Journal Article

Insomnia Disorder

Winkelman, John W

2015

Overview

Evaluation of insomnia should include a complete medical and psychiatric history and assessment of sleep-related behaviors and symptoms. Therapies for persistent insomnia include cognitive behavioral therapy (considered the first-line treatment) and hypnotic medications. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage A 77-year-old overweight woman with hypertension and arthritis reports that she has had trouble sleeping for “as long as I can remember.” She has taken hypnotic medications nightly for almost 50 years; her medication was recently switched from lorazepam (1 mg), which had been successful, to trazodone (25 mg) by her primary care physician, who was concerned about her use of the former. She spends 9 hours in bed, from 11 p.m. to 8 a.m. She has only occasional difficulty falling asleep, but she awakens two to three times per night to urinate and lies in bed for over . . .

• Publisher: Massachusetts Medical Society
• Subject: Antidepressants / Benzodiazepines / Cognitive ability / Cognitive behavioral therapy / Coronary artery disease / Diabetes mellitus / Heart diseases / Insomnia / Melatonin / Mental depression / Orexins / Sleep disorders