Insomnia
What Is It?
Difficulty initiating or maintaining sleep, or non-restorative sleep, with daytime impairment occurring 3 or more nights per week for 3 or more months.
How Is It Diagnosed?
Sleep diary, Insomnia Severity Index (ISI), PSQI questionnaire. Rule out sleep apnea, restless legs, medication effects, mood disorders.
How Is It Treated?
Cognitive behavioral therapy for insomnia (CBT-I) is first-line. Sleep hygiene counseling. Short-term medications: melatonin, doxepin, trazodone, zolpidem (use cautiously). Avoid long-term hypnotics.
Tests and Imaging Typically Needed
Sleep diary, ISI scale, TSH, CBC, consider home sleep test if apnea suspected.
Approximate Self-Pay Costs
Office visit: $95-$150. CBT-I (therapist): varies. Sleep medications: $5-$30/month.