Insomnia and Anxiety: Diagnostic and Management Implications of Complex Interactions

Concurrent clinical presentation of insomnia and anxiety is frequent in clinical practice. The onset and course of anxiety and insomnia are intimately related; traditional conceptualizations of insomnia as secondary to anxiety are no longer clinically viable. Evolving evidence suggests a relationship between these 2 conditions that is complex and reciprocal and that evolves over time. In terms of diagnosis and management, unless initial assessment and intervention are initiated in the earliest stages of illness, emerging opinion supports recognition of cooccurring anxiety and insomnia as independent comorbid conditions with each condition likely requiring targeted therapeutic attention to achieve optimal therapeutic outcomes.