Insomnia: A primary care perspective

Primary care physicians once considered insomnia a nuisance diagnosis with which they had little concern. A complaint of insomnia is often brought to a physician's attention as a last-minute secondary complaint, which may be dismissed as unimportant by the physician. However, chronic insomnia is prevalent, associated with a decrease in quality of life, and can be an exacerbating factor in other psychiatric and medical conditions. Primary care physicians therefore should be aware of the signs of insomnia and include the detection of it in the evaluation of patients who present with other complaints or as part of annual physical examinations. Physicians can assess insomnia with tools they already use, such as a patient's initial history. If insomnia is detected, primary care physicians should work with patients to educate them. Management necessitates the inclusion of education and patient counseling about sleep hygiene and correction of dysfunctional beliefs and behaviors. It may also include pharmacologic treatment, nonpharmacologic treatment, or a combination of both.