Insomnia: Therapeutic Approach

, MD, , MD, , Department of Psychiatry and Behavioral Medicine, University of Louisville School of Medicine, Louisville, Ky

South Med J. 2001;94(9) 

In This Article

Management of Insomnia

Insomnia should be addressed to avoid functional impairment. Persistent insomnia might be a precursor to depressive illnesses[27,28,29] and to psychophysiologic insomnia.[9] Diagnosing sleep disorders has important treatment implications. Hypnotic medications may worsen conditions such as sleep apneas, and symptomatic therapies without management of the actual cause of an insomnia may be countertherapeutic.

Short-term insomnia due to stress can be interrupted by a short course of hypnotics.[30] Such agents might be helpful in brief exposures, during bereavements, hospitalizations, and other acutely disturbing events.[20] In more chronic cases, sparingly prescribe symptomatic medicines after treatment of the specific cause of the insomnia. Life-style adjustment in conjunction with drug treatment is advised. Monitor patients, especially for dependence, and do not provide prolonged, multiple refills without clinical observation; provide careful follow-up to assess the pattern of use, efficacy, and possible abuse.[26] There are also people under medical supervision who take sleeping pills for prolonged periods without complications or misuse.


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