INTRODUCTION
International Classification of Sleep Disorders, 3rd edition (ICSD-3)
distinct insomnia to acute and chronic (insomnia symptoms
>3 nights per week for >3
months).1 Various symptoms of sleep disorders comprise
difficulty initiating sleep, difficulty maintaining sleep, and
nonrestorative sleep.2 Prevalence of insomnia is
alarming high as it affects 6% to 10% of the adult
population.3 Insomnia is more prevalent in females and
older individuals.4 Besides primary insomnia, comorbid
sleep disorders are also common accompanying different
diseases/conditions, e.g., chronic pain, nocturia, chronic cough,
pruritus, emotional trauma, and pregnancy.5,6 Sleep
difficulties are also common complaints of shift workers. If not
adequately treated, insomnia can result in psychopathological
conditions, hypertension, and other serious health
problems.7 Treatment options for insomnia cover
pharmacological and non-pharmacological approaches. Commonly used agents
are benzodiazepine receptor agonists, sedating antidepressants, sedating
antihistamines, melatonin receptor agonists, and dual orexin receptor
antagonists.7 However, all medications are associated
with their potential side effects. Being aware of the possible side
effects of hypnotic/sedating drugs is particularly important in elderly
patients. Regarding geriatric patients using
hypnotic/sedating medication, an
increased risk of falls, physical dependence, and confusion have been
documented.8 Considering the possible adverse effects
of the above-mentioned agents, a non-pharmacologic approach should be
preferred in most cases.9 Of the patients presenting
with insomnia symptoms, most do not require sleep specialist referral
and can be managed by general practitioners.10Notably, in relation to the COVID-19 pandemic, 43.5% of sleep
departments in the Czech Republic and Slovakia completely interrupted
their service. In similar situations, primary care physicians may need
to manage insomnia symptoms even in more complicated
cases.11 Multicomponent behavioral therapy and
psychotherapy are considered first-line treatment according to
guidelines of the American College of Physicians, European Sleep
Research Society, and British Association for
Psychopharmacology.12,13,14 The non-pharmacological
treatment components are cognitive-behavioral therapy for insomnia
(CBT-i), sleep hygiene, stimulus control, sleep restriction,
psychotherapy and relaxation techniques, exercise, complementary and
alternative approaches, e.g., phototherapy, massage, music therapy,
aromatherapy, herbal medicine, acupuncture/acupressure.