbidity of insomnia indicates that it is a condition that warrants treatment.

Take an individualized approach to treatment, based on the patient's preferences, the severity of their insomnia, the risks versus benefits of treatment, and the availability of specialist treatment options such as cognitive behavioral therapy.

For most patients, initial treatment with a behavioral therapy such as cognitive behavioral therapy for insomnia (CBT-I) is likely to provide the best balance between efficacy and safety.

As per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR), insomnia disorder is defined as difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. https://www.psychiatry.org/psychiatrists/practice/dsm The resulting sleep disturbance leads to impairment in social, occupational, educational, academic, behavioral, 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-wake disorder.

Definitions vary, but acute insomnia is typically considered to be insomnia lasting less than 4 weeks, occurring in response to an identifiable stressor.[2]Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Feb 15;13(2):307-49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263087 http://www.ncbi.nlm.nih.gov/pubmed/27998379?tool=bestpractice.com [3]American Academy of Sleep Medicine. The International Classification of Sleep Disorders (ICSD-3). 3rd ed. Westchester, IL: American Academy of Sleep Medicine; 2014. Chronic insomnia is typically considered to be insomnia persisting beyond 4 weeks.