Secondary insomnia: diagnostic challenges and intervention opportunities.
The assessment and treatment of secondary insomnia (SI), the most common form of insomnia, are often complicated. Establishing an accompanying disorder as causal rather than comorbid is the key to assessment, but can be difficult even for experienced clinicians. Treatment often focuses on the primary disorder. In many cases, however, there is reason to treat the insomnia directly (insomnia is partially independent, does not respond to treatment of the primary condition, or has been misdiagnosed as SI). Although hypnotic medications are frequently used, behavioral interventions may be the best treatment approach, providing better long-term management of symptoms. Older adults warrant special consideration as age-related illnesses, changes in drug absorption and metabolism, and polypharmacy make them especially susceptible to SI. Recent research suggests successful treatment of insomnia may also relieve the primary disorder and merits follow-up. Future research is also needed on the efficacy of psychological treatment for SI for specific disorders as well as for older adults.