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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2013

Treating Insomnia in the Primary Care Setting 

Lack of sleep can interfere with a patient’s ability to function in social and work situations, taking a toll on energy levels, mood, job performance, and overall quality of life. According to the National Sleep Foundation, patients who are experiencing insomnia may report: having trouble falling asleep, waking up frequently throughout the night, difficulty returning to sleep, awakening too early in the morning, having sleep that is not refreshing, daytime sleepiness, difficulty concentrating, and irritability.

Sleep disorders may spring from a variety of sources, and common causes, according to both the National Sleep Foundation and the American Sleep Association, include:

  • Illnesses, including asthma, arthritis, or gastrointestinal disorders
  • Stress
  • Mood disorders, such as anxiety or depression
  • Pain conditions
  • Medications that delay or disrupt sleep
  • Alcohol, tobacco, caffeine, or other substances
  • Other sleep disorders, such as restless leg syndrome
  • Environmental and lifestyle factors, such as a poor sleep environment or a change in your sleep schedule (for example, switching from a day to night shift at work)

An assessment of the root causes of a patient’s sleeplessness should include a comprehensive medical exam; a review of lifestyle factors and sleep habits; and a screening for potential behavioral health conditions. If this examination uncovers a behavioral root cause, such as anxiety, depression, or substance abuse, Harvard Pilgrim providers may refer patients to United Behavioral Health for assistance.

Treatment includes addressing any underlying health problems, recommending good sleep habits, using behavioral approaches such as relaxation exercises or sleep conditioning, and prescribing medication. Before prescribing medications, explore whether a patient’s inability to get adequate sleep is the result of temporary lifestyle factors or insomnia. By adopting good sleep habits and relaxation techniques, some patients find that their sleep problems are relieved.

Medications used to treat insomnia include antidepressants, benzodiazepines, non-benzodiazepine sedative hypnotics, and some over-the-counter antihistamines. Typically, medications are not recommended for long-term use (more than one month).

How United Behavioral Health can help your patients—For complex clinical situations, United Behavioral Health (UBH) is available to provide consultative assistance. Practitioners can call the UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call UBH at
(888) 777-4742.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
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Manager, Network Planning and Administration

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