Ten percent to 40% of adults have intermittent insomnia, and 15% have long-term sleep difficulties. This article provides a review of the classification, differential diagnosis, and treatment options available for insomnia. We performed a MEDLINE search using OVID and the key words "insomnia," "sleeplessness," "behavior modification," "herbs," "medicinal," and "pharmacologic therapy." Articles were selected based on their relevance to the topic. Evaluation of insomnia includes a careful sleep history, review of medical history, review of medication use (including over-the-counter and herbal medications), family history, and screening for depression, anxiety, and substance abuse. Population-based studies estimate that 10% to 40% of American adults have intermittent insomnia; 10% to 15% have long-term sleep difficulties.
2Insomnia has been associated with decreases in work performance and increases in motor vehicle accidents and hospitalization rates.3 Cost estimates for lost productivity and insomnia-related accidents exceed $100 billion per year. 4 The purpose of this review is to provide a current review of the classification, the differential diagnosis, and treatment options for insomnia. We performed a MEDLINE search using OVID and the key words "insomnia," "sleeplessness," "behavior modification," "herbs," "medicinal," and "pharmacologic therapy." Abstracts were reviewed by 2 of the authors (ENR, SLP). Articles were then selected based on relevance to the topical review.