Principles of treating insomnia in adults

Note: Aim to improve sleep quality and quantity, and relieve distress and daytime impairment.

The goals of treating insomnia are to reduce nocturnal hyperarousal, improve sleep quality and quantity, and relieve distress and daytime impairment. Use the following multimodal approach to achieve these goals:

address factors affecting sleep—for example, treat contributing disorders or, if a drug is thought to be causing insomnia, change the administration time, reduce the dose or change to another drug
encourage good sleep practices
use other psychological and behavioural interventions.

Ask the patient to keep a sleep diary to monitor their sleep and treatment progress.

Review a patient with insomnia regularly. Chronic insomnia can be a primary disorder and should be treated independently of related conditions. Consider referral to a sleep expert if the patient does not respond to therapy.

Although widely used, pharmacological therapy has a limited role in the treatment of insomnia—see here for advice.

Patients are often interested in taking complementary medicines to treat insomnia. Limited evidence suggests that complementary medicines (eg valerian, chamomile, hops, wuling, passionflower, kava) are no more effective than placebo for treating insomnia. Although these herbs appear to be generally well tolerated and are only associated with mild adverse effects, kava and valerian have very rarely caused liver damage. Advise patients interested in taking complementary medicines to visit the Sleep Health Foundation website for further information.

For additional considerations in treating insomnia in:

older people, see here
dementia, see here
the perinatal period, see here
inpatient settings, see here
long-term hypnotic use, see here
problem substance use, see here.

For considerations in treating psychiatric disorders in females of childbearing potential, see here.