BMJ Best Practice Podcast Insomnia
Apr 21, 2025
John Winkelman, a leading sleep disorders expert from Massachusetts General Hospital and Harvard Medical School, dives into the widespread issue of insomnia, affecting 10% to 30% of the population. He discusses the serious implications of insomnia, such as accidents and decreased work productivity. Winkelman highlights the importance of understanding long-term insomnia, identifying its various factors, and tailoring treatments. He emphasizes the value of cognitive behavioral therapy and the complexities of prescribing medications while addressing concerns about addiction.
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Assess Insomnia Duration and Type
- Determine insomnia duration to differentiate short-term from chronic insomnia disorder.
- Identify if the problem is trouble falling asleep or staying asleep to guide treatment.
Comprehensive Insomnia Evaluation
- Ask about behavioral, cognitive, medical, psychiatric contributors and medications impacting sleep.
- Screen for anxiety, mood disorders, restless leg syndrome, sleep apnea, and circadian rhythm issues.
Targeted Insomnia Testing
- Order home sleep apnea tests if obstructive sleep apnea is suspected.
- Check iron levels in restless leg syndrome and consider thyroid disorder as contributor.