Insomnio: enfoque clínico y terapéutico

Insomnia is one of the most prevalent conditions in clinical practice, with significant mental, physical, and social consequences. This review aims to provide an updated and clinically oriented synthesis of current evidence on its diagnosis, pathophysiology, and therapeutic management, integrating cognitive perspectives and the role of shared decision-making. Its conceptualization has shifted from an unspecific symptom to a distinct disorder with well-established neurobiological foundations. Diagnosis is primarily clinical and requires assessment of functional impact, perpetuating factors, and patient expectations. International guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as the first-line treatment, with pharmacotherapy reserved for selected cases. Sleep hygiene measures, while necessary, are insufficient when used in isolation. Dysfunctional beliefs and shared decision-making are central to optimizing adherence and preventing chronicity. Contemporary management demands an integral, personalized, and person-centered approach that combines educational strategies, psychotherapy, and rational pharmacological interventions.