The diagnosis and management of insomnia in clinical practice: a practicalevidence-based approach

INSOMNIA, OR THE DISSATISFACTION WITH THE QUANTITY, quality or timing of sl eep, is a common complaint. Because the definition of "normal" sleep is not well established, the estimates of the prevalence and severity of insomnia vary widely. Insomnia is often secondary to underlying psychiatric and med ical conditions, and these should be evaluated and treated as a first measu re. Nonpharmacological interventions for insomnia including sleep hygiene m anoeuvres and exercise are recommended, although the success of these inter ventions has not been well documented. Benzodiazepines have been the pharma cologic agents of choice for the treatment of insomnia, but there is reason to exercise caution with their use; their overall benefit compared with pl acebo appears to be minor, and they are often associated with adverse cogni tive effects. Unfortunately, no other class of drugs has proven to be super ior to the benzodiazepines in terms of benefit:risk ratio. Given the import ance of sleep for health and normal daily functioning the diagnosis, progno sis and treatment of insomnia should be a research priority.