Diagnosis and treatment of insomnia

Insomnia is an extremely common complaint. Frequently, it occurs secondary to a number of medical and psychiatric conditions that directly affect the ability to initiate or maintain sleep. Insomnia can also occur secondary to behavioral factors, such as shift work, whereby patients either do not follow or control the dictates of their internal circadian rhythm or develop inappropriate conditioned responses to their sleep surroundings. Insomnia can be a primary and even lifelong complaint. Patients with primary insomnia probably have a physiologic problem that has not been clearly identified as the basis for their subjective complaint.