🕷️ Crawler Inspector

URL Lookup

Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 113 (from laksa142)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa113.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://bestpractice.bmj.com/topics/en-gb/227\')), getAhrefsUnparsedNoserviceFromURL(\'https://bestpractice.bmj.com/topics/en-gb/227\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227","crawl_time":1765618796,"first_indexed_time":0,"http_code":200,"src_unparsed":"com,bmj!bestpractice,\/topics\/en-gb\/227 s443","src_root_hash":"7270522143396850113","history_drop_reason":null,"meta_title":"Insomnia - Symptoms, diagnosis and treatment | BMJ Best Practice","meta_descriptions":["Insomnia is one of the most common complaints reported in primary care. Diagnosis is made primarily by patient interview. Sleep diaries, actigraphy, and polysomnography may assist in confirming diagnosis. Identification of the correct aetiology, contributing factors, and\/or comorbidities is essen..."],"attrs_boilerpipe_text":"Dr Joshua Hyong-Jin Cho, Dr Paul Barkopoulos, and Dr Anthony E. Reading would like to gratefully acknowledge Dr John W. Winkelman, Dr Teofilo Lee-Chiong, and Dr Vipin Malik, previous contributors to this topic. Disclosures JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation. TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.","attrs_markdown":"[Skip to main content](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227#main-content)[Skip to search](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227#mainSearchField)\n\n- Log in\n\n- [Personal account](https:\/\/bestpractice.bmj.com\/log-in)\n- [Access through your institution](https:\/\/bestpractice.bmj.com\/access-through-your-institution)[(Open Athens)](https:\/\/bestpractice.bmj.com\/oac)\n\n- [Subscribe](https:\/\/bestpractice.bmj.com\/info\/subscribe)\n- [Access through your institution](https:\/\/bestpractice.bmj.com\/access-through-your-institution)\n- [Log in](https:\/\/bestpractice.bmj.com\/log-in)\n\n[Home](https:\/\/bestpractice.bmj.com\/info\/)\n\n[Home](https:\/\/bestpractice.bmj.com\/info\/)\n\n![open menu](https:\/\/bestpractice.bmj.com\/images\/burger-menu.svg)\n\n- [About us](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  Overview[What is BMJ Best Practice?](https:\/\/bestpractice.bmj.com\/info\/about-bmj-best-practice)[Our history](https:\/\/bestpractice.bmj.com\/info\/history-of-bmj-best-practice)\n  \n  Key features[Clinical tools](https:\/\/bestpractice.bmj.com\/info\/clinical-tools) [Local guidance](https:\/\/bestpractice.bmj.com\/info\/local-guidance)[Earn CME\/CPD points](https:\/\/bestpractice.bmj.com\/info\/earn-cme-cpd-points)[Comorbidities Manager](https:\/\/bestpractice.bmj.com\/info\/\/comorbidities)[Access anywhere](https:\/\/bestpractice.bmj.com\/info\/access-anywhere)[Our app](https:\/\/bestpractice.bmj.com\/info\/\/app)[Integration](https:\/\/bestpractice.bmj.com\/info\/integration)\n  \n  Our Evidence approach[Trusted content](https:\/\/bestpractice.bmj.com\/info\/trusted-content)[Updating process](https:\/\/bestpractice.bmj.com\/info\/evidence-based)\n- [Who we help](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  Best Practice for...[Clinicians](https:\/\/bestpractice.bmj.com\/info\/clinicians)[Hospitals](https:\/\/bestpractice.bmj.com\/info\/hospitals)[Medical librarians](https:\/\/bestpractice.bmj.com\/info\/us\/librarian)[Medical schools](https:\/\/bestpractice.bmj.com\/info\/medical-schools)[Medical students](https:\/\/bestpractice.bmj.com\/info\/medical_student)[Nurses](https:\/\/bestpractice.bmj.com\/info\/nurses)[Pharmacists](https:\/\/bestpractice.bmj.com\/info\/pharmacists)[Primary care](https:\/\/bestpractice.bmj.com\/info\/clinics)[Paramedics](https:\/\/bestpractice.bmj.com\/info\/paramedics)[Telehealth](https:\/\/bestpractice.bmj.com\/info\/telehealth)\n- [How we help](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  Impact and effectiveness[Evidence of effectiveness](https:\/\/bestpractice.bmj.com\/info\/impact\/evidence-of-effectiveness) [Global impact](https:\/\/bestpractice.bmj.com\/info\/global_impact)[Customer stories](https:\/\/bestpractice.bmj.com\/info\/recent-updates)\n- [Browse clinical content](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  [Recent updates](https:\/\/bestpractice.bmj.com\/recent-updates)\n  \n  [Specialties](https:\/\/bestpractice.bmj.com\/specialties)\n  \n  [Try a free topic](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000086)\n  \n  [Patient information](https:\/\/bestpractice.bmj.com\/patient-leaflets)\n  \n  [Videos](https:\/\/bestpractice.bmj.com\/procedural-videos)\n  \n  [Calculators](https:\/\/bestpractice.bmj.com\/calculators)\n- [What’s new](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  [Clinical updates](https:\/\/bestpractice.bmj.com\/recent-updates)\n  \n  [News](https:\/\/bestpractice.bmj.com\/info\/news)\n  \n  [Podcast](https:\/\/bestpractice.bmj.com\/info\/podcast)\n- [Access](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  Log in via...[Personal subscription or user profile](https:\/\/bestpractice.bmj.com\/log-in)[Access through your institution](https:\/\/bestpractice.bmj.com\/access-through-your-institution)\n  \n  [Access code](https:\/\/myaccount.bmj.com\/myaccount\/signup.html?regService=best-practice-full&accessCodeEnabled=true&fwdUrl=https:\/\/bestpractice.bmj.com)\n  \n  [Subscribe](https:\/\/bestpractice.bmj.com\/info\/subscribe)\n  \n  [Free trial](https:\/\/bestpractice.bmj.com\/info\/free-trial)\n  \n  [How do I get access?](https:\/\/bestpractice.bmj.com\/info\/how-do-i-get-access)\n  \n  [Download the app](https:\/\/bestpractice.bmj.com\/info\/app)\n- [Help](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  [FAQs](https:\/\/bestpractice.bmj.com\/info\/faq)\n  \n  [How do I get access?](https:\/\/bestpractice.bmj.com\/info\/how-do-i-get-access)\n  \n  [Contact us](https:\/\/bestpractice.bmj.com\/info\/contact-us)\n\nWhen viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.\n\nOK\n\nCancel\n\n# Insomnia\n[View PDF](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227\/pdf\/227\/Insomnia.pdf)\n\n[ Menu Close](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n\n- Overview \n- Theory \n- Diagnosis \n- Management \n- Follow up \n- Resources \n\n- [Overview](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  - [Summary](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n- [Theory](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  - Epidemiology\n  - Aetiology\n  - Case history\n- [Diagnosis](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  - Approach\n  - History and exam\n  - Investigations\n  - Differentials\n  - Criteria\n- [Management](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  - Approach\n  - Treatment algorithm\n  - Emerging\n  - Prevention\n  - Patient discussions\n- [Follow up](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  - Monitoring\n  - Complications\n  - Prognosis\n- [Resources](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227)\n  - Guidelines\n  - References\n  - Patient information\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\nLast reviewed: 13 Nov 2025\n\nLast updated: 21 Oct 2025\n## Summary\nInsomnia is one of the most common complaints reported in primary care.\n\nDiagnosis is made primarily by patient interview. Sleep diaries, actigraphy, and polysomnography may assist in confirming diagnosis.\n\nIdentification of the correct aetiology, contributing factors, and\/or comorbidities is essential for adequate treatment of insomnia. Their management is necessary, although often not sufficient, for the resolution of insomnia.\n\nThe significant morbidity of insomnia indicates that it is a condition that warrants treatment.\n\nTake an individualised approach to treatment, based on the patient's preferences, the severity of their insomnia, the risks versus benefits of treatment, and the availability of specialist treatment options such as cognitive behavioural therapy.\n\nFor most patients, initial treatment with cognitive behavioural therapy for insomnia (CBT-I) is likely to provide the best balance between efficacy and safety.\n### Definition\nThe Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) defines insomnia disorder (i.e., clinical insomnia) as difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening despite adequate opportunity for sleep; leading to clinically significant distress or impairments in functioning; and with a frequency of 3 or more nights per week and a duration of 3 months or longer.[\\[1\\]](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/227#referencePop1)American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. https:\/\/www.psychiatry.org\/psychiatrists\/practice\/dsm  Insomnia is not explained by the presence of mental disorders or medical conditions and is not associated with another sleep-wake disorder.\n### History and exam\n#### Key diagnostic factors\n- presence of risk factors\n- sleep partner complaints\n- delayed sleep onset\n- multiple or long awakenings\n\nFull details\n\n#### Other diagnostic factors\n- impairment of functioning\n- accidents\n- decreased sleep time\n- daytime napping\n- thyrotoxicosis\n- chronic pain\n- restless legs syndrome\n- obstructive sleep apnoea\n\nFull details\n\n#### Risk factors\n- female sex\n- advanced age\n- chronic medical conditions\n- chronic pain\n- psychiatric illness\n- alcohol or substance misuse\n- stimulant use\n- poor sleep hygiene\n- traumatic brain injury\n- neuropsychiatric illness\n- use of certain medications\n- recent travel across time zones\n- night work\n- hyperthyroidism\n- participation in elite sport\n- sedentary behaviour\n\nFull details\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\n### Diagnostic investigations\n#### 1st investigations to order\n- sleep diary\n- Pittsburgh Sleep Quality Index (PSQI)\n- Insomnia Severity Index (ISI)\n- Stanford Sleepiness Scale (SSS)\n- Epworth Sleepiness Scale (ESS)\n- Athens Insomnia Scale (AIS)\n- Generalised Anxiety Disorder-7 (GAD-7)\n- Patient Health Questionnaire-9 (PHQ-9)\n\nFull details\n\n#### Investigations to consider\n- polysomnography (PSG)\n- actigraphy\n- thyroid-stimulating hormone (TSH)\n- FBC and iron studies\n- urine or blood substance use panel\n\nFull details\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\n### Treatment algorithm\nACUTE\n\n### acute insomnia\nONGOING\n\n### chronic insomnia\n\n[![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\n### Contributors\nVIEW ALLAuthors\n#### Authors\n##### Joshua Hyong-Jin Cho, MD, PhD\nHealth Sciences Clinical Professor\n\nDirector, UCLA Insomnia Clinic\n\nCousins Center for Psychoneuroimmunology\n\nDepartment of Psychiatry & Biobehavioral Sciences\n\nDavid Geffen School of Medicine at UCLA\n\nLos Angeles\n\nCA\n\n###### Disclosures\nJHC is an author of a reference cited in this topic.\n\n##### Paul Barkopoulos, MD, MPH\nClinical Professor\n\nDepartment of Psychiatry & Biobehavioral Sciences\n\nDavid Geffen School of Medicine at UCLA\n\nLos Angeles\n\nCA\n\n###### Disclosures\nPB is an author of a reference cited in this topic.\n\n##### Anthony E. Reading, MPhil, PhD\nClinical Professor\n\nDepartment of Psychiatry & Biobehavioral Sciences\n\nDavid Geffen School of Medicine at UCLA\n\nLos Angeles\n\nCA\n\n###### Disclosures\nAER declares that he has no competing interests.\n\n##### Acknowledgements\nDr Joshua Hyong-Jin Cho, Dr Paul Barkopoulos, and Dr Anthony E. Reading would like to gratefully acknowledge Dr John W. Winkelman, Dr Teofilo Lee-Chiong, and Dr Vipin Malik, previous contributors to this topic.\n\n###### Disclosures\nJWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation. TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.\n\nVIEW ALLPeer reviewers\n\n#### Peer reviewers\n##### Karl Doghramji, MD\nDirector\n\nSleep Disorders Center\n\nThomas Jefferson University Hospital\n\nPhiladelphia\n\nPA\n\n###### Disclosures\nKD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.\n\n##### Chiadi U. Onyike, MD, MHS\nAssistant Professor\n\nGeriatric Psychiatry and Neuropsychiatry\n\nThe Johns Hopkins Hospital\n\nBaltimore\n\nMD\n\n###### Disclosures\nCUO declares that he has no competing interests.\n\n##### Roy Goldberg, MD\nMedical Director\n\nKings Harbor Multicare Center\n\nBronx\n\nNY\n\n###### Disclosures\nRG declares that he has no competing interests.\n\n##### Craig Sawchuk, MD\nAffiliate Assistant Professor\n\nDepartment of Psychiatry and Behavioral Sciences\n\nUniversity of Washington Medical Center\n\nSeattle\n\nWA\n\n###### Disclosures\nCS declares that he has no competing interests.\n\n##### David Cunnington, MD\nDirector\n\nMelbourne Sleep Disorders Centre\n\nMelbourne\n\nVictoria\n\nAustralia\n\n###### Disclosures\nDC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis.\n\n##### Peer reviewer acknowledgements\nBMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.\n\n###### Disclosures\nPeer reviewer affiliations and disclosures pertain to the time of the review.\n\n### References\n*Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.*\n\n#### Key articles\nAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.[Full text](https:\/\/www.psychiatry.org\/psychiatrists\/practice\/dsm)\n\nSateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Feb 15;13(2):307-49.[Full text](https:\/\/jcsm.aasm.org\/doi\/10.5664\/jcsm.6470)  [Abstract](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27998379?tool=bestpractice.com)\n\nQaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33.[Full text](https:\/\/www.acpjournals.org\/doi\/10.7326\/M15-2175)  [Abstract](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27136449?tool=bestpractice.com)\n\nEdinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb 1;17(2):255-62.[Full text](https:\/\/jcsm.aasm.org\/doi\/10.5664\/jcsm.8986)  [Abstract](http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/33164742?tool=bestpractice.com)\n\n#### Reference articles\n##### A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.\n\n- #### Differentials\n  - Restless legs syndrome\n  - Periodic limb movement disorder (PLMD)\n  - Obstructive sleep apnoea (OSA)\n  \n  More Differentials\n- #### Guidelines\n  - Australasian Sleep Association 2024 guidelines for sleep studies in adults\n  - Manual for the scoring of sleep and associated events\n  \n  More Guidelines\n- #### Patient information\n  Insomnia\n  \n  Sleep apnoea in adults (obstructive)\n  \n  More Patient information\n- [![padlock-locked](https:\/\/bestpractice.bmj.com\/images\/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https:\/\/bestpractice.bmj.com\/log-in)\n\nUse of this content is subject to our [disclaimer](https:\/\/bestpractice.bmj.com\/info\/disclaimer\/)\n\n### Log in or subscribe to access all of BMJ Best Practice\nSee all options\n\n×\n\n### Log in or subscribe to access all of BMJ Best Practice\n### Log in to access all of BMJ Best Practice\n[personpersonal subscriptionor user profile](https:\/\/bestpractice.bmj.com\/log-in)\n\n[Access through your institution](https:\/\/bestpractice.bmj.com\/info\/access-through-your-institution\/)\n\nOR\n\n[SUBSCRIPTION OPTIONS](https:\/\/bestpractice.bmj.com\/info\/subscribe\/)\n\n## Browse\n- [Home](https:\/\/bestpractice.bmj.com\/)\n- [Recent updates](https:\/\/bestpractice.bmj.com\/recent-updates)\n- [Specialties](https:\/\/bestpractice.bmj.com\/specialties)\n- [Calculators](https:\/\/bestpractice.bmj.com\/calculators)\n- [Patient information](https:\/\/bestpractice.bmj.com\/patient-leaflets)\n- [Procedural videos](https:\/\/bestpractice.bmj.com\/procedural-videos)\n- [Evidence](https:\/\/bestpractice.bmj.com\/info\/evidence)\n- [Drugs](https:\/\/bestpractice.bmj.com\/drugs)\n\n## Services\n- [Log in](https:\/\/bestpractice.bmj.com\/log-in)\n- [Free trial](https:\/\/bestpractice.bmj.com\/info\/subscribe\/free-trial\/)\n- [Subscribe](https:\/\/bestpractice.bmj.com\/info\/subscribe)\n- [About us](https:\/\/bestpractice.bmj.com\/info\/about-bmj-best-practice)\n- [About CME\/CPD](https:\/\/bestpractice.bmj.com\/info\/earn-cme-cpd-points)\n- [Contact us](https:\/\/bestpractice.bmj.com\/info\/contact-us)\n- [Sign up for email alerts](https:\/\/emails.bmj.com\/k\/Bmj\/marketing_permission_opt_in)\n\n## Legal\n- [Disclaimer](https:\/\/bestpractice.bmj.com\/info\/disclaimer)\n- [Terms and conditions](https:\/\/bestpractice.bmj.com\/topics\/en-gb\/%20https:\/\/www.bmj.com\/company\/legal-information\/)\n- [Privacy notice](https:\/\/bestpractice.bmj.com\/info\/privacy-policy\/)\n- [Cookie policy](https:\/\/www.bmj.com\/company\/your-privacy\/cookies-policy\/)\n- [Accessibility](https:\/\/bestpractice.bmj.com\/info\/accessibility)\n\n- [![Facebook Logo](https:\/\/bestpractice.bmj.com\/images\/icon-facebook.png)External link opens in a new window](https:\/\/www.facebook.com\/BMJBestPractice)\n- [![X Logo](https:\/\/bestpractice.bmj.com\/images\/icon-twitter.png)External link opens in a new window](https:\/\/twitter.com\/BMJBestPractice)\n- [![LinkedIn Logo](https:\/\/bestpractice.bmj.com\/images\/icon-linkedin.png)External link opens in a new window](https:\/\/www.linkedin.com\/showcase\/15218227\/)\n- [![RSS Feed](https:\/\/bestpractice.bmj.com\/images\/rss.svg)External link opens in a new window](https:\/\/bestpractice.bmj.com\/info\/rss-feeds)\n- [![Youtube Logo](https:\/\/bestpractice.bmj.com\/images\/icon-youtube.png)External link opens in a new window](https:\/\/www.youtube.com\/channel\/UCt72GZ0cPXpk4EzgFhdWYdQ)\n\n© BMJ Publishing Group 2025\n\nISSN 2515-9615\n\n[![Eco-Friendly Web Alliance](https:\/\/bestpractice.bmj.com\/images\/EFWA-logo-2026.png)](https:\/\/ecofriendlyweb.org\/client\/bmj-best-practice\/)\n\nCookie Settings\n\n## Help us improve BMJ Best Practice\nClose ×\n\nPlease complete all fields.\n\n## Thank you\nYour feedback has been submitted successfully.\n\n FEEDBACK\n\n![](https:\/\/dc.ads.linkedin.com\/collect\/?pid=103646&fmt=gif)\n\n","attrs_readable_markdown":null,"meta_canonical":null}

3. Robots.txt Check

Query:

Response:

4. Spam/Ban Check

Query:

Response:

5. Seen Status Check

ℹ️ Skipped - page is already crawled

📄

INDEXABLE

✅

CRAWLED

3 months ago

🤖

ROBOTS ALLOWED

Page Info Filters

Filter	Status	Condition	Details
HTTP status	PASS	`download_http_code = 200`	HTTP 200
Age cutoff	PASS	`download_stamp > now() - 6 MONTH`	3.9 months ago
History drop	PASS	`isNull(history_drop_reason)`	No drop reason
Spam/ban	PASS	`fh_dont_index != 1 AND ml_spam_score = 0`	ml_spam_score=0
Canonical	PASS	`meta_canonical IS NULL OR = '' OR = src_unparsed`	Not set

Page Details

Property	Value
URL	https://bestpractice.bmj.com/topics/en-gb/227
Last Crawled	2025-12-13 09:39:56 (3 months ago)
First Indexed	not set
HTTP Status Code	200
Meta Title	Insomnia - Symptoms, diagnosis and treatment \| BMJ Best Practice
Meta Description	Insomnia is one of the most common complaints reported in primary care. Diagnosis is made primarily by patient interview. Sleep diaries, actigraphy, and polysomnography may assist in confirming diagnosis. Identification of the correct aetiology, contributing factors, and/or comorbidities is essen...
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Boilerpipe Text	Dr Joshua Hyong-Jin Cho, Dr Paul Barkopoulos, and Dr Anthony E. Reading would like to gratefully acknowledge Dr John W. Winkelman, Dr Teofilo Lee-Chiong, and Dr Vipin Malik, previous contributors to this topic. Disclosures JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation. TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap.
Markdown	[Skip to main content](https://bestpractice.bmj.com/topics/en-gb/227#main-content)[Skip to search](https://bestpractice.bmj.com/topics/en-gb/227#mainSearchField) - Log in - [Personal account](https://bestpractice.bmj.com/log-in) - [Access through your institution](https://bestpractice.bmj.com/access-through-your-institution)[(Open Athens)](https://bestpractice.bmj.com/oac) - [Subscribe](https://bestpractice.bmj.com/info/subscribe) - [Access through your institution](https://bestpractice.bmj.com/access-through-your-institution) - [Log in](https://bestpractice.bmj.com/log-in) [Home](https://bestpractice.bmj.com/info/) [Home](https://bestpractice.bmj.com/info/) ![open menu](https://bestpractice.bmj.com/images/burger-menu.svg) - [About us](https://bestpractice.bmj.com/topics/en-gb/227) Overview[What is BMJ Best Practice?](https://bestpractice.bmj.com/info/about-bmj-best-practice)[Our history](https://bestpractice.bmj.com/info/history-of-bmj-best-practice) Key features[Clinical tools](https://bestpractice.bmj.com/info/clinical-tools) [Local guidance](https://bestpractice.bmj.com/info/local-guidance)[Earn CME/CPD points](https://bestpractice.bmj.com/info/earn-cme-cpd-points)[Comorbidities Manager](https://bestpractice.bmj.com/info//comorbidities)[Access anywhere](https://bestpractice.bmj.com/info/access-anywhere)[Our app](https://bestpractice.bmj.com/info//app)[Integration](https://bestpractice.bmj.com/info/integration) Our Evidence approach[Trusted content](https://bestpractice.bmj.com/info/trusted-content)[Updating process](https://bestpractice.bmj.com/info/evidence-based) - [Who we help](https://bestpractice.bmj.com/topics/en-gb/227) Best Practice for...[Clinicians](https://bestpractice.bmj.com/info/clinicians)[Hospitals](https://bestpractice.bmj.com/info/hospitals)[Medical librarians](https://bestpractice.bmj.com/info/us/librarian)[Medical schools](https://bestpractice.bmj.com/info/medical-schools)[Medical students](https://bestpractice.bmj.com/info/medical_student)[Nurses](https://bestpractice.bmj.com/info/nurses)[Pharmacists](https://bestpractice.bmj.com/info/pharmacists)[Primary care](https://bestpractice.bmj.com/info/clinics)[Paramedics](https://bestpractice.bmj.com/info/paramedics)[Telehealth](https://bestpractice.bmj.com/info/telehealth) - [How we help](https://bestpractice.bmj.com/topics/en-gb/227) Impact and effectiveness[Evidence of effectiveness](https://bestpractice.bmj.com/info/impact/evidence-of-effectiveness) [Global impact](https://bestpractice.bmj.com/info/global_impact)[Customer stories](https://bestpractice.bmj.com/info/recent-updates) - [Browse clinical content](https://bestpractice.bmj.com/topics/en-gb/227) [Recent updates](https://bestpractice.bmj.com/recent-updates) [Specialties](https://bestpractice.bmj.com/specialties) [Try a free topic](https://bestpractice.bmj.com/topics/en-gb/3000086) [Patient information](https://bestpractice.bmj.com/patient-leaflets) [Videos](https://bestpractice.bmj.com/procedural-videos) [Calculators](https://bestpractice.bmj.com/calculators) - [What’s new](https://bestpractice.bmj.com/topics/en-gb/227) [Clinical updates](https://bestpractice.bmj.com/recent-updates) [News](https://bestpractice.bmj.com/info/news) [Podcast](https://bestpractice.bmj.com/info/podcast) - [Access](https://bestpractice.bmj.com/topics/en-gb/227) Log in via...[Personal subscription or user profile](https://bestpractice.bmj.com/log-in)[Access through your institution](https://bestpractice.bmj.com/access-through-your-institution) [Access code](https://myaccount.bmj.com/myaccount/signup.html?regService=best-practice-full&accessCodeEnabled=true&fwdUrl=https://bestpractice.bmj.com) [Subscribe](https://bestpractice.bmj.com/info/subscribe) [Free trial](https://bestpractice.bmj.com/info/free-trial) [How do I get access?](https://bestpractice.bmj.com/info/how-do-i-get-access) [Download the app](https://bestpractice.bmj.com/info/app) - [Help](https://bestpractice.bmj.com/topics/en-gb/227) [FAQs](https://bestpractice.bmj.com/info/faq) [How do I get access?](https://bestpractice.bmj.com/info/how-do-i-get-access) [Contact us](https://bestpractice.bmj.com/info/contact-us) When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance. OK Cancel # Insomnia [View PDF](https://bestpractice.bmj.com/topics/en-gb/227/pdf/227/Insomnia.pdf) [ Menu Close](https://bestpractice.bmj.com/topics/en-gb/227) - Overview  - Theory  - Diagnosis  - Management  - Follow up  - Resources  - [Overview](https://bestpractice.bmj.com/topics/en-gb/227) - [Summary](https://bestpractice.bmj.com/topics/en-gb/227) - [Theory](https://bestpractice.bmj.com/topics/en-gb/227) - Epidemiology - Aetiology - Case history - [Diagnosis](https://bestpractice.bmj.com/topics/en-gb/227) - Approach - History and exam - Investigations - Differentials - Criteria - [Management](https://bestpractice.bmj.com/topics/en-gb/227) - Approach - Treatment algorithm - Emerging - Prevention - Patient discussions - [Follow up](https://bestpractice.bmj.com/topics/en-gb/227) - Monitoring - Complications - Prognosis - [Resources](https://bestpractice.bmj.com/topics/en-gb/227) - Guidelines - References - Patient information [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) Last reviewed: 13 Nov 2025 Last updated: 21 Oct 2025 ## Summary Insomnia is one of the most common complaints reported in primary care. Diagnosis is made primarily by patient interview. Sleep diaries, actigraphy, and polysomnography may assist in confirming diagnosis. Identification of the correct aetiology, contributing factors, and/or comorbidities is essential for adequate treatment of insomnia. Their management is necessary, although often not sufficient, for the resolution of insomnia. The significant morbidity of insomnia indicates that it is a condition that warrants treatment. Take an individualised approach to treatment, based on the patient's preferences, the severity of their insomnia, the risks versus benefits of treatment, and the availability of specialist treatment options such as cognitive behavioural therapy. For most patients, initial treatment with cognitive behavioural therapy for insomnia (CBT-I) is likely to provide the best balance between efficacy and safety. ### Definition The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) defines insomnia disorder (i.e., clinical insomnia) as difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening despite adequate opportunity for sleep; leading to clinically significant distress or impairments in functioning; and with a frequency of 3 or more nights per week and a duration of 3 months or longer.[\[1\]](https://bestpractice.bmj.com/topics/en-gb/227#referencePop1)American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. https://www.psychiatry.org/psychiatrists/practice/dsm Insomnia is not explained by the presence of mental disorders or medical conditions and is not associated with another sleep-wake disorder. ### History and exam #### Key diagnostic factors - presence of risk factors - sleep partner complaints - delayed sleep onset - multiple or long awakenings Full details #### Other diagnostic factors - impairment of functioning - accidents - decreased sleep time - daytime napping - thyrotoxicosis - chronic pain - restless legs syndrome - obstructive sleep apnoea Full details #### Risk factors - female sex - advanced age - chronic medical conditions - chronic pain - psychiatric illness - alcohol or substance misuse - stimulant use - poor sleep hygiene - traumatic brain injury - neuropsychiatric illness - use of certain medications - recent travel across time zones - night work - hyperthyroidism - participation in elite sport - sedentary behaviour Full details [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) ### Diagnostic investigations #### 1st investigations to order - sleep diary - Pittsburgh Sleep Quality Index (PSQI) - Insomnia Severity Index (ISI) - Stanford Sleepiness Scale (SSS) - Epworth Sleepiness Scale (ESS) - Athens Insomnia Scale (AIS) - Generalised Anxiety Disorder-7 (GAD-7) - Patient Health Questionnaire-9 (PHQ-9) Full details #### Investigations to consider - polysomnography (PSG) - actigraphy - thyroid-stimulating hormone (TSH) - FBC and iron studies - urine or blood substance use panel Full details [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) ### Treatment algorithm ACUTE ### acute insomnia ONGOING ### chronic insomnia [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) ### Contributors VIEW ALLAuthors #### Authors ##### Joshua Hyong-Jin Cho, MD, PhD Health Sciences Clinical Professor Director, UCLA Insomnia Clinic Cousins Center for Psychoneuroimmunology Department of Psychiatry & Biobehavioral Sciences David Geffen School of Medicine at UCLA Los Angeles CA ###### Disclosures JHC is an author of a reference cited in this topic. ##### Paul Barkopoulos, MD, MPH Clinical Professor Department of Psychiatry & Biobehavioral Sciences David Geffen School of Medicine at UCLA Los Angeles CA ###### Disclosures PB is an author of a reference cited in this topic. ##### Anthony E. Reading, MPhil, PhD Clinical Professor Department of Psychiatry & Biobehavioral Sciences David Geffen School of Medicine at UCLA Los Angeles CA ###### Disclosures AER declares that he has no competing interests. ##### Acknowledgements Dr Joshua Hyong-Jin Cho, Dr Paul Barkopoulos, and Dr Anthony E. Reading would like to gratefully acknowledge Dr John W. Winkelman, Dr Teofilo Lee-Chiong, and Dr Vipin Malik, previous contributors to this topic. ###### Disclosures JWW has received honoraria for consulting to Avadel, CVS, Eisai, and Merck, and research grants from Merck and the RLS Foundation. TLC is the Chief Medical Liaison for Philips, a company that makes devices to treat sleep apnoea. VM received research funding from Philips Respironics for a study on COPD-OSA overlap. VIEW ALLPeer reviewers #### Peer reviewers ##### Karl Doghramji, MD Director Sleep Disorders Center Thomas Jefferson University Hospital Philadelphia PA ###### Disclosures KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck. ##### Chiadi U. Onyike, MD, MHS Assistant Professor Geriatric Psychiatry and Neuropsychiatry The Johns Hopkins Hospital Baltimore MD ###### Disclosures CUO declares that he has no competing interests. ##### Roy Goldberg, MD Medical Director Kings Harbor Multicare Center Bronx NY ###### Disclosures RG declares that he has no competing interests. ##### Craig Sawchuk, MD Affiliate Assistant Professor Department of Psychiatry and Behavioral Sciences University of Washington Medical Center Seattle WA ###### Disclosures CS declares that he has no competing interests. ##### David Cunnington, MD Director Melbourne Sleep Disorders Centre Melbourne Victoria Australia ###### Disclosures DC has received consulting fees from Sanofi-Aventis and Lundbeck, and honoraria for speaking from Sanofi-Aventis. ##### Peer reviewer acknowledgements BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic. ###### Disclosures Peer reviewer affiliations and disclosures pertain to the time of the review. ### References Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible. #### Key articles American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.[Full text](https://www.psychiatry.org/psychiatrists/practice/dsm) Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Feb 15;13(2):307-49.[Full text](https://jcsm.aasm.org/doi/10.5664/jcsm.6470) [Abstract](http://www.ncbi.nlm.nih.gov/pubmed/27998379?tool=bestpractice.com) Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33.[Full text](https://www.acpjournals.org/doi/10.7326/M15-2175) [Abstract](http://www.ncbi.nlm.nih.gov/pubmed/27136449?tool=bestpractice.com) Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb 1;17(2):255-62.[Full text](https://jcsm.aasm.org/doi/10.5664/jcsm.8986) [Abstract](http://www.ncbi.nlm.nih.gov/pubmed/33164742?tool=bestpractice.com) #### Reference articles ##### A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice. - #### Differentials - Restless legs syndrome - Periodic limb movement disorder (PLMD) - Obstructive sleep apnoea (OSA) More Differentials - #### Guidelines - Australasian Sleep Association 2024 guidelines for sleep studies in adults - Manual for the scoring of sleep and associated events More Guidelines - #### Patient information Insomnia Sleep apnoea in adults (obstructive) More Patient information - [![padlock-locked](https://bestpractice.bmj.com/images/padlock-lock.svg)Log in or subscribe to access all of BMJ Best Practice](https://bestpractice.bmj.com/log-in) Use of this content is subject to our [disclaimer](https://bestpractice.bmj.com/info/disclaimer/) ### Log in or subscribe to access all of BMJ Best Practice See all options × ### Log in or subscribe to access all of BMJ Best Practice ### Log in to access all of BMJ Best Practice [personpersonal subscriptionor user profile](https://bestpractice.bmj.com/log-in) [Access through your institution](https://bestpractice.bmj.com/info/access-through-your-institution/) OR [SUBSCRIPTION OPTIONS](https://bestpractice.bmj.com/info/subscribe/) ## Browse - [Home](https://bestpractice.bmj.com/) - [Recent updates](https://bestpractice.bmj.com/recent-updates) - [Specialties](https://bestpractice.bmj.com/specialties) - [Calculators](https://bestpractice.bmj.com/calculators) - [Patient information](https://bestpractice.bmj.com/patient-leaflets) - [Procedural videos](https://bestpractice.bmj.com/procedural-videos) - [Evidence](https://bestpractice.bmj.com/info/evidence) - [Drugs](https://bestpractice.bmj.com/drugs) ## Services - [Log in](https://bestpractice.bmj.com/log-in) - [Free trial](https://bestpractice.bmj.com/info/subscribe/free-trial/) - [Subscribe](https://bestpractice.bmj.com/info/subscribe) - [About us](https://bestpractice.bmj.com/info/about-bmj-best-practice) - [About CME/CPD](https://bestpractice.bmj.com/info/earn-cme-cpd-points) - [Contact us](https://bestpractice.bmj.com/info/contact-us) - [Sign up for email alerts](https://emails.bmj.com/k/Bmj/marketing_permission_opt_in) ## Legal - [Disclaimer](https://bestpractice.bmj.com/info/disclaimer) - [Terms and conditions](https://bestpractice.bmj.com/topics/en-gb/%20https://www.bmj.com/company/legal-information/) - [Privacy notice](https://bestpractice.bmj.com/info/privacy-policy/) - [Cookie policy](https://www.bmj.com/company/your-privacy/cookies-policy/) - [Accessibility](https://bestpractice.bmj.com/info/accessibility) - [![Facebook Logo](https://bestpractice.bmj.com/images/icon-facebook.png)External link opens in a new window](https://www.facebook.com/BMJBestPractice) - [![X Logo](https://bestpractice.bmj.com/images/icon-twitter.png)External link opens in a new window](https://twitter.com/BMJBestPractice) - [![LinkedIn Logo](https://bestpractice.bmj.com/images/icon-linkedin.png)External link opens in a new window](https://www.linkedin.com/showcase/15218227/) - [![RSS Feed](https://bestpractice.bmj.com/images/rss.svg)External link opens in a new window](https://bestpractice.bmj.com/info/rss-feeds) - [![Youtube Logo](https://bestpractice.bmj.com/images/icon-youtube.png)External link opens in a new window](https://www.youtube.com/channel/UCt72GZ0cPXpk4EzgFhdWYdQ) © BMJ Publishing Group 2025 ISSN 2515-9615 [![Eco-Friendly Web Alliance](https://bestpractice.bmj.com/images/EFWA-logo-2026.png)](https://ecofriendlyweb.org/client/bmj-best-practice/) Cookie Settings ## Help us improve BMJ Best Practice Close × Please complete all fields. ## Thank you Your feedback has been submitted successfully.  FEEDBACK ![](https://dc.ads.linkedin.com/collect/?pid=103646&fmt=gif) 
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