insomnia
INSOMNIA
Treatment Guideline Chart

Insomnia can be either having difficulty in initiating sleep, maintaining sleep or experiencing early morning awakening wherein returning to sleep is not easily attained.

These disturbances can cause significant distress and impairment in daytime functioning.

It is the most prevalent sleep disorder in the general population thus accurate diagnosis and effective treatment is necessary.

Insomnia References

  1. Costa e Silva JA. Sleep disorders in psychiatry. Metabolism. 2006 Oct;55(10)(Suppl 2):S40-S44. PMID: 16979426
  2. Roehrs T, Roth T. Safety of Insomnia pharmacotherapy. Sleep Med Clin. 2006 Sep;1(3):399-407
  3. Doghramji K. The evaluation and management of insomnia. Clin Chest Med. 2010 Jun;31(2):327-339. PMID: 20488291
  4. Sateia M, Nowell PD. Insomnia. Lancet. 2004 Nov;364(9449):1959-1973. PMID: 15567013
  5. Walsh JK, Krystal AD, Amato DA, et al. Nightly treatment of primary insomnia with eszopiclone for six months: effect on sleep, quality of life, and work limitations. Sleep. 2007;30(8):959-968. PMID: 17702264
  6. Schute-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct;4(5):487-504. PMID: 18853708
  7. Roth T, Roehrs T, Pies R. Insomnia: pathophysiology and implications for treatment. Sleep Med Rev. 2007 Feb;11(1):71-79. PMID: 17175184
  8. Sleep Disorder. In: Sadock BJ, et al. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009:2150-2177
  9. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  10. MedWorm http://www.medworm.com/rss/index.php/Psychiatry/172/ www.medworm.com/rss/medicalfeeds/specialities/Psychiatry-News.xml
  11. Guideline Working Group for Insomnia for the Toward Optimized Practice Program (TOP) Program, Alberta Medical Association, Alberta Health and Wellness, the College of Physicians and Surgeons, and Alberta’s Health Regions. Clinical practice guideline adult primary insomnia: diagnosis to management. Feb 2007
  12. Buscemi N, Vandermeer B, Friesen C, et al. Manifestations and management of chronic insomnia in adults. Agency for Healthcare Research and Quality. http://archive.ahrq.gov. Jun 2005.
  13. National Institutes of Health. NIH State-of-the-Science Conference Statement on Manifestations and management of chronic insomnia in adults. http://consensus.nih.gov/2005/insomniastatement.pdf. Jun 2005
  14. Bonnet MH, Arand DL. Evaluation and diagnosis of insomnia in adults. UpToDate. http://www.uptodate.com. 26 Aug 2019. Accessed 10 Sep 2011.
  15. Bonnet MH, Arand DL. Behavioral and pharmacological therapies for chronic insomnia in adults. UpToDate. http://www.uptodate.com. Mar 2019. Accessed 10 Sep 2011.
  16. Bonnet MH, Arand DL. Types of insomnia. UpToDate. http://www.uptodate.com/contents/types-of-insomnia. May 2011. Accessed 10 Sep 2011.
  17. American Psychiatric Association. Sleep-wake disorders. In: Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:362-363.
  18. Davidson JR. Treating chronic insomnia in primary care-early recognition and management. Insomnia Rounds. 2012;1(3). http://www.insomniarounds.ca. Accessed 31 Oct 2014
  19. Pavlova M. Sleep disorders. In: Samuels’s Manual of Neurologic Therapeutics. 8th ed: Lippincott Williams & Wilkins; 2010:102-104.
  20. Shneerson JM. Insomnia. Sleep Medicine: a Guide to Sleep and Its Disorders. 2nd ed: Blackwell Publishing; 2005:161-184.
  21. Teofilo Lee-Chiong. Insomnia. In: Sleep Medicine: Essentials and Review: Oxford University Press; 2008:73-132.
  22. University of Texas at Austin School of Nursing, Family Nurse Practitioner Program. Clinical guideline for the treatment of primary insomnia in middle-aged and older adults. http://www.guideline.gov/content.aspx?id=48218. May 2014.
  23. Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul;165(2):125-133. doi: 10.7326/M15-2175. PMID: 27136449
  24. Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 Dec;26(6):675-700. doi: 10.1111/jsr.12594. PMID: 28875581
  25. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014 Nov;146(5):1387-1394. doi: 10.1378/chest.14-0970. PMID: 25367475
  26. Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Feb;13(2):307-349. doi: 10.5664/jcsm.6470. PMID: 27998379
  27. Winkelman JW. Overview of the treatment of insomnia in adults. UpToDate. https://www.uptodate.com. 23 Apr 2021. Accessed 06 May 2021.
  28. Bragg S, Benich JJ, Christian N, et al. Updates in insomnia diagnosis and treatment. Int J Psychiatry Med. 2019 Sep;54(4-5):275-289. doi: 10.1177/0091217419860716. PMID: 31269837
  29. Chan NY, Chan JWY, Li SX, et al. Non-pharmacological approaches for management of insomnia. Neurotherapeutics. 2021 Jan;18(1):32-43. doi: 10.1007/s13311-021-01029-2. Accessed 06 May 2021. PMID: 33821446
  30. Morin CM, Edinger JD, Beaulieu-Bonneau S, et al. Effectiveness of sequential psychological and medication therapies for insomnia disorder: a randomized clinical trial. JAMA Psychiatry. 2020 Nov;77(11):1107-1115. doi: 10.1001/jamapsychiatry.2020.1767. PMID: 32639561
  31. Neubauer DN. Pharmacotherapy for insomnia in adults. UpToDate. https://www.uptodate.com. 12 Apr 2021.
  32. Toward Optimized Practice (TOP) Insomnia Group. Assessment to management of adult insomnia: clinical practice guidelines. ACCT. http://www.topalbertadoctors.org. Dec 2015.
  33. Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016 Mar;149(3):631-638. doi: 10.1378/chest.15-0903. PMID: 26378880
  34. Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. Psychopharmacol. 2019 Aug;33(8):923-947. doi: 10.1177/0269881119855343. PMID: 31271339
  35. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019;18(3):337-352. doi: 10.1002/wps.20674. PMID: 31496087
  36. Lemoine P, Nir T, Laudon M, et al. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007 Dec;16(4):372-380. doi: 10.1111/j.1365-2869.2007.00613.x. PMID: 18036082
  37. Lie JD, Tu KN, Shen DD, et al. Pharmacological treatment of insomnia. P T. 2015 Nov;40(11):759-768, 771. Accessed 02 Dec 2020. PMID: 26609210
  38. Maness DL, Khan M. Nonpharmacologic management of chronic insomnia. Am Fam Physician. 2015;92(12):1058-1064.
  39. Mansfield D, Grima NA, Bei Bei. Insomnia management. Aust J Gen Pract. 2019 Apr;48(4):198-202. PMID: 31256489
  40. Martin JL. Cognitive behavioral therapy for insomnia in adults. UpToDate. https://www.uptodate.com. 10 Oct 2020.
  41. Matheson E, Hainer BL. Insomnia: pharmacologic therapy. Am Fam Physician. 2017 Jul;96(1):29-35. PMID: 28671376
  42. Nazarian PK, Park SH. Antidepressant management of insomnia disorder in the absence of a mood disorder. Ment Health Clin [Internet]. 2014 Mar;4(2):41-46. doi: 10.9740/mhc.n188364. [DateAccess]
  43. SingHealth. Insomnia. SingHealth. https://www.singhealth.com.sg/. 01 Mar 2018.
  44. Sleep Foundation. Cognitive behavioral therapy for insomnia (CBT-I). Sleep Foundation. https://www.sleepfoundation.org/. 22 Oct 2020.
  45. Sleep Foundation. Sleep hygiene. Sleep Foundation. https://www.sleepfoundation.org/. 14 Aug 2020.
  46. Stepnowsky CJ Jr, Ancoli-Israel S. Sleep and its disorders in seniors. Sleep Med Clin. 2008;3(2):281-293. doi: 10.1016/j.jsmc.2008.01.011. PMID: 19122865
  47. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb;17(2):255-262. doi: 10.5664/jcsm.8986. PMID: 33164742
  48. Buysse DJ. Insomnia. JAMA. 2013 Feb;309(7):706-716. doi: 10.1001/jama.2013.193. PMID: 23423416
  49. Klein HE. Daridorexant approved for adults with insomnia [Internet]. AJMC. https://www.ajmc.com/. 11 Jan 2022.
  50. Martin JL. Cognitive behavioral therapy for insomnia in adults. UpToDate. https://www.uptodate.com. 03 Dec 2021.
  51. Mason BJ, Quello S, Shadan F. Gabapentin for the treatment of alcohol use disorder. Expert Opin Investig Drugs. 2018 Jan;27(1):113-124. doi: 10.1080/13543784.2018.1417383. PMID: 29241365
  52. Momin RR, Ketvertis K. Short term insomnia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/.
  53. Neubauer DN. Pharmacotherapy for insomnia in adults. UpToDate. https://www.uptodate.com. 04 Mar 2022.
  54. Todd Arnedt J. Insomnia in patients with a substance abuse disorder. UpToDate. https://www.uptodate.com. 11 Aug 2020.
  55. U.S. Food & Drug Administration. Novel drug approvals for 2022 [Internet]. US FDA. https://www.fda.gov/. 02 May 2022.
  56. Winkelman JW. Overview of the treatment of insomnia in adults. UpToDate. https://www.uptodate.com. 27 Apr 2022.
Editor's Recommendations
Special Reports