An integrative approach to the management of insomnia

Over the last three decades, an evolution has occurred in our understanding of the nature of chronic insomnia, the guidelines for its identification, and the methods for its treatment. The conceptualization of insomnia is generally agreed to be contingent on the patient’s subjective perception of unsatisfactory sleep quantity and/or quality, rather than on the actual amount of sleep deficit. Factors contributing to the aetiopathogenesis of chronic insomnia can be divided into three categories: predisposing, precipitating, and perpetuating. Assessment of the patient’s overall clinical problem should be conducted in an individualized and integrative fashion, while special attention should be given to any psychopathology or psychological distress, which is quite common but often denied. Because of its multifaceted and variable aetiopathogenesis, chronic insomnia necessitates a multidimensional treatment plan. The treatment modalities are broadly divided into non-pharmacological ones (sleep hygiene education, cognitive-behavioural techniques, and/or psychodynamic psychotherapy) and pharmacological ones (mainly the use of benzodiazepine or non-benzodiazepine hypnotics, at the initial stages). In an integrative therapeutic approach, two or more treatment modalities are combined and their application is based on a sound patient-doctor relationship.