Managing insomnia in the primary care setting

Primary insomnia is a common condition, occurring at a rate of approximately 10% in its chronic form in the general population. It often starts with a specific problem, such as loss of a job, or a change in sleep patterns, e.g. with childbirth. It is often co-morbid with other psychiatric disturbances where the insomnia predates the other psychiatric symptoms. Advancing age is associated with reduced amount of sleep, reduced sleep efficiency and more awakenings. Women are twice as likely to develop insomnia as men. The condition becomes chronic when perpetuated by the following factors: anxiety about sleep, maladaptive sleep habits, underlying vulnerability in sleep-regulating mechanisms and persistence of the precipitant stressor.