Insomnia disorder
ICD-10 F51.01
- ~0%
- US adults with weekly insomnia symptoms
- 0-15%
- with chronic insomnia disorder
- CBT-I
- first-line per AASM
- ~0%
- respond to first-line CBT-I
What is insomnia disorder?
Insomnia disorder is persistent difficulty falling asleep, staying asleep, or non-restorative sleep, with daytime functional impairment, occurring ≥3 nights per week for ≥3 months. Affects 10-15% of US adults chronically. Often secondary to anxiety, depression, pain, or substance use.
What are the symptoms of insomnia disorder?
- Difficulty falling asleep (sleep-onset insomnia)
- Frequent awakenings or trouble returning to sleep (sleep-maintenance insomnia)
- Early-morning awakening before desired wake time
- Daytime fatigue, irritability, or impaired concentration
- Symptoms occurring ≥3 nights/week for ≥3 months (chronic threshold)
Who is at risk for insomnia disorder?
- Mood disorders (depression, anxiety) — bidirectional relationship
- Female sex (lifetime prevalence ~1.5× men)
- Age — prevalence rises after 60
- Shift work and irregular sleep schedules
- Caffeine, nicotine, alcohol exposure (alcohol fragments sleep architecture)
- Medications: stimulants, decongestants, some antidepressants, corticosteroids
- Chronic pain, GERD, restless legs syndrome (treat the underlying driver)
How is insomnia disorder diagnosed?
Clinical, supported by sleep diary 1-2 weeks and validated tools (Insomnia Severity Index). Polysomnography is not routinely needed unless evaluating for sleep apnea or periodic limb movement disorder. Rule out shift-work disorder and circadian rhythm sleep-wake disorders.
How is insomnia disorder treated?
First-line: cognitive behavioral therapy for insomnia (CBT-I) — better long-term outcomes than medications. Pharmacotherapy: low-dose doxepin, melatonin agonists (ramelteon), orexin antagonists (suvorexant, daridorexant) for chronic insomnia. Z-drugs (zolpidem, eszopiclone) for short-term use only. Benzodiazepines avoided due to tolerance and falls risk.
Authority reference: aasm.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults · American Academy of Sleep Medicine, 2017
- Cognitive Behavioral Therapy for Insomnia: A Meta-Analysis · Annals of Internal Medicine, 2015 · PMID 26054060
People also ask
Are sleep medications safe long-term?
Z-drugs (zolpidem, eszopiclone) and benzodiazepines carry tolerance, dependence, and falls risks especially in older adults — AASM guidelines limit them to short-term use. Newer orexin antagonists (suvorexant, daridorexant) and low-dose doxepin appear safer for chronic use but long-term data is still maturing. Non-pharmacologic CBT-I outperforms long-term medication on most outcomes.
Does melatonin work for insomnia?
Melatonin shifts circadian timing — useful for shift work, jet lag, and delayed sleep phase disorder. Effect on chronic insomnia is modest (reduces sleep onset by ~7 minutes vs placebo in meta-analyses). Quality varies widely between OTC supplements; doses on labels often exceed what's clinically useful. Prescription ramelteon is the regulated melatonin agonist.
What is CBT-I and where can I get it?
Cognitive behavioral therapy for insomnia is a structured 6-8 session program targeting sleep restriction, stimulus control, cognitive restructuring, and relaxation. It outperforms medication on long-term outcomes. Available from sleep psychologists, sleep medicine clinics, and digital programs (Sleepio, Somryst — FDA-cleared as prescription digital therapeutic).
Is insomnia caused by depression or vice versa?
Both. The relationship is bidirectional — insomnia precedes depression in ~40% of cases and follows it in another ~30%. Treating the underlying mood disorder typically improves sleep; treating insomnia in depressed patients improves depression outcomes. Many SSRIs cause insomnia as a side effect during the activation window.