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Acute Insomnia

General practitioners (GPs) play a key role in the diagnosis and management of short-term or acute insomnia (present for <3 months) and chronic insomnia or insomnia disorder (present for 3 months or more). Psychological issues including insomnia are among the most common reasons for GP consultations. 12

Acute insomnia is: 3, 4

  • Present for <3 months
  • The most common form of insomnia
  • Often related to an identifiable psychologic or physiologic stressor (e.g. emotional or financial stress, physical illness)
  • Expected to resolve when the stressor is removed or when the patient adapts to the stressor

Most patients experiencing episodes of acute insomnia do not develop insomnia disorder. Providing reassurance support to the patient is therefore worthwhile as a first line management strategy.

The clinical approach to managing acute insomnia includes discussing the role that any stressor is having in disturbing the sleep.

Precipitating factors that initiate the insomnia may include:

  • Stressful life event (e.g. death in family, relationship difficulties, job loss, starting a new job, newborn)
  • Pain (including gastro-oesophageal reflux) or itch (e.g. eczema)
  • Menopause
  • Shift work (day and night shifts) including hospitality work
  • Travel between time zones
  • Circadian disruption (e.g. daylight savings)
  • Environmental factors (e.g. noise disturbance, temperature)
  • Lifestyle risk factors including the use of non-illicit substances that contain caffeine (e.g. coffee and black tea, energy drinks, gels, shots, electrolyte replacements, protein, meal/weight replacement shakes) and alcohol
  • Medication
  • Medical disorders

Management options for acute insomnia in primary care may furthermore include:

If pharmacological therapy is used, e.g. sedative-hypnotic medicines (benzodiazepines, 'z-drugs'):

  • They should be prescribed at the lowest effective dose
  • For the shortest possible duration (i.e. <4 weeks)
  • With an early established strategy to withdraw from sedative-hypnotic use to prevent patterns of long-term use and/or dependence

AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/mental-health/cognitive-behavioural-therapy-for-chronic-insomnia
  2. Royal Australian College of General Practitioners. Health of the Nation: Summary Report. Royal Australian College of General Practitioners (RACGP): Health Profession Health Australia. 2022.
  3. International Classification of Sleep Disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine 2014
  4. Winkelman JW. Overview of the treatment of insomnia in adults. In UpToDate, Benca R (ed). Waltham, MA: UpToDate 2020