Authors’ approach
The author’s insomnia management approach includes detailed sleep
history taking focusing on behavior around the bed and sleep, stress,
depression, and laboratory testing (including serum thyroid-stimulating
hormone and free T3 and free T4). Furthermore, we consider
adjusting/replacing medications that may disturb sleep (e.g.,
corticosteroids and SSRI antidepressants). We also make an effort to
control symptoms of comorbid diseases (e.g., chronic pain, nocturia,
chronic cough, pruritus). The first-line treatment in our clinical
practice is nonpharmacologic, focusing on sleep hygiene and stimulus
control. In the author’s opinion, most of these patients do not require
sleep specialist referral and can be managed by general practitioners. A
primary care physician may consider referral to a sleep specialist for
refractory cases or if the diagnosis is in doubt. Sleep physicians may
indicate paraclinical examinations such as polysomnography and
actigraphy in those patients.