Insomnia.

Abstract

OBJECTIVE This article reviews sleep basics, including stages, need, changes with aging, sleep drive, and circadian rhythm, to provide a normative framework and to reveal potential opportunities for insomnia intervention. In addition, it elucidates the symptoms, causes, consequences, diagnosis, and treatment of insomnia, including the role of sleep aids and cognitive behavioral therapy (CBT) for insomnia. LATEST DEVELOPMENTS The wide-ranging consequences of insomnia are increasingly appreciated, with research highlighting its detrimental effects on health. Newer medication options include three orexin receptor antagonists. Home-based sleep tracking may allow screening to identify contributing factors, including sleep disorders that require treatment, and assessment of the environment for early intervention to optimize sleep. Existing and emerging wearable technology and software as digital therapy will increase access to CBT for insomnia through increasingly individualized programs. ESSENTIAL POINTS Insomnia is the most common sleep disorder, with significant effects on quality of life and long-term health. Optimizing the sleep drive and circadian rhythm, addressing underlying causes, reducing hyperarousal, and enhancing conditioning are key components of improving the disorder. Over-the-counter and prescription sleep aids may have a limited role because of modest benefits and the potential for side effects. CBT for insomnia remains the preferred treatment, with a growing number of novel modes of access.