Diagnosing and Treating Insomnia in Adults and Older Adults

Insomnia, the most prevalent sleep-wake disorder, affects 6% to 10% of adults. It may result in interpersonal and occupational problems and has a deleterious effect on quality of life. Patients may experience difficulty with sleep onset, sleep maintenance, or both. Insomnia disorder is commonly comorbid with psychiatric, medical, and neurologic disorders, and insomnia and comorbid conditions have bidirectional relationships. Diagnosis should be based on patient interview, assessment with tools, and use of criteria. Selection of treatment for patients with insomnia should factor in efficacy for the patient's specific complaint as well as other features such as safety profile and abuse liability. Cognitive-behavioral therapy for insomnia is a first-line recommendation by guidelines, but some patients are unable or unwilling to try it or may not respond to it. Older adults with insomnia disorder require careful consideration of medications' risk-benefit profiles.