Journal of Clinical Sleep Medicine, Vol. 4, No. 5, 2008 487 SUMMARY RECOMMENDATIONS General:  Insomnia is an important public health problem that re- quires accurate diagnosis and effective treatment. (Stan- dard)  An insomnia diagnosis requires associated daytime dys- function in addition to appropriate insomnia symptomatol- ogy. (ICSD-2 deinition) Evaluation:  Insomnia is primarily diagnosed by clinical evaluation through a thorough sleep history and detailed medical, sub- stance, and psychiatric history. (Standard) • The sleep history should cover speciic insomnia com- plaints, pre-sleep conditions, sleep-wake patterns, oth- er sleep-related symptoms, and daytime consequences. (Consensus) • The history helps to establish the type and evolution of insomnia, perpetuating factors, and identiication of comorbid medical, substance, and/or psychiatric con- ditions. (Consensus)  Instruments which are helpful in the evaluation and dif- ferential diagnosis of insomnia include self-administered questionnaires, at-home sleep logs, symptom checklists, psychological screening tests, and bed partner interviews. (Guideline) • At minimum, the patient should complete: (1) A gen- eral medical/psychiatric questionnaire to identify co- morbid disorders (2) The Epworth Sleepiness Scale or other sleepiness assessment to identify sleepy patients and comorbid disorders of sleepiness (3) A two-week sleep log to identify general patterns of sleep-wake times and day-to-day variability. (Consensus) • Sleep diary data should be collected prior to and dur- ing the course of active treatment and in the case of relapse or reevaluation in the long-term. (Consensus) • Additional assessment instruments that may aid in the baseline evaluation and outcomes follow-up of pa- tients with chronic insomnia include measures of sub- jective sleep quality, psychological assessment scales, daytime function, quality of life, and dysfunctional beliefs and attitudes. (Consensus)  Physical and mental status examination may provide im- portant information regarding comorbid conditions and differential diagnosis. (Standard)  Polysomnography and daytime multiple sleep latency test- ing (MSLT) are not indicated in the routine evaluation of chronic insomnia, including insomnia due to psychiatric or neuropsychiatric disorders. (Standard) • Polysomnography is indicated when there is reason- able clinical suspicion of breathing (sleep apnea) or movement disorders, when initial diagnosis is uncer- tain, treatment fails (behavioral or pharmacologic), or precipitous arousals occur with violent or injurious behavior. (Guideline) Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults Sharon Schutte-Rodin, M.D. 1 ; Lauren Broch, Ph.D. 2 ; Daniel Buysse, M.D. 3 ; Cynthia Dorsey, Ph.D. 4 ; Michael Sateia, M.D. 5 1 Penn Sleep Centers, Philadelphia, PA; 2 Good Samaritan Hospital, Suffern, NY; 3 UPMC Sleep Medicine Center, Pittsburgh, PA; 4 SleepHealth Centers, Bedford, MA; 5 Dartmouth-Hitchcock Medical Center, Lebanon, NH Submitted for publication July, 2008 Accepted for publication July, 2008 Address correspondence to: Sharon L. Schutte-Rodin, M.D., Penn Sleep Centers, University of Pennsylvania Health System, 3624 Market St., 2 nd Floor, Philadelphia, PA 19104; Tel: (215) 615-3669; Fax: (215) 615-4835; E-mail: rodins@hphs.upenn.edu SpECIAl ARTIClE Insomnia is the most prevalent sleep disorder in the general popula- tion, and is commonly encountered in medical practices. Insomnia is deined as the subjective perception of dificulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate oppor- tunity for sleep, and that results in some form of daytime impairment. 1 Insomnia may present with a variety of speciic complaints and eti- ologies, making the evaluation and management of chronic insomnia demanding on a clinician’s time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such pa- rameters do not exist. Unless otherwise stated, “insomnia” refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks. Citation: Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. Clinical guideline for the evaluation and management of chronic in- somnia in adults. J Clin Sleep Med 2008;4(5):487-504.