Insomnia: Assessment and management in primary care

Patients with insomnia may experience one or more of the following problems : difficulty falling asleep, difficulty maintaining sleep. waking up too ea rly in the morning and nonrefreshing sleep. In addition, daytime consequenc es such as fatigue, lack of energy, difficulty concentrating and irritabili ty are often present. Approximately 10 percent of adults experience persist ent insomnia, although most patients do not mention it during routine offic e visits. Asking sleep-related questions during the general review of syste ms and asking patients with sleep complaints to keep a sleep diary are help ful approaches in detecting insomnia. Behavior and pharmacologic therapies are used in treating insomnia. Behavior approaches take a few weeks to impr ove sleep but continue to provide relief even after training sessions have ended. Hypnotic medications are safe and effective in inducing, maintaining and consolidating sleep. Effective treatment of insomnia may improve the q uality of life for many patients.