Insomnia: A Primary Care Perspective

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