1. Criteria

There is a predominant complaint of dissatisfaction with sleep quantity or quality.
The complaint takes the form of difficulty initiating sleep, difficulty maintaining sleep with frequent awakenings or trouble returning to sleep, or early-morning awakening with inability to return to sleep.

The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.

The sleep difficulty occurs at least 3 nights per week.

The sleep difficulty has been present for at least 3 months.

The sleep difficulty occurs despite adequate opportunity for sleep.

The insomnia is not better explained by another sleep-wake disorder.

The insomnia is not attributable to a substance or medication.

Coexisting mental disorders and medical conditions do not adequately explain the predominant insomnia complaint.

2. Context

Insomnia disorder is the pattern of not being able to fall asleep, stay asleep, or get back to sleep in a way that actually affects daytime life. The diagnosis becomes more convincing when the sleep complaint is persistent, happens despite adequate opportunity to sleep, and starts showing up as fatigue, irritability, poor concentration, or reduced functioning.
Opportunity matters: A patient can only meet criteria if there is enough time and a reasonable setting for sleep. Chronic sleep deprivation from schedule alone is not the same thing.
Daytime impact: The complaint should not stop at the night. Daytime fatigue, mood change, cognitive problems, or functional impairment help make it a disorder rather than a preference or nuisance.
Clinical frame: It helps to ask whether the problem is with sleep onset, sleep maintenance, early morning awakening, or a mix of all three, because that often changes management.
Clinical focus: Most common brief measure for insomnia severity and treatment response.

3. Validated scales

Insomnia Severity Index

Most common brief measure for insomnia severity and treatment response.

Pittsburgh Sleep Quality Index

Useful when you want a broader view of sleep quality and sleep-related impairment.

Sleep diary

Essential for mapping sleep onset, awakenings, total sleep time, and patterns over time.

4. FDA approved treatments

FDA-approved medications for insomnia

These medications have insomnia-related FDA labeling, although the exact indication may target sleep onset, sleep maintenance, or both depending on the product.

Common off-label medications

Interventional psychiatry modalities

CBT-I remains the first-line nonpharmacologic intervention and is central to management.
TMS and other interventional psychiatry approaches are not standard treatments for insomnia disorder itself.
Ketamine and ECT are not standard insomnia interventions.

5. Top management articles

Management review for Insomnia Disorder PubMed search
Insomnia Disorder treatment guideline PubMed search
Insomnia Disorder pharmacotherapy or psychotherapy review PubMed search

Simple Psych

Insomnia Disorder

1. Criteria

Criterion A

Criterion B

Criterion C

Criterion D

Criterion E

Criterion F

Criterion G

Criterion H