Insomnia in Adults

Insomnia is a prevalent condition, existing as both a symptom and a syndrome, and is associated with significant impairments of daytime functioning, reduced quality of life, and increased risk of depression. When insomnia is secondary to a psychiatric, medical, or another sleep disorder, treatment should focus initially on the underlying condition. For acute and situational insomnia, treatment should address the precipitating factors when possible, but in certain circumstances (eg, stressful events, travel, or jet lag), a hypnotic medication is necessary to alleviate sleep difficulties. Benzodiazepine-receptor agents are the treatment of choice among the pharmacologic options. For chronic and primary insomnia, behavior treatment should represent the main intervention, with hypnotic medications serving as an adjunct. Behavior and pharmacologic treatments can be effectively combined in order to take advantage of the faster results obtained from medication administration, and the longer-lasting benefits associated with behavior interventions. For recurrent insomnia, the use of intermittent medication can be very useful to prevent or minimize continued sleep difficulties.