Management of Insomnia

This article provides a comprehensive overview of the assessment and evidence-based management of insomnia disorder, defined as persistent dissatisfaction with sleep quality or duration despite adequate opportunity to sleep. It emphasizes cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, incorporating sleep restriction, stimulus control, cognitive restructuring, and sleep hygiene education. CBT-I yields large effect sizes in improving symptom severity and sleep efficiency, with sustained benefits. Digital CBT-I platforms may expand access. FDA-approved medications such as benzodiazepine receptor agonists, orexin receptor antagonists, and low-dose doxepin are supported for short-term or adjunctive use, though long-term efficacy data are limited. The article underscores a stepped-care approach, matching therapy intensity to clinical need and comorbid conditions. Pharmacologic selection should be tailored to symptom profiles, patient characteristics, and safety considerations, especially in older adults. It concludes with evidence-based recommendations for combining CBT-I with intermittent medication use when warranted.

This article provides a comprehensive overview of the assessment and evidence-based management of insomnia disorder, defined as persistent dissatisfaction with sleep quality or duration despite adequate opportunity to sleep. It emphasizes cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, incorporating sleep restriction, stimulus control, cognitive restructuring, and sleep hygiene education. CBT-I yields large effect sizes in improving symptom severity and sleep efficiency, with sustained benefits. Digital CBT-I platforms may expand access. FDA-approved medications such as benzodiazepine receptor agonists, orexin receptor antagonists, and low-dose doxepin are supported for short-term or adjunctive use, though long-term efficacy data are limited. The article underscores a stepped-care approach, matching therapy intensity to clinical need and comorbid conditions. Pharmacologic selection should be tailored to symptom profiles, patient characteristics, and safety considerations, especially in older adults. It concludes with evidence-based recommendations for combining CBT-I with intermittent medication use when warranted.