Insomnia

Introduction
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By David E McCarty MD and Andrew L Chesson Jr MD

Nearly everyone suffers from an occasional night of poor sleep. For many, that occasional problem can become persistent and bothersome and can cause us to struggle as we attempt to optimize our daily lives. Despite better insomnia classification and recent evidence-based clinical guidelines, some evidence suggests that current classification systems do not fully capture the range of subjective sleep complaints. Recent research has focused on evaluating existing treatments for patients with primary insomnia. With the growing evidence base for nonpharmacological interventions for insomnia, recent studies have also aimed to evaluate the efficacy of these interventions in a broader range of patient populations.

Key points

  • Current diagnostic classification systems may not capture the full range of subjective sleep complaints.
  • Compared to pharmacotherapy, cognitive behavioral therapy for insomnia is equally efficacious in the short term and has more durable effects.
  • Nonpharmacological treatments for insomnia are efficacious in treating insomnia that is comorbid with other medical and psychiatric conditions.
  • The choice of pharmacologic agents should be directed by symptom pattern, treatment goals, past treatment responses, patient preference, cost, availability of other treatments, comorbid conditions, contraindications, and side effects.