Non-pharmacologic treatment of insomnia in primary care settings.

INTRODUCTION Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a non-pharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the non-pharmacologic approach is often underestimated by both patients and physicians. OBJECTIVE To provide primary care physicians an up-to-date approach to the non-pharmacologic treatment of insomnia. METHODS PubMed, Web of Science, and Scopus databases were searched for relevant articles about the non-pharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. MAIN MESSAGE Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and non-pharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. CONCLUSIONS This paper provides an overview of current recommendations and up-to-date evidence for the non-pharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, eg, light therapy, aromatherapy, music therapy, and herbal medicine.