Insomnia
Insomnia is persistent difficulty falling or staying asleep with daytime impairment, managed per the American Academy of Sleep Medicine (AASM) clinical practice guideline.
Symptoms
Difficulty falling asleep, staying asleep, or waking too early, occurring 3 or more nights per week for 3 months or longer, along with daytime fatigue, mood changes, or difficulty concentrating.
Causes and risk
Stress, irregular sleep schedules, certain medications, caffeine, and underlying mental health or medical conditions can all contribute; insomnia is strongly linked to depression and anxiety.
How it is evaluated
Diagnosis is clinical, based on DSM-5 frequency and duration criteria; a sleep diary or screening questionnaire often supports evaluation, per current NEJM clinical guidance.
Treatment
CBT for insomnia (CBT-I) is the strongly recommended first-line treatment, per the AASM guideline; medication is a secondary option, with benzodiazepines, Z-drugs, and antihistamines specifically cautioned against in older adults per the American Geriatrics Society Beers Criteria.
When to seek care
Insomnia paired with thoughts of self-harm, or with symptoms of a serious sleep disorder like loud gasping/choking during sleep (possible sleep apnea), warrants prompt evaluation.