Chronic insomnia is defined as difficulty falling asleep, staying asleep, or early-morning awakening occurring at least 3 nights per week for at least 3 months, with associated daytime impairment (DSM-5 and ICSD-3 criteria). Shorter episodes are typically classified as acute or short-term insomnia.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment per the 2021 AASM clinical practice guideline. It is the only intervention with sustained benefit beyond one year. Sleep medications are second-line and are typically used for short-term symptom relief while CBT-I is being learned.

Sleep medications can help short-term but are not first-line for chronic insomnia. Risks include dependence, tolerance, next-day sedation, and falls in older adults. AASM recommends CBT-I before or alongside medication. Discuss benefits and risks specific to your situation with your physician.

Yes. Sleep-related breathing disorders including OSA can present as insomnia, particularly difficulty maintaining sleep or early-morning awakening. This is sometimes called "comisa" (comorbid insomnia and sleep apnea). A sleep study may be indicated when insomnia does not respond to standard treatment or when OSA risk factors are present.

Consider sleep specialist evaluation if insomnia persists more than 3 months, causes meaningful daytime impairment, does not respond to CBT-I or initial medication, or is accompanied by symptoms suggesting OSA, restless legs, or other primary sleep disorders.