Abstract
Insomnia is characterized by difficulty falling asleep or staying asleep, with consequent
daytime impairment of mental and/or physical function. A detailed clinical history
reveals the relative impact of a variety of different contributing and perpetuating
factors, which then informs prioritization among different treatment options. Nonpharmacological
approaches, especially the validated approach of cognitive–behavioral therapy for
insomnia, are preferred over hypnotic medications. If hypnotics are chosen, the goal
is short-term interventions after a careful risk-benefit assessment and shared decision-making
with the patient. Although objective testing via polysomnography is not routinely
indicated, such investigations can be informative in those at risk for concurrent
primary sleep disorders, and in those who are treatment refractory. Circadian rhythm
disorders can present with insomnia complaints, but are managed with chronotherapy.
Whatever management pathway is pursued, the response to therapy should be anchored
in improvements in daytime function.
Keywords
insomnia - hypnotic - phenotyping - polysomnography - cognitive–behavioral therapy
