Insomnia
topic
Insomnia is the most prevalent sleep disorder — affecting 10–15% of adults as a chronic condition and 30–35% occasionally — characterized by difficulty initiating sleep (sleep-onset insomnia), difficulty maintaining sleep through the night (sleep-maintenance insomnia), or early morning awakening with inability to return to sleep, despite adequate opportunity for sleep, producing daytime impairment in mood, cognition, or function. It is primarily driven by hyperarousal (physiological, cognitive, and emotional activation that prevents the nervous system transition required for sleep onset) and perpetuated by conditioned arousal and dysfunctional beliefs about sleep.
Role
Insomnia is the most over-medicated and most under-behaviorally-treated sleep disorder in modern healthcare. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most evidence-supported long-term treatment — showing superior outcomes to sleep medication at 6-month follow-up and without the dependence, tolerance, and withdrawal risks — yet sleep medications are prescribed far more frequently because they produce faster symptom relief and require less therapeutic investment. The majority of people with chronic insomnia have never received CBT-I and have never been told it is more effective long-term than the medications they are taking.