• Definition and Prevalence
• Clinical Presentation
• Risk Factors
• Diagnosis and Differential Diagnosis
• Treatment and Management
• Pharmacologic Treatment

Risk Factors
Long-term or chronic insomnia may be caused by chron-ic medical conditions, such as cerebrovascular disease, arthritis, chronic obstructive pulmonary disease, and neurologic disorders. The pain and discomfort associated with these disorders may interfere with sleep. Psychiat-ric disorders are strongly related to the insomnia complaint.

Depression is one of the most common causes of insomnia, and depressive symptoms are very common in the elderly population. Alerting or stimulating medications may cause insomnia, such as CNS stimulants, decongestants, beta-blockers, calcium channel blockers, corticosteroids, bronchodilators, and stimulating antidepressants. Substances such as alcohol, caffeine, and nicotine can all cause insomnia. Sedating medications may cause daytime drowsiness, which may lead to daytime napping, which subsequently may also lead to insomnia at night. Circadian rhythm changes with age may also present as an insomnia complaint.