Chronic insomnia is diagnosed by the presence of symptoms that (1) cause substantial functional distress or impairment; (2) occur at least 3 nights per week for at least 3 months; and (3) are not associated with other sleep, medical, or mental disorders.

Management

1. CBT-I and improved sleep hygiene is the preferred first line therapy
2. Pharmacologic therapy can be trialled on a short term basis vis shared decision making:
   1. low-dose doxepin
   2. nonbenzodiazepine GABA agonists (zolpidem, zaleplon, eszopiclone) which can improve subjective sleep latency, total sleep time, and sleep quality outcomes

Trazodone is not routinely recommended; it does improve the subjective measure of sleep quality but does not affect other sleep characteristics

References

1. MKSAP 19