The Bidirectional Relationship Between Insomnia and Comorbid Disorders


Insomnia is often comorbid with psychiatric, medical, and neurologic disorders. Follow along as Dr Rosenberg discusses the bidirectional relationship between insomnia disorder and frequently co-occurring conditions.

Target Audience

  • Psychiatrists, primary care clinicians, and neurologists
  • Nurse practitioners and physician assistants in psychiatry, primary care, and neurology settings

Learning Objective

Distinguish chronic insomnia from medical or psychiatric disorders


Insomnia is often comorbid with psychiatric, medical, and neurologic disorders. For years, insomnia was thought to be secondary to various disorders; therefore, it did not receive the attention it needed because the other disorder was viewed as playing the primary role in the insomnia problem. However, our thinking has moved away from treating the other condition to resolve the insomnia toward treating insomnia as a separate condition. Insomnia and comorbid conditions have a bidirectional effect, with the status of each impacting the other, potentially affecting the treatment course and outcome. This report describes conditions that commonly appear in patients with insomnia.

From the Series: Current Management Approaches for Insomnia
To cite: Rosenberg R. The Bidirectional Relationship Between Insomnia and Comorbid Disorders. J Clin Psychiatry. 2021;82(2):EI20008BR2C.
To share:
© Copyright 2021 Physicians Postgraduate Press, Inc.

Activity summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation
Activity opens: 
Activity expires: 

Support Statement

Supported by an educational grant from Eisai, Inc.

Learning Objective

After completing this educational activity, you should be able to:

  • Distinguish chronic insomnia from medical or psychiatric disorders

Release, Review, and Expiration Dates

This brief report activity was published in February 2021 and is eligible for AMA PRA Category 1 Credit™ through February 28, 2023. The latest review of this material was November 2020.

Statement of Need and Purpose

Clinicians are not vigilant enough in documenting patients’ sleep histories. Because insomnia frequently accompanies psychiatric or medical illnesses and has a variety of negative consequences, clinicians must routinely screen patients for sleep-onset or sleep-maintenance insomnia. Therefore, education is needed to address clinicians’ incomplete understanding and assessment of insomnia. In addition, many clinicians are failing to provide recommended treatments for insomnia because they have reservations about the safety and appropriateness of some agents. Lack of understanding about the differences between treatments can prevent them from explaining and providing insomnia treatment options to patients. Education for clinicians about both approved and unapproved treatments is warranted to improve their management of insomnia. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on insomnia.

Disclosure of Off-Label Usage

Dr Rosenberg has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this activity.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.


This activity is derived from the teleconference series “Current Management Approaches for Insomnia,” which was held in June, September, and October 2020 and supported by an educational grant from Eisai Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

Faculty Affiliation

Russell P. Rosenberg, PhD
Atlanta School of Sleep Medicine and Technology and NeuroTrials Research, Inc., Georgia


Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:

Dr Rosenberg is a consultant and member of the speakers/advisory boards for Jazz, Eisai, and Harmony BioSciences and has received grant/research support from Jazz, Eisai, and Avadel.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.



Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

Available Credit

  • 0.50 AMA PRA Category 1 Credit™
  • 0.50 Participation


Please login or register to take this activity.

Register for free on our site to participate in this and many other free CME courses.