Effective management of insomnia begins with recognition and adequate assessment

A seminar in this week’s issue of THE LANCET outlines the common but poorly understood condition of insomnia, concluding that awareness and assessment of insomnia by family doctors is a priority.

Estimates suggest that between 5 and 35% of people experience insomnia. Michael J Sateia (Dartmouth Medical School, USA) and colleagues outline how effective management of insomnia begins with recognition and adequate assessment. Family doctors and other health care providers such as practice nurses and psychologists should, the authors believe, routinely enquire about sleep habits as a component of overall health assessment. Identification and treatment of primary psychiatric disorders, medical conditions, circadian disorders, or specific physiological sleep disorders—eg, sleep apnoea and periodic limb movement disorder—are essential steps in management of insomnia.

The authors discuss how drug treatments are common, despite little empirical research among patients with insomnia: ‘Approved hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in various short-term situations. Despite widespread use of standard hypnotics and sedating antidepressants for chronic insomnia, their role for this indication still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with durable long-term improvement in sleep.’

Professor Sateia comments: “Many challenges remain in the characterisation, recognition, and treatment of insomnia. Future research must expand our knowledge of the biological dimensions, as well as the behavioural aspects, of the disorder. New data are emerging for pharmacological and behavioural treatments, but we have yet to achieve a clear understanding of how best to integrate these approaches for maximum effectiveness in a variety of clinical settings. Most importantly, we must educate family doctors about identification and assessment of chronic insomnia. Awareness of effective treatment strategies must be promoted and cost-effective systems for implementation of non-pharmacological treatments should be developed.”