Insomnia is a common problem that can cause significant distress and reduced functioning. Chronic insomnia can be more challenging to manage, as it may be associated with an underlying cause, or be an independent disorder that can precipitate or worsen other comorbid conditions (eg depression). The understanding of chronic insomnia is still evolving.
The first step is comprehensive medical assessment, including identification of any underlying issues, and diagnosis.
Where treatment is indicated:
- First-line therapy should be non-drug interventions. Cognitive behavioural therapy (CBT), which may include stimulus control, sleep restriction, relaxation techniques and sleep hygiene education is well supported by evidence. It should therefore be offered to patients, including older adults. (Level A Evidence) Rec 1.
- Decisions to prescribe pharmacological treatment should be made on an individual basis, after serious consideration of all risks and possible benefits.
- Effective pharmacological therapies include benzodiazepines and Z drugs (benzodiazepine receptor agonists), and both should be treated with the same cautions. (Level A Evidence) Rec 2, Rec 3
- Short-term or intermittent dosing of benzodiazepines should be used to reduce the risk of tolerance and dependence. (Level B Evidence) Rec 4, Rec 5.
- Pharmacological treatment should be accompanied by specific patient education, regular review and continued efforts to employ the lowest effective dosage of medication, and to taper medication when conditions allow.
Note: When access to CBT is an issue, GPs and practice nurses may consider offering brief behavioural therapy to patients (refer to www.racgp.org.au/your-practice/guidelines/handi/interventions/mental-health/ brief-behavioural-therapy-for-insomnia-in-adults).