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Sleep Disorders Medicine pp 673–696Cite as

Nature, Evaluation, and Treatment of Insomnia

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Abstract

Insomnia is a prevalent sleep complaint in the general population and in clinical practice. Chronic insomnia carries significant burden for the individual and for society at large. It is associated with negative health outcomes including increased risk for role impairments, work disability, depression, and hypertension. Despite its high prevalence and negative consequences, insomnia is often under-recognized and undertreated. Treatment options currently available include basic sleep hygiene education, cognitive behavioral therapies, various classes of prescribed medications, and several complementary and alternative therapies. Of these, only two therapeutic approaches, cognitive behavioral therapies and benzodiazepine receptor agonists, have adequate data supporting both their safety and efficacy. These therapies have been shown effective for improving sleep continuity, but neither approach produces optimal therapeutic outcome. Medication is particularly effective on a short-term basis, but there is limited data about benefits once medication is discontinued or about long-term outcomes with prolonged treatment. Cognitive behavioral therapies are effective for chronic insomnia, and while more time-consuming initially, they produce sleep improvements that are well sustained over time. As no single treatment is effective for all forms of insomnia or acceptable to all patients, additional research is needed to examine optimal treatment algorithms using sequential or combination therapies. Clinical practice guidelines are still much needed.

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Acknowledgments

Preparation of this chapter was facilitated by research grants from the National Institute of Mental Health (MH091053) and by the Canadian Institutes for Health Research (MT-42504).

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Authors and Affiliations

  1. École de psychologie, Université Laval, 1123, rue des Bibliothèques, Pavillon F.A.S, Quebec City, QC, G1V 0A6, Canada

    Charles M. Morin

  2. Department of Psychiatry, University of Wesconsin, 6001 Research Park Blvd, Madison, WI, 53719-1176, USA

    Ruth M. Benca

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  1. School of Graduate Medical Education, Seton Hall University, South Orange, New Jersey, USA

    Sudhansu Chokroverty

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Morin, C.M., Benca, R.M. (2017). Nature, Evaluation, and Treatment of Insomnia. In: Chokroverty, S. (eds) Sleep Disorders Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6578-6_37

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