Insomnia as a presenting symptom of mania

Chronic insomnia often can be traced to a treatable physical or psychological disorder. Thorough history taking and physical examination, including comprehensive questioning about the patient's sleep disturbance, may be enough to define the underlying cause and thus avoid the use of benzodiazepines. Mood disorders are prevalent in patients with chronic insomnia, and treatment is best directed at the psychological problem rather than the sleep disturbance. If treatment is not adequate, psychological referral is appropriate.