AAFP Home Page Journals Vol. 60/No. 5 (October 1, 1999)
Chronic Insomnia: A Practical Review
A patient information handout on insomnia, written by the authors of this article, is provided on page 1441. A pproximately one third of American adults report that they have sleep problems, and nearly one half of persons with insomnia consider the difficulty to be serious. Not only does insomnia cause daytime drowsiness, it may impair quality of life in other ways; poor sleepers have been found to receive fewer promotions, to have increased rates of absenteeism and to demonstrate poor productivity. Also, the risk of motor vehicle crashes is increased in this group because of fatigue. Transient, or intermittent, insomnia lasts only a few days and is usually related to identifiable factors such as acute medical illness, changes in the sleeping environment, self-medication, jet lag and acute or recurring stress from work problems, concerns about health, marital strife, etc. In most cases, this type of insomnia can be relieved with appropriate attention to the inciting stimulus. Chronic insomnia is best defined as the subjective experience of an inadequate quantity or quality of sleep that has persisted for at least one month. Chronic insomnia is more complex than acute transient insomnia, requiring a more directed approach to its identification, etiology and treatment. After establishing the chronicity of the complaint, a differential assessment of chronic insomnia can be made on the basis of whether the patient has difficulty staying asleep as opposed to difficulty falling asleep
- VIJAY RAJPUT, M.D.
- Robert Wood Johnson Medical School, Camden, New Jersey
- STEVEN M. BROMLEY, M.D.
- University of Pennsylvania Health System, Philadelphia, Pennsylvania