Insomnia

Insomnia is characterized by dissatisfaction with sleep amount or quality and resulting daytime impairment. Insomnia is a common sleep disorder, particularly among older adults, and is often comorbid with other medical and psychiatric conditions. Psychological factors play a critical role in onset and maintenance of chronic insomnia, such that cognitions and behaviors that occur in response to difficulty sleeping inadvertently condition arousal when attempting to sleep. In most cases, assessment of insomnia in clinical settings occurs via interview and self-monitoring using daily sleep diaries. The most well-established interventions for insomnia include cognitive behavioral therapy for insomnia (CBT-I) and the non-benzodiazepine hypnotic medications. CBT-I focuses on altering behaviors and cognitions that maintain insomnia using stimulus control and sleep restriction, among other strategies. CBT-I is considered the initial treatment of choice due to its strong efficacy and lower risk of adverse events as compared with pharmacotherapy.