Evaluation and Management of Insomnia in the Psychiatric Setting

Insomnia is experienced by nearly one-third of the population over the course of a year. It affects many dimensions of daily human function. Although its pathophysiology is poorly understood, it is felt to be the final product of excessive arousal in multiple neurophysiological and psychological systems. Because it can coexist with a wide variety of medical and psychiatric disorders, the first task of the clinician in the management of this condition is to engage in a comprehensive evaluation to identify comorbid disorders. Once these are identified, specific treatment can be conducted with confidence. A variety of cognitive/behavioral and pharmacological management techniques are also available for primary insomnia.