From the Guidelines
For a chronic insomnia sleep medicine consultation, I strongly recommend using a structured interview approach that prioritizes cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment, as supported by the American Academy of Sleep Medicine clinical practice guideline 1. This approach should cover sleep patterns, contributing factors, and treatment history. Begin by introducing yourself and explaining the purpose of the consultation.
- Ask about the patient's chief sleep complaint, including difficulty falling asleep, staying asleep, or waking too early.
- Inquire about the insomnia's duration, frequency, and severity, noting if it occurs at least three nights per week for at least three months (chronic criteria).
- Explore sleep habits by asking about typical bedtime, time to fall asleep, number and duration of awakenings, final wake time, and total sleep time.
- Assess daytime consequences like fatigue, mood changes, concentration problems, and impact on daily functioning.
- Investigate potential contributing factors including medical conditions (pain, respiratory disorders, neurological conditions), medications (stimulants, steroids, certain antidepressants), psychological factors (anxiety, depression, stress), and environmental issues (noise, light, temperature).
- Review sleep hygiene practices and previous treatments tried, including over-the-counter remedies, prescription medications, and behavioral interventions like CBT-I. The American College of Physicians also recommends CBT-I as the initial treatment for chronic insomnia disorder, with a strong recommendation based on moderate-quality evidence 1. This comprehensive approach helps identify the specific insomnia subtype and contributing factors, allowing for targeted treatment recommendations that address the underlying causes rather than just symptom management. It is essential to discuss different CBT-I delivery modalities with patients, considering availability, affordability, treatment format, duration, and patient preferences and values 1. By prioritizing CBT-I and using a structured interview approach, clinicians can provide effective treatment for chronic insomnia disorder, improving patient outcomes and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.