Until recently, it has not been generally recognized that there has been very little exposure to and training in sleep medicine (including insomnia) on the part of students in most medical schools. Insomnia is ubiquitous yet poorly recognized and poorly managed in the health care field for a variety reasons. It is the second most common complaint, after pain, in the primary care setting, but primary care text and reference books often do not include chapters that address the evaluation and treatment of insomnia. Insomnia is also the second most common complaint encountered by sleep specialists, the first being sleep-disordered breathing, which itself is frequently associated with insomnia. However, the field of sleep medicine is much more zealous in setting up sleep study facilities and performing polysomnograms than in evaluating patients themselves. What is more, insomnia can not only be a primary diagnosis but also a principal presenting symptom for a number of sleep disorders as well as other medical and psychiatric conditions. Diagnosing insomnia is more of an art than a science in many cases because the constellation of insomnia symptoms are often subjective and difficult to quantify objectively. It also poses a tremendous challenge to primary care providers as well as sleep specialists who have to manage patients with insomnia because there is a paucity of data on long-term use of hypnotics, particularly with regard to a patient's potential tolerance, dependence, and adverse reactions to hypnotics. As such, many patients with insomnia frequently self-treat with alcohol or over-the-counter medications. In some study series, cognitive-behavioral therapy for insomnia yielded comparable results to pharmacotherapy during acute treatment, with even better long-term efficacy. However, cognitive-behavioral therapy is time-consuming, and the clinical course of this type of therapy is difficult to follow.
Kuang TY. Clinical Handbook of Insomnia, 2nd ed. Arch Neurol. 2011;68(5):682-683. doi:10.1001/archneurol.2011.72