Before referral, assess for medical causes and consider pain, depression, anxiety, or other primary psychiatric causes. Consider other sleep disorders (e.g., sleep apnea) that can cause insomnia and refer to UM Sleep Disorders Center. Consider referral to our clinic if insomnia/circadian rhythm disorder persists despite adequate management of other contributing conditions.
We emphasize cognitive-behavioral treatment (CBT) and other non-pharmacological approaches to the management of sleep disorders, as well as integration of pharmacological and non-pharmacological approaches to sleep problems. CBT is specifically indicated for patients with chronic difficulties (3+ nights/week for more than a month) initiating or maintaining sleep, whether primary or co-morbid with stable psychiatric/medical conditions. Transient insomnia episodes can be managed with hypnotics. Medications should be viewed as short-term, symptom-focused therapy. All patients should be counseled about good sleep practices and advised that non-pharmacological treatments are often preferable for long-term management of sleep problems.
Suggested Additional Test/Management Prior to Specialty Visit
Laboratory tests to rule out medical conditions that can cause insomnia (e.g., thyroid conditions).