Chronic Insomnia Diagnosis and Management

A comprehensive, multifaceted approach is essential in managing chronic insomnia. The initial step involves obtaining a detailed sleep history to understand the patient’s sleep patterns, including bedtime, wake time, sleep latency, and nighttime awakenings. Particular attention is paid to what the patient does during periods of wakefulness—whether they stay in bed, use electronic devices, or watch television—as these behaviors can contribute to ongoing sleep disturbances. Evaluating how long the patient has been experiencing symptoms and the amount of time spent in bed each night helps inform the choice of intervention strategies.

Both pharmacologic and nonpharmacologic treatments are utilized, with an emphasis on identifying and managing any coexisting sleep disorders. A sleep study is often performed early in the assessment to rule out or diagnose comorbid conditions that might be impacting sleep quality. Nonpharmacologic therapy plays a central role, especially cognitive behavioral therapy for insomnia (CBT-I), which is recommended for most patients. This evidence-based treatment targets the thoughts and behaviors that perpetuate insomnia and is considered a first-line intervention.

When medication is indicated, treatment typically involves the use of FDA-approved pharmacologic options. These may include benzodiazepine receptor agonists or newer agents such as dual orexin receptor antagonists, depending on the patient’s needs and medical profile. Pharmacologic treatments are generally used alongside behavioral therapies rather than as standalone solutions. This integrated approach, combining behavioral modification with appropriate pharmacotherapy, aims to address both the symptoms and underlying causes of insomnia, leading to more effective and sustainable outcomes.