Dysfunctions of sleep and the human circadian rhythm are issues that often appear in the primary care physician’s office in myriad forms. These include direct complaints of sleep difficulties or as intransigent medical or mental health problems. This supplement provides insight into the recognition and evaluation of sleep problems and interventions effective in helping patients. Gary S. Richardson, M.D., begins with an update on our rapidly advancing understanding of circadian rhythm mechanisms and disorders arising in the brain homeostatic systems involved. Thomas Roth, Ph.D., then identifies the prevalence of insomnia in the general population and in primary care practice, risk factors (especially psychiatric problems), consequences of insomnia on function and quality of life, and treatments including over-the-counter treatments used by those affected. Larry Culpepper, M.D., M.P.H., provides a primary care perspective on insomnia, including cues to recognition and diagnostic evaluation and differentiation from other sleep disorders, and strategies for management of insomnia. The pharmacologic and nonpharmacologic therapeutic options currently available, including promising new treatments directly affecting neurologic processes involved in the circadian rhythm, are discussed by Milton K. Erman, M.D. Insomnia becomes increasingly prevalent and problematic among older patients, with both the insomnia itself and the medications that are often used likely to significantly impair mental and physical function. Sonia Ancoli-Israel, Ph.D., reviews management options most beneficial in the elderly, with particular attention to new pharmacologic agents, including those directed at the circadian rhythm. Finally, Roland R. Griffiths, Ph.D., and Matthew W. Johnson, Ph.D., provide an approach to defining the abuse potential of medications used for insomnia, with a grading system for current and emerging agents. With the insights from this supplement, primary care physicians are well positioned to understand and effectively manage insomnia for their patients’ benefit.
Larry Culpepper, MD, MPH
Editor in Chief
The Primary Care Companion to the Journal of Clinical Psychiatry