26 - Insomnia

Summary

Chronic insomnia affects up to 10% of American adults, and exacts a major personal and societal burden. Cognitive behavioral therapy for insomnia (CBT-I) has become the gold standard therapy for primary insomnia, and has demonstrated efficacy for comorbid insomnia. A variety of objective and subjective measures have a role in clinical insomnia trials. Practical considerations of these measures are introduced in the chapter. The chapter highlights the examples of some recent clinical trials that evaluated non-pharmacologic, pharmacologic, or dual therapies for insomnia. Early studies focused nearly exclusively on changes in sleep parameters with treatment, but the importance of including collateral clinical measures and relevant assessments of daytime functioning has become increasingly recognized. In general, hypnotic trials have evaluated efficacy over short-term periods, weeks to months. A few population based studies have examined the direct and indirect costs of untreated insomnia.