Insomnia: A health care (gap that is growing)

Insomnia is a highly prevalent and costly condition. It is underdiagnosed and many patients remain untreated. All patients should be asked about their sleep-related health. If the patient has sleep difficulties accompanied by impairment in physical or cognitive function or quality of life, medical intervention should be considered. Optimal treatment requires formulating a diagnosis based on a comprehensive medical/sleep history. Treatment should be chosen in order to best address the identified type and timing of the sleepwake disorder. The risk-benefit ratio of any treatment must be considered in relationship to the needs of the individual patient. Comorbid psychiatric disorders are common and should be treated concomitantly with insomnia. Nonpharmacologic therapies can be used as first-line treatment and can be used in combination with medication. Patients should be monitored for therapeutic response and, if refractory, should be referred to a sleep medicine specialist for further evaluation. When insomnia is accurately diagnosed and effectively treated, the cycle of compromised sleep and function is broken, sleep can be restored, and patients can regain their quality of life.

Duke Scholars

Author Andrew Darrell Krystal Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...