Practice parameters for the evaluation of chronic insomnia

Chronic insomnia is the most common sleep complaint which health care pract itioners must confront. Most insomnia patients are not, however, seen by sl eep physicians but rather by a variety of primary care physicians. There is little agreement concerning methods for effective assessment and subsequen t differential diagnosis of this pervasive problem. The most common basis f or diagnosis and subsequent treatment has been the practitioner's clinical impression from an unstructured interview. No systematic, evidence-based gu idelines for diagnosis exist for chronic insomnia. This practice parameter paper presents recommendations for the evaluation of chronic insomnia based on the evidence in the accompanying review paper. We recommend use of thes e parameters by the sleep community, but even more importantly, hope the la rge number of primary care physicians providing this care can benefit from their use. Conclusions reached in these practice parameters include the following reco mmendations for the evaluation of chronic insomnia. Since the complaint of insomnia is so widespread and since patients may overlook the impact of poo r sleep quality on daily functioning, the health care practitioner should s creen for a history of sleep difficulty. This evaluation should include a s leep history focused on common sleep disorders to identify primary and seco ndary insomnias. Polysomnography, and the Multiple Sleep Latency Test (MSLT ) should not be routinely used to screen or diagnose patients with insomnia complaints. However, the complaint of insomnia does not preclude the appro priate use of these tests for diagnosis of specific sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, and narcolepsy t hat may be present in patients with insomnia. There is insufficient evidenc e to suggest whether portable sleep studies, actigraphy, or other alternati ve assessment measures including static charge beds are effective in the ev aluation of insomnia complaints. Instruments such as sleep logs, self-admin istered questionnaires, symptom checklist, or psychological screening tests may be of benefit to discriminate insomnia patients from normals, but thes e instruments have not been shown to differentiate subtypes of insomnia com plaints.