Insomnia. Diagnosis and management.
BACKGROUND
Insomnia is a complaint of perceived poor sleep quality resulting in impairment of daytime function. It is the commonest clinical sleep disorder with approximately 6-12% of adults complaining of chronic insomnia.


OBJECTIVE
To review current knowledge on causes and effects of insomnia and to provide a brief evidence based review of management options for the family practitioner.


CONCLUSIONS
Patients with insomnia are characterised by excessive arousal and an inability to sleep despite reported reduced sleep hours and poor sleep quality. Current management approaches are focussed on reducing this 'hyperarousal' and its behavioural manifestations by a range of behavioural treatments. Good evidence exists for the efficacy of hypnotics for short term insomnia but long term data is currently lacking. Nonbenzodiazepine hypnotics (zopiclone, zolpidem) have less adverse effects and similar efficacy to benzodiazepines.
Grunstein
Ron
R
Sleep Research Group, Institute of Respiratory Medicine, University of Sydney. rrg@mail.med.usyd.edu.au
D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D053961:Azabicyclo Compounds; D015928:Cognitive Behavioral Therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use; D011613:Psychotherapy; D007319:Sleep Initiation and Maintenance Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013693:Temazepam / Q000627:therapeutic use
D014151:Anti-Anxiety Agents; D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; C515050:zopiclone; D013693:Temazepam