title: [Management of adult secondary insomnia in primary health care].
abstract: BACKGROUND
  Insomnia is the most common sleep disorder in adults, with secondary insomnia being the most prevalent. This sleep disorder is associated with important medical and social consequences. The General Practitioner (GP) plays a key role in the diagnosis of insomnia, which may affect about 69% of their patients in the PHC (Primary Health Care).
  
  
  OBJECTIVE
  Recognize the differential diagnosis of secondary insomnia in adults, evaluate and manage these patients in the PHC, appropriately use the treatments available and meet the criteria for referral.
  
  
  METHODS
  Bibliographic search in MEDLINE databases, and evidence based review databases, using the MeSH terms: Primary Health Care, Sleep Disorders, Insomnia, for articles published since January 2000 until July 2009, in English, Portuguese, French and Spanish. Index de Revistas Médicas Portuguesas and scientific societies dedicated to sleep disorders were searched.
  
  
  RESULTS
  Mood and anxiety disorders are the main co-morbidities associated with secondary insomnia, being present in 30% to 50% of patients with insomnia. The medical pathology and substance abuse are present respectively in 10% of patients. It is essential a proper clinical history, with a history of sleep, sleep diary and the partner information. There is evidence that the combination of specific pharmacological treatments (benzodiazepines and the benzodiazepine receptor agonists) with the nonpharmacological (cognitive-behavioral therapy) may be useful in secondary insomnia, as co-adjuvant treatment of the underlying disease. There are several treatment options with their indications and adverse effects. The criteria for referral should be defined according to the availability of human resources.
  
  
  CONCLUSIONS
  Due to the high prevalence and the serious consequences of secondary insomnia in adults, it must be systematically managed by the GP. It is important to know and to use non-pharmacological therapy in GP consultation, because this therapy was shown to be important in treating this type of insomnia. The GP must know the precise indications for pharmacological treatment and criteria for referral.
authors.affiliation: Unidade Local de Saúde de Matosinhos, Portugal.
authors.forename: Luís Filipe
authors.initials: LF
authors.lastname: Cavadas
authors.forename: Lúcia
authors.initials: L
authors.lastname: Ribeiro
mesh_terms: D006801:Humans; D011320:Primary Health Care; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy*