Insomnia is common and can have serious consequences, such as increased risk of depression and hypertension.
Acute and chronic insomnia require different management approaches.
Chronic insomnia is unlikely to spontaneously remit, and over time will be characterised by cycles of relapse and remission or persistent symptoms.
Chronic insomnia is best managed using non-drug strategies such as cognitive behaviour therapy.
For patients with ongoing symptoms, there may be a role for adjunctive use of medications such as hypnotics.
- 1. Lack L, Miller W, Turner D. A survey of sleeping difficulties in an Australian population. Community Health Stud 1988; 12: 200-207.
- 2. Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Sleep health New South Wales: chronic sleep restriction and daytime sleepiness. Intern Med J 2008; 38: 24-31.
- 3. Britt H, Miller G, Charles J, et al. General practice activity in Australia 2009–10. Canberra: Australian Institute of Health and Welfare, 2010. (AIHW Cat. No. GEP 27; General Practice Series No. 27.)
- 4. Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011; 135: 10-19.
- 5. Vozoris NT. The relationship between insomnia symptoms and hypertension using United States population-level data. J Hypertens 2013; 31: 663-671.
- 6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing, 2013.
- 7. Charles J, Harrison C, Britt H. Insomnia. Aust Fam Physician 2009; 38: 283.
- 8. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 1987; 10: 541-553.
- 9. Morin CM, Belanger L, LeBlanc M, et al. The natural history of insomnia: A population-based 3-year longitudinal study. Arch Intern Med 2009; 169: 447.
- 10. Sivertsen B, Overland S, Bjorvatn B, et al. Does insomnia predict sick leave? The Hordaland health study. J Psychosom Res 2009; 66: 67-74.
- 11. Arroll B, Fernando A, Falloon K, et al. Development, validation (diagnostic accuracy) and audit of the Auckland Sleep Questionnaire: a new tool for diagnosing causes of sleep disorders in primary care. J Prim Health Care 2011; 3: 107-113.
- 12. Morin CM, Belleville G, Bélanger L, Ivers H. The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011; 34: 601-608.
- 13. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4: 487-504.
- 14. Morin CM, Bootzin RR, Buysse DJ, et al. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 2006; 29: 1398-1414.
- 15. Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006; 295: 2851-2858.
- 16. Manber R, Edinger JD, Gress JL, et al. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 2008; 31: 489-495.
- 17. Sivertsen B, Vedaa O, Nordgreen T. The future of insomnia treatment — the challenge of implementation. Sleep 2013; 36: 303-304.
- 18. Espie CA, Kyle SD, Williams C, et al. A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep 2012; 35: 769-781.
- 19. Espie CA. “Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep 2009; 32: 1549-1558.
- 20. Bootzin R. A stimulus control treatment for insomnia. Proc Am Psychol Assoc 1972; 7: 395-396.
- 21. Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep 1987; 10: 45-56.
- 22. Fernando A, Arroll B, Falloon K. A double-blind randomised controlled study of a brief intervention of bedtime restriction for adult patients with primary insomnia. J Prim Health Care 2013; 5: 5-10.
- 23. Hauri PJ, Esther MS. Insomnia. Mayo Clin Proc 1990; 65: 869-882.
- 24. Ong JC, Shapiro SL, Manber R. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study. Behav Ther 2008; 39: 171-182.
- 25. Ong J, Sholtes D. A mindfulness-based approach to the treatment of insomnia. J Clin Psychol 2010; 66: 1175-1184.
- 26. Lack LC, Wright HR. Treating chronobiological components of chronic insomnia. Sleep Med 2007; 8: 637-644.
- 27. Krystal AD, Erman M, Zammit GK, et al; ZOLONG Study Group. Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep 2008; 31: 79-90.
- 28. Roth T, Walsh JK, Krystal A, et al. An evaluation of the efficacy and safety of eszopiclone over 12 months in patients with chronic primary insomnia. Sleep Med 2005; 6: 487-495.
- 29. Krystal AD, Walsh JK, Laska E, et al. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep 2003; 26: 793-799.
- 30. Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res 2007; 16: 372-380.
- 31. Arendt J, Skene DJ. Melatonin as a chronobiotic. Sleep Med Rev 2005; 9: 25-39.
- 32. Wiegand MH. Antidepressants for the treatment of insomnia: a suitable approach? Drugs 2008; 68: 2411-2417.
- 33. Morin CM, Koetter U, Bastien C, et al. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 2005; 28: 1465-1471.
- 34. Bent S, Padula A, Moore D, et al. Valerian for sleep: a systematic review and meta-analysis. Am J Med 2006; 119: 1005-1012.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.