1.0 Introduction Insomnia Is the Most Commonly Reported Sleep Problem, Not Only in the United States, but in Industrialized Nations

INSOMNIA IS THE MOST COMMONLY REPORTED SLEEP PROBLEM, NOT ONLY IN THE UNITED STATES, BUT IN INDUSTRIALIZED NATIONS WORLDWIDE.1-5 Although the scope of the problem is large, most insomniacs do not seek medical treatment6 and physician training in the recognition of sleep specific symptoms continues to be minimal.7-9 The high incidence of insomnia complaints in conjunction with the minimal recognition of the problem by healthcare professionals has led to an underestimation of the tangible consequences of chronic insomnia. For example, poor sleep may be associated with a perceived decrease in quality of life, an increase in physical complaints, and economic repercussions including decreased work productivity.6 There may also be dangerous and expensive consequences in the form of occupational and vehicular accidents secondary to poor quality sleep.10-12 Even more sobering are data which suggest that decreased sleep time and use of sleeping pills are associated with increased mortality.13,14 The magnitude of this problem indicates that routine clinical assessment and treatment of insomnia complaints may have important health consequences for the patient. The objectives of this paper are threefold. The first is to review the current literature on diagnostic practices in the clinical evaluation of insomnia. The second is to present an overview of key features associated with an insomnia complaint. The third is to address the methods by which healthcare professionals can obtain comprehensive information regarding the nature of the disorder, its consequences, and potential contributing factors. Only clinical evaluation will be presented here since polysomnographic evaluation has been addressed elsewhere.15,16