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Diagnosing and Treating Insomnia in Adults and Older Adults
Overview
Drs Rosenberg and Krystal identify key steps in the diagnosis and treatment of insomnia disorder.
Target Audience
Psychiatrists, primary care clinicians, and neurologists; nurse practitioners and & physician assistants in psychiatry, primary care, and neurology settings
Learning Objectives
- Routinely include sleep history and use screening tools as part of patient assessment
- Develop an effective evidence-based treatment plan for patients with insomnia
Abstract
Insomnia, the most prevalent sleep-wake disorder, affects 6% to 10% of adults. It may result in interpersonal and occupational problems and has a deleterious effect on quality of life. Patients may experience difficulty with sleep onset, sleep maintenance, or both. Insomnia disorder is commonly comorbid with psychiatric, medical, and neurologic disorders, and insomnia and comorbid conditions have bidirectional relationships. Diagnosis should be based on patient interview, assessment with tools, and use of criteria. Selection of treatment for patients with insomnia should factor in efficacy for the patient’s specific complaint as well as other features such as safety profile and abuse liability. Cognitive-behavioral therapy for insomnia is a first-line recommendation by guidelines, but some patients are unable or unwilling to try it or may not respond to it. Older adults with insomnia disorder require careful consideration of medications’ risk-benefit profiles.
From the Series: Current Management Approaches for Insomnia
To cite: Rosenberg RP, Krystal AD. Diagnosing and treating insomnia in adults and older adults. J Clin Psychiatry. 2021;82(6):EI20008AH5C.
To share: https://doi.org/10.4088/JCP.EI20008AH5C
© Copyright 2021 Physicians Postgraduate Press, Inc.
Support Statement
Supported by an educational grant from Eisai Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Routinely include sleep history and use screening tools as part of patient assessment
- Develop an effective evidence-based treatment plan for patients with insomnia
Release, Review, and Expiration Dates
This Academic Highlights activity was published in September 2021 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2023. The latest review of this material was August 2021.
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.
Disclosure of Off-Label Usage
The faculty members have determined that, to the best of their knowledge, trazodone, mirtazapine, amitriptyline, quetiapine, olanzapine, risperidone, lurasidone, and melatonin are not approved by the US Food and Drug Administration for the treatment of insomnia.
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.
Acknowledgment
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
Andrew D. Krystal, MD
Department of Psychiatry and Behavioral Sciences, University of California San Francisco
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. Dr Krystal is a consultant for or receives research support from Adare, Axsome Therapeutics, Big Data, Eisai, Evecxia Therapeutics, Ferring, Galderma, Harmony Biosciences, Idorsia, Janssen, Jazz, Millenium, Merck, Neurocrine Biosciences, Pernix Therapeutics, Otsuka, Sage Therapeutics, and Takeda and has received grant/research support from Janssen, Axsome Therapeutics, Reveal Biosensors, The Ray and Dagmar Dolby Family Fund, and the National Institutes of Health.
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 1.00 AMA PRA Category 1 Credit™. 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
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation