Insomnia in primary care: Considerations for screening, assessment, and management

Abstract

Insomnia, including insomnia disorder, is a common but often overlooked complaint in primary care settings. It is a risk factor for various medical and psychiatric diagnoses and is associated with substantial health care costs. While cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder, access to CBT-I is limited. This article provides a pragmatic approach to screening, assessment, and treatment of insomnia in the primary care setting, promoting a population health approach. The authors review the role of CBT-I, treatment of comorbid conditions, and pharmacologic recommendations in working with primary care patients with insomnia. In addition, the authors highlight the potential utility of technology in improving access to insomnia care.

Sleep related movement disorders in the elderly: a review of recent literature

“…Sleep related movement disorders are common in individuals over age 55, and may be underrecognized by patients and providers (Mathew et al, 2020). Routine screening assessments of sleep health at primary care visits, even with the simple questions on the commonly used Patient Health Questionnaire-9 (PHQ-9), may alert a provider to symptoms of poor sleep and prompt more detailed sleep history-taking (Senthilvel et al, 2011;Gordon et al, 2022;Yamamoto et al, 2023). Collateral history from a partner or caregiver can provide additional insight into a person's nighttime behaviors and movements, triggering further work up for SRMD like RLS, PLMD, NMC, or SB as discussed in this review.…”