ÎÎPsychological and behavioral therapies are indicated for treatment
of chronic insomnia (Tables 8A, 8B); sustained efficacy has been
demonstrated
ÎÎRole of long-term pharmacological treatment has not been well established
ÎÎIf long-term pharmacological treatment is used, the following principles
should be applied:
>> Most hypnotics have not been approved for this use
>> Patient should be informed of any off-label use
>> Follow-up should be ongoing concerning efficacy and side effects
>> Efforts to identify any contributing medical, psychiatric, or other factors should continue
>> Formal psychological and behavioral therapies should continue
>> Patients should be cautioned about use of OTC medications and herbal/natural remedies
>> No evidence to date that OTC medications have long-term effectiveness greater than
placebo for chronic insomnia
>> Herbal/natural remedies are not regulated and may contain elements that are harmful or
incompatible with accepted therapeutic regimens for insomnia management
Table 1. Sleep History
ÎÎ Complaint/nature of onset/duration/course/frequency/severity
ÎÎ Sleep-wake schedule
ÎÎ Pre-sleep and sleep onset:
>> Pre-bedtime activities (eg, watching TV, reading, working, physical activity/exercise,
snacking)
>> Factors prolonging sleep onset
>> Factors shortening sleep onset
>> Behavior/activity when sleep onset prolonged
>> Use of sleep aids
ÎÎ Nighttime sleep:
>> Number, times, and causes of awakenings
>> Behavior/activity during awakenings
>> Pre-bedtime activities associated with awakenings
ÎÎ Nocturnal disturbances:
>> Respiratory (snoring, sleep apnea)
>> Motor (restless legs syndrome, periodic limb movement disorder)
>> Behavioral disturbance/nocturnal panic/nightmare/headache/GERD
>> Environmental (bed, location, bed partner, sounds, light/darkness, temperature)
ÎÎ Daytime functioning:
>> Drowsiness/sleepiness (frequency, during what activity, under what circumstances,
degree of impairment, napping)*
>> Mood disturbance (eg, alteration of attitude, concentration, attention span)
>> Cognitive disturbances (eg, impaired concentration, difficulty thinking, memory
impairment)
ÎÎ Prior treatment and results
*Presence of significant daytime sleepiness may indicate other sleep disorder.
