Insomnia Disease Summary

Overview

Insomnia affects about 10% of adults. The definition of insomnia and its prevalence can be found in the Introduction and Epidemiology sections.

The Pathophysiology and Risk Factors sections provide a detailed discussion on the risks, factors and processes involved in the development of insomnia in individuals.

The differences between short-term and chronic insomnia are identified and explained in the Classification section. 

History and Physical Examination

Factors to look into such as the patient’s sleep history, physical symptoms as well as screening tests (eg Insomnia Severity Index, Pittsburgh Sleep Quality Index, Morningness-Eveningness Questionnaire) to be done in patients suspected to have insomnia are in the History section. 

Diagnosis

DSM-5 criteria is used to diagnose patients with insomnia. The parameters required to fulfill a DSM-5-based diagnosis is in the Diagnosis or Diagnostic Criteria section.

The Screening section enumerates the significance of polysomnography and its use in the diagnosis of insomnia.

Tests that may be conducted to identify patient comorbidities are enumerated in the Laboratory Tests and Ancillaries section.

Medical, substance use, and/or behavioral factors listed in the Differential Diagnosis section should be ruled out to diagnose insomnia.

Management

There are common medical disorders, comorbid psychiatric disorders, and medications that are associated with insomnia, and they are all enumerated in the Evaluation section.

Clinicians should set treatment goals and rely on clinical judgement when treating insomnia in the presence of comorbidities. Primary treatment goals and other factors to be considered in managing patients with insomnia is in the Principles of Therapy section.

Insomnia clinically improves with Nonpharmacological alone or in combination with Pharmacological therapy.

The different types of cognitive therapy that can be done to clinically improve insomnia are discussed in detail in the Nonpharmacological section. Adjuvant drug therapies such as benzodiazepines, nonbenzodiazepine hypnotics, dual orexin receptor antagonists and other agents to be considered are then enumerated and discussed in the section of Pharmacological therapy.

Things to be noted during patient follow-up are in the Monitoring section.