From the Guidelines
Diagnosis and Treatment of Insomnia
Insomnia is a prevalent sleep disorder that requires a comprehensive diagnostic approach and a multifaceted treatment plan. Diagnosis involves a detailed sleep history, physical examination, and assessment of sleep patterns using tools such as sleep diaries or actigraphy 1. The diagnostic criteria for insomnia disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), include difficulty with sleep initiation, difficulty maintaining sleep, or early-morning waking, causing clinically significant distress or impairment, and occurring at least 3 nights per week for at least 3 months 1.
Treatment Options
Treatment of insomnia typically involves a combination of non-pharmacological and pharmacological interventions. Cognitive-behavioral therapy for insomnia (CBT-I) is a first-line recommendation for the treatment of insomnia disorder, as it has been shown to be effective in improving sleep quality and reducing symptoms of insomnia 1. CBT-I is a multimodal cognitive behavioral therapy that targets specific sleep-related beliefs and behaviors, and can be delivered in-person, via telephone, or through online modules.
Pharmacological Interventions
For pharmacological treatment, medications such as zolpidem (5-10mg, 1-2 weeks) or eszopiclone (1-3mg, 1-2 weeks) may be prescribed for short-term use, while ramelteon (8mg, 1-2 weeks) or melatonin (0.5-5mg, 1-3 months) may be considered for longer-term management 1. However, pharmacological interventions should be used judiciously and with caution, as they can have potential side effects and risks.
Key Points
- Insomnia diagnosis requires a comprehensive clinical evaluation, including a detailed sleep history and assessment of sleep patterns.
- CBT-I is a first-line recommendation for the treatment of insomnia disorder.
- Pharmacological interventions, such as zolpidem, eszopiclone, ramelteon, and melatonin, may be used for short-term or longer-term management of insomnia.
- Treatment goals include improving sleep quality, reducing symptoms of insomnia, and enhancing overall quality of life.
From the Research
Diagnostic Criteria for Insomnia
- Insomnia is characterized as a subjective complaint of poor sleep quality or quantity despite adequate time for sleep, resulting in daytime fatigue, irritability, and decreased concentration 2
- Insomnia can be classified as idiopathic or comorbid, with comorbid insomnias associated with psychiatric disorders, medical disorders, substance abuse, and specific sleep disorders 2
- The duration of insomnia symptoms can be categorized as acute (lasting from one night to a few weeks) or chronic (lasting at least three nights weekly for at least one month) 2
- Diagnostic tools for identifying insomnia are multifactorial and may include clinical interviews, sleep questionnaires, and sleep diaries 2, 3, 4
Treatment Options for Insomnia
- Nonpharmacologic interventions for insomnia include sleep-hygiene education, stimulus-control therapy, relaxation therapy, and sleep-restriction therapy 2
- Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia in adults of any age 3, 4, 5, 6
- Pharmacologic therapies for insomnia may include benzodiazepines, benzodiazepine-receptor agonists, melatonin-receptor agonists, and antidepressants, with the choice of agent depending on patient-specific factors 2, 3, 4
- Other treatment options, such as light therapy and exercise, may be useful as adjunct therapies to CBT-I 3, 4
- Digital CBT-I may assist in the delivery of treatment and improve access to care 5, 6