Assessment of Insomnia

Insomnia is the subjective report of difficulty initiating or maintaining sleep, or a report of nonrestorative sleep. This symptom occurs commonly, with about one-third of adults reporting insomnia in a given year (1–3). Most of these cases are transient insomnia and will remit. However, one-third of these patients report insomnia that is chronic or severe (1). Transient insomnia is usually treated by primary care, whereas patients with chronic insomnia may be referred to sleep specialists. The general evaluation strategy described later is designed for cases of chronic insomnia. Strategies to efficiently evaluate a complaint of insomnia with the goal of identifying the contributing factors in a specific case are crucial to treatment planning. Insomnia is a nonspecific symptom that may be exacerbated by a myriad of medical, psychological, and behavioral factors. In cases of chronic insomnia, there are likely to be multiple contributing factors, and identification of these factors is necessary to focus treatment.