insómni

Insomnia is a sleep disorder defined by persistent difficulties with sleep initiation, sleep maintenance, or nonrestorative sleep despite adequate opportunity to sleep, leading to distress or impairment during daytime activities. Acute insomnia lasts days to weeks, while chronic insomnia occurs three or more nights per week for three months or longer.

Insomnia can be classified as primary, when it is not attributable to another condition, or secondary (comorbid), when it occurs in association with medical, psychiatric, or environmental factors. Common causes and contributors include stress, anxiety, depression, medical illnesses, medications, caffeine or alcohol use, irregular sleep schedules, and shift work. Risk factors include female sex, older age, and a history of mental health disorders.

Symptoms typically involve difficulty falling asleep, trouble staying asleep, early morning waking, or waking up feeling unrefreshed. Insomnia often coexists with other sleep disorders such as sleep apnea, restless legs syndrome, or circadian rhythm disorders, which can complicate diagnosis and treatment.

Diagnosis is based on clinical history and, when needed, sleep diaries or standardized questionnaires. Physical examination and screening for underlying conditions are important; polysomnography is not routinely required unless another sleep disorder is suspected or there are indications such as excessive daytime sleepiness or abnormal breathing during sleep.

Treatment prioritizes nonpharmacological approaches. Cognitive behavioral therapy for insomnia (CBT-I) is considered first-line and includes elements such as sleep restriction, stimulus control, cognitive restructuring, and sleep hygiene. Pharmacotherapy may be used short-term or episodically, with options including short-acting sedative-hypnotics, melatonin receptor agonists, or other agents, all chosen with caution due to potential side effects and dependence. Addressing comorbid conditions, lifestyle factors, and consistent sleep-wake schedules enhances management and prognosis.