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Chronic Insomnia / Insomnia Disorder


Insomnia is a very common sleep disorder which negatively impacts mental and physical health and leads to increased healthcare costs. The information provided in this resource is intended for all primary care providers involved in the care of adult patients with 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.1

Insomnia disorder:

  • Is present for >3 nights per week for 3 months or more
  • Occurs despite adequate opportunity for sleep
  • Is characterised by patient reported:

i. Difficulty initiating sleep defined by sleep latency (time taken to fall asleep >30 min)

ii. Difficulty maintaining sleep (wake periods >30 min) and unable to fall back to sleep

iii. Early waking (termination of sleep >30 minutes before desired wake time) and unable to fall back to sleep

  • Is accompanied by impaired daytime functioning including:

i. Stress

ii. Concerns and worries

iii. Impaired attention, concentration and memory

iv. Mood disturbance

v. Headaches

vi. Pervasive malaise

vii. GI symptoms

viii. Deterioration in work performance

ix. Fatigue, lethargy, weariness

x. Tiredness, sleepiness

Insomnia disorder affects health-related quality of life and can have serious consequences including:

Many patients with insomnia disorder have unrealistic expectations of sleep, poor sleep habits, or inappropriate attributions about the association of daytime symptoms and nocturnal sleep. Cognitive Behavioural Therapy for insomnia (CBTi) targets these factors to improve the insomnia.2, 3, 4, 5

Successful management of insomnia requires identification of the multiple factors that may play a role, including nocturnal and daytime insomnia symptoms, assessment of risk factors, perpetuating factors, and other co-morbid conditions. It is important to consider co-morbid mental and physical conditions which may share bi-directional relationships with insomnia. When co-occurring with other conditions, insomnia is responsive to targeted insomnia-treatment, which often improves management of the other condition too.

First line treatment for insomnia disorder includes non-drug therapy such as Brief Behavioural Therapy for Insomnia (BBTi) and Cognitive Behavioural Therapy for Insomnia (CBTi). These non-drug treatments include behavioural and cognitive modifications to break the cycle of poor sleep habits and self-fulfilling worry about chronic poor sleep, and are a better long-term strategy than any pharmacotherapy as they are associated with fewer harms and therapeutic improvements in sleep and daytime functioning that are sustained over time.6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22


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. Johnson KA, et al. The association of insomnia disorder characterised by objective short sleep duration with hypertension, diabetes and body mass index: A systematic review and meta-analysis. Sleep Medicine Reviews. 202
  3. Li L,et al. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC psychiatry. 2016;16(1):375
  4. Meng L, et al. The relationship of sleep duration and insomnia to risk of hypertension incidence: a meta-analysis of prospective cohort studies. Hypertension Research. 2013;36(11):985-995
  5. Baglioni C, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of affective disorders, 2011;135(1-3):10-19
  6. Sweetman A, et al. Insomnia treatment Improved access to effective nondrug options. Medicine Today 2020;21(11);14-20
  7. Wilson SJ, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010;24(11):1577–601
  8. Bloom HG, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriat Soc. 2009;57(5):761–89
  9. Guideline Development Group for the management of patients with insomnia in primary care. Clinical Practice Guidelines for the management of patients with Insomnia in Primary Care. UETS No 2007/5-1. Madrid: Ministry of Health and Social Policy, 2009
  10. Winkelman JW. Overview of the treatment of insomnia in adults. In UpToDate Benca R (ed). Waltham, MA: UpToDate, 2020
  11. Katz DA, et al. Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med. 1998;158(10):1099–107
  12. Krystal AD. Psychiatric comorbidity: the case for treating insomnia. Sleep Med Clin. 2006;1:359
  13. Cunnington D, et al. Insomnia: prevalence, consequences and effective treatment. Med J Aust. 2013;199(8):S36-40
  14. Kierlin L. Sleeping without a pill: non pharmacological treatments for insomnia. Journal of Psychiatric Practice. 2008;14(6):403-7
  15. Hasora P, et al. Nonpharmacological management of chronic insomnia. American Family Physician. 2009;79(2):125-30
  16. Montgomery P, et al. Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2003(1):CD003161
  17. Mitchell MD, et al. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract. 2012;13:40
  18. Buysse DJ, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171(10):887-95
  19. Fernando A, et al. A double-blind randomised controlled study of a brief intervention of bedtime restriction for adult patients with primary insomnia. J Prim Health Care. 2013;5(1):5-10
  20. Troxel WM, et al. Clinical management of insomnia with brief behavioral treatment (BBTI). Behav Sleep Med. 2012;10(4):266-79
  21. Royal Australian College of General Practitioners. Handbook of non-drug interventions (HANDI). Brief behavioural therapy: insomnia in adults. Melbourne: RACGP;2014
  22. Montgomery P, et al. Physical exercise for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2002(4):CD003404