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

Mari Yamamoto; Christopher T Lim; Heather Huang; Margaret Spottswood; Hsiang Huang

doi:10.1177/27550834231156727

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

J Med Access. 2023 Mar 15:7:27550834231156727. doi: 10.1177/27550834231156727. eCollection 2023 Jan-Dec.

Authors

Mari Yamamoto¹, Christopher T Lim², Heather Huang³, Margaret Spottswood^{4

5}, Hsiang Huang^{6

7}

Affiliations

¹ Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA.
² Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
³ Departments of Internal Medicine and Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, USA.
⁵ Community Health Centers of Burlington, Burlington, VT, USA.
⁶ Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
⁷ Harvard Medical School, Boston, MA, USA.

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.

Keywords: Sleep initiation and maintenance disorders; behavioral medicine; cognitive behavioral therapy for insomnia (CBT-I); insomnia; insomnia treatment; primary health care.

Publication types

Review