Management of Insomnia

The general physician is the most appropriate person to evaluate and treat patients presenting with the complaint of insomnia. However, there has recently been an overemphasis on the need for patients to be evaluated in sleep disorders clinics, particularly in their sleep laboratories. These sleep laboratory evaluations are expensive and time consuming, and often con­ tribute only minimally to the overall management of the insomniac patient. In fact, they may even detract from the comprehensive psychiatric, neuro­ logical, pharmacological, and general medical approac:h that is necessary for the effective management of insomnia. The primary goal of sleep disor­ ders clinics and their staff should be to supplement and enhance the general physician's ability to evaluate and treat patients with sleep disorders, partic­ ularly insomnia, the most common sleep disorder (1). This review is de­ signed to strengthen the physician's ability to more rationally and effectively evaluate and treat the condition of insomnia in his office practice. Thus, clinical and laboratory findings are presented, the causative factors of in­ somnia are defined, assessment guidelines are delineated, and appropriate treatment methods are reviewed.