[Skip to Navigation]
November 28, 2017

Clinical Management of Insomnia Disorder

Author Affiliations
  • 1Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 2Duke-National University of Singapore, Singapore
  • 3Department of Psychiatry, Duke University Medical School, Durham, North Carolina
JAMA. 2017;318(20):1973-1974. doi:10.1001/jama.2017.15683

The central feature of insomnia disorder is dissatisfaction with sleep quantity or quality, associated with difficulty falling asleep, maintaining sleep, or early morning awakening.1 Insomnia disorder causes clinically significant distress or impairment in important areas of functioning. Sleep difficulties occur at least 3 nights per week for at least 3 months, and are not better explained by use of substances, medications, or by another disorder. Insomnia is diagnosed only when an individual has adequate opportunity for sleep; this distinguishes insomnia from sleep deprivation, which has different causes and consequences. Insomnia disorder is often comorbid with other sleep-wake, mental, or medical disorders that require separate management. Increased neural, physiological, and psychological arousal, together with perpetuating behavioral factors (such as excessive time in bed) are thought to underlie most cases of chronic insomnia. Acute insomnia, which meets all diagnostic criteria as chronic insomnia except in duration, may have different causes and specific treatment implications.