Key Points
Definition
ÎÎChronic insomnia is a complaint of difficulty initiating or maintaining sleep
or of non-restorative sleep that:
>> Occurs despite adequate opportunity and circumstances for sleep
>> Lasts for at least 1 month
>> Causes clinically significant distress or impairment of social, occupational, or other areas
of function
Evaluation
ÎΕ Obtain sleep history (Table 1) and sleep log (Table 2)
>> Fundamental to assessment of presenting insomnia complaint
>> Principal diagnostic tools
ÎÎPolysomnography and the Multiple Sleep Latency Test should not be
routinely used in assessment of insomnia
ÎÎMajor indication for polysomnography is a reasonable clinical suspicion of
sleep disorders such as sleep apnea, periodic limb movement disorder, or
narcolepsy
Formulation
ÎΕ Identify:
>> Associated medical condition (Table 3) or psychiatric disorder (Table 4) that may
contribute to insomnia
>> Contributing substances (eg, prescription/OTC medications, substances of abuse)
(Table 5)
>> Insomnia-perpetuating cognitive and behavioral patterns (Table 6)
>> Primary sleep disorders (eg, sleep apnea, periodic limb movement disorder, restless legs
syndrome, narcolepsy); polysomnography may be indicated, especially for suspected sleep
apnea
>> Sleep-wake schedule disturbances (eg, delayed or advanced sleep phase, irregular/shift
work)
Management
ÎÎTreat any medical, mental, or other factors that may contribute to or
exacerbate insomnia (Tables 3, 4, 5)
ÎÎTreat primary sleep disorders
ÎÎAdvise proper sleep hygiene
ÎÎJudicious use of hypnotic medication may be indicated for short-term relief
of insomnia symptoms (Table 7). Instructions are necessary concerning side
effects, follow-up for efficacy, discontinuation
