Chronic insomnia is a common condition that affects people worldwide and has negative effects on patients’ health and wellbeing. Patients with comorbid medical and psychiatric conditions are at particularly increased risk, with psychiatric and chronic pain disorders having insomnia rates as high as 50% to 75%.11–13 The risk relationship between insomnia and psychiatric disorders appears to be bidirectional; several studies have also demonstrated an increased risk of psychiatric disorders among individuals with prior insomnia.13 The course of insomnia is often chronic, with studies showing persistence in 50% to 85% of individuals over follow-up intervals of one to several years.14. Although medications can play a valuable role in the management of insomnia, a subset of chronic insomnia patients may have limited or only transient improvement with medication. 2008 Oct 15; 4(5): 487–504.. PMCID: PMC2576317 Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults An American Academy of Sleep Medicine reportSleep199922112833, 10617175, 5 Morgenthaler T, et al.Practice parameters for the psychological and behavioral treatment of insomnia: an update. Frequency of administration of hypnotics depends on the specific clinical presentation; empirical data support both nightly and intermittent (2–5 times per week) administration.49–51 Many clinicians recommend scheduled non-nightly dosing at bedtime as a means of preventing tolerance, dependence, and abuse, although these complications may be less likely with newer BzRA agents. The insomnia history includes evaluation of: The Primary Complaint: Patients with insomnia may complain of difficulty falling asleep, frequent awakenings, difficulty returning to sleep, awakening too early in the morning, or sleep that does not feel restful, refreshing, or restorative. Table 9 describes the key features of ICSD-2 insomnia disorders. Specific BzRAs differ from each other primarily in terms of pharmacokinetic properties, although some agents are relatively more selective than others for specific gamma amino-butyric acid (GABA) receptor subtypes. The latter behavior is of particular significance in that it often is associated with “trying hard” to fall asleep and growing frustration and tension in the face of wakefulness. (Consensus), Sleep diary data should be collected prior to and during the course of active treatment and in the case of relapse or reevaluation in the long-term. Insomnia occurs in individuals of all ages and races, and has been observed across all cultures and countries.8,9 The actual prevalence of insomnia varies according to the stringency of the definition used. 1 American Academy of Sleep MedicineInternational classification of sleep disorders, 2nd ed. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time.
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