Insomnia: A Practical Review

Insomnia has two components: the subjective complaint of trouble sleeping and a perceived daytime consequence of the nocturnal problem. The prevalence of insomnia in the general population is high, and the problem increases with increasing age. Psychiatrists usually encounter insomnia complaints that result from either comorbid mental illness or a side effect of pharmacotherapy. Clinicians should be aware of the multiple non-psychiatric causes of insomnia and be familiar with common primary sleep disorders. Obtaining a medical and sleep history is a critical first step in securing a diagnosis. Polysomnographic measurements, although not always necessary, provide definitive information that will assist in diagnosing sleep disorders. When the diagnosis requires monitoring the patient in a sleep laboratory, the clinician may choose to consult a sleep specialist. In general, drug therapy is recommended only as an adjunctive measure and on a short-term basis. Treatment should be directed at the underlying condition, management of stress, and improvement of sleep hygiene. This review, with case examples, highlights some common etiologies of insomnia, outlines both pharmaeologic and nonpharmacologic treatment options, and discusses when to refer potential sleep disorder cases to a specialist.