insomnia

Insomnia is a sleep disorder characterized by persistent difficulty with sleep initiation, maintenance, or non-restorative sleep that causes daytime impairment. It can be acute (a few days to weeks) or chronic (three or more nights per week for three months or longer). Insomnia is classified as primary when it is not attributable to another condition, or secondary (comorbid) when it coexists with another medical, psychiatric, or substance-related problem.

Symptoms include trouble falling asleep, frequent awakenings, waking too early, and waking feeling unrefreshed. Daytime effects may involve fatigue, concentration problems, irritability, and reduced performance. Causes are multifactorial and may include stress, irregular schedules, medical illnesses, mental health disorders, medications, stimulants or alcohol, and poor sleep hygiene or environmental factors.

Diagnosis is usually based on history and sleep diaries; polysomnography or other testing is used to rule out other sleep disorders when indicated.

Treatment typically begins with cognitive behavioral therapy for insomnia (CBT-I), including stimulus control, sleep restriction, relaxation techniques, and good sleep hygiene. Medications may be used for short periods under medical supervision, such as short-acting sedative-hypnotics or melatonin, but are generally adjuncts to behavioral therapy.

Prognosis varies; many people improve with appropriate treatment, though insomnia can become chronic. Untreated insomnia is associated with higher risk of mood disorders, cardiovascular disease, and reduced quality of life.