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.