Treatment of Insomnia

Abstract Insomnia is a highly prevalent and often persistent condition in patients with medical and psychiatric disorders. Persistent insomnia is a risk factor for several other conditions (e.g., depression, hypertension), and it may exacerbate the course or interfere with the treatment of comorbid medical and psychiatric conditions. Despite its high prevalence and negative consequences, insomnia often remains unrecognized and untreated. Notwithstanding, several treatment options are available including cognitive-behavioral therapy (CBT), pharmacological, and complementary and alternative therapies. CBT is the treatment of choice for persistent insomnia, whereas medication is indicated primarily for acute or short-term insomnia. There is still little evidence documenting the risks and benefits of complementary and alternative therapies for the management of insomnia. Even when insomnia is comorbid with another medical or psychiatric condition, it is necessary to target the sleep difficulties directly because such difficulties often persist when treatment focuses only on the coexisting condition. Although most cognitive-behavioral interventions are indicated for the management of comorbid insomnia, it may be necessary to adapt specific clinical recommendations to the unique features of each comorbid disorder. CBT produces comparable or slightly smaller outcomes for patients with or without comorbid medical or psychiatric conditions. Further research is warranted to validate optimal treatment algorithms for comorbid insomnia, in particular to determine what should be our first-line treatment, what to do with nonresponders, and whether it is preferable to treat insomnia first, the comorbid condition first, or to treat them both concurrently.