Diagnosis and treatment of insomnia and risks associated with lack of treatment.

Despite the fact that the prevalence rate for insomnia in the United States is high (35.2%), the number of patients with this condition do not represent a large percentage of patients evaluated and treated in sleep disorders clinics. On the other hand, the great majority of patients with insomnia do not seek treatment for their condition from their physicians. Several hypotheses have been created to explain this phenomenon: (1) lack of training for physicians in the area of sleep disorders, (2) pessimism in relation to treatment outcome shared by patients and physicians, and (3) time constraints and other reasons on the part of the physicians. Insomniacs, however, deserve accurate diagnosis and effective treatments for their condition. Insomnia is often the result of multiple factors converging rather than one single cause. For academic purposes, however, different disorders in difficulties with initiation and maintenance of sleep are discussed. Among them, adjustment sleep disorder, obstructive sleep apnea, periodic limb movements in sleep, circadian abnormalities, and psychiatric disturbances. Emphasis is placed on the treatment of each, along with the treatment of the other factors that are commonly found in patients with insomnia: poor sleep hygiene, use of medications that disrupt sleep, performance anxiety, deficient exposure to entrainers of circadian rhythms, diet, and exercise. A comprehensive treatment that includes a multifactorial approach is the ideal way to treat patients with insomnia. Research that will enhance our knowledge of the biological substrate of insomnia will provide clinicians with additional tools to improve the outcome of their treatments of patients with insomnia.