Disorders of Sleep in Women: Insomnia

Insomnia is defined as a persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment. A comprehensive history and physical examination differentiate the subtypes of insomnia: acute, chronic, and associated with comorbid disorders. Evaluation of insomnia entails understanding the predisposing, precipitating, and perpetuating factors of insomnia unique to each person. Effective treatment is incomplete without implementing cognitive-behavioral therapy for behaviors nonconducive to sleep as monotherapy or in combination with pharmacotherapy. Setting realistic goals and expectations of quality and quantity of sleep required to feel rested determine treatment success and outcomes. This article reviews the prevalence, symptoms, subtypes, and diagnosis and management of insomnia, particularly in women with emotional and hormonal changes of symptomatic premenstrual syndrome, pregnancy, and menopause. [ Psychiatr Ann. 2019;49(12):518–523.]