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Insomnia disorder involves persistent difficulty initiating or maintaining sleep, or early morning awakening with inability to return to sleep, causing significant distress or daytime impairment.
Quick Answer
Insomnia disorder involves persistent difficulty initiating or maintaining sleep, or early morning awakening with inability to return to sleep, causing significant distress or daytime impairment. Dr. Ruja Shrestha (NMC 19766, Experienced clinical practice in psychiatry and mental health) evaluates insomnia disorder at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, Opposite of Yak & Yeti Hotel, Kathmandu 44600, Nepal — evidence-based, medically reviewed.
Insomnia disorder is characterized by recurrent complaints of difficulty with sleep onset, maintenance, or early awakening, occurring at least three nights per week for at least three months, with associated daytime impairment. It is the most common sleep disorder, affecting 10-15% of adults. Insomnia has bidirectional relationships with psychiatric conditions (depression, anxiety) and medical conditions (chronic pain, cardiovascular disease). Cognitive-behavioral therapy for insomnia (CBT-I) is first-line treatment.
Clinical diagnosis based on DSM-5 or ICSD-3 (International Classification of Sleep Disorders) criteria. Assessment includes sleep history, sleep diary, and validated questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index). Polysomnography is not routinely required but may be considered to rule out comorbid sleep disorders (sleep apnea, restless legs syndrome). Screening for comorbid psychiatric conditions and substance use is important.
CBT-I is first-line treatment and more effective than medication in the long term. CBT-I includes sleep restriction, stimulus control, cognitive therapy for dysfunctional beliefs about sleep, sleep hygiene education, and relaxation training. Short-term pharmacotherapy (low-dose trazodone, melatonin receptor agonists, or short-term benzodiazepine receptor agonists) may be considered for acute management. Treating comorbid conditions (depression, anxiety, pain) is essential.
Management is individualized and discussed with benefits, limitations, and follow-up.
Maintaining consistent sleep-wake schedules, creating a sleep-conducive environment, limiting caffeine and alcohol intake (especially in the evening), establishing a relaxing pre-sleep routine, and managing stress effectively. Addressing insomnia symptoms early prevents chronicity.
Most adults need 7-9 hours per night. However, individual needs vary. The key indicator is daytime functioning � if you feel rested and alert during the day, your sleep duration is likely adequate.
Yes. CBT-I is the first-line treatment for chronic insomnia, with response rates of 70-80%. It produces durable improvements and is more effective than medication for long-term outcomes.
Medication should not be first-line for chronic insomnia. CBT-I is preferred. If medication is used, it should be short-term (2-4 weeks) and combined with CBT-I when possible.
Yes � Dr. Jitendra Prasad Yadav (NMC 8029) provides insomnia assessment and treatment at Kathmandu Neurology Clinic & Cognitive Center.
Chronic insomnia is associated with increased risk of depression, anxiety, cardiovascular disease, diabetes, and impaired immune function. Treating insomnia can improve overall health outcomes.
Comprehensive psychiatric evaluation for mood, anxiety, psychosis, and other mental health concerns, including medication assessment and long-term care planning.
Structured, evidence-based cognitive behavioral therapy for anxiety, depression, insomnia, and related conditions.
Evaluation and treatment for major depressive disorder, persistent depressive disorder, and depressive episodes associated with medical conditions.
Generalized anxiety disorder (GAD) involves persistent, excessive worry about everyday matters that is difficult to control and may cause physical symptoms.
Major depressive disorder (MDD) is a common mood disorder characterized by persistent sadness, loss of interest, and a range of emotional and physical symptoms that impair daily functioning.
Substance use disorder (SUD) is a chronic condition involving compulsive use of a substance despite harmful consequences, characterized by loss of control over use and continued use despite adverse effects.
Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-09-04
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.
Doctor — medically reviewed
Dr. Ruja Shrestha
Consultant Psychiatrist & CBT Therapist • MBBS, MD (Psychiatry) • NMC 19766
This condition guide was medically reviewed by Dr. Ruja Shrestha.
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