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Patient information: See related handout on insomnia, written by the authors of this article. Physicians may initiate treatment of insomnia at an initial visit; for patients with a clear acute stressor such as grief, no further evaluation may be indicated. An approach to the evaluation and treatment of the patient with insomnia is shown in Figure 1. However, if insomnia is severe or long-lasting, a thorough evaluation to uncover coexisting medical, neurologic, or psychiatric illness is warranted.

If the initial evaluation identifies an acute stressor such as grief or noise, no further evaluation is indicated and treatment can be initiated. Treatment should begin with nonpharmacologic therapy, addressing sleep hygiene issues and exercise. A more comprehensive evaluation should be pursued with nonresponders or if a comorbid condition is present or suspected.The evaluation of chronic insomnia should involve a detailed history and examination to detect any coexisting medical or psychiatric illness and may include an interview with a partner or caregiver.
Food and Drug Administration (FDA) to treat circadian rhythm sleep disorder in blind children and adults, but it is unregulated and preparations vary greatly in strength.

Exercise improves sleep as effectively as benzodiazepines in some studies and, given its other health benefits, is recommended for patients with insomnia.
Benzodiazepines are most useful for short-term treatment; however, long-term use may lead to adverse effects and withdrawal phenomena.

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