When insomnia occurs with suspected comorbidity such as depression, what is a prudent management approach?

• A. Refer to sleep laboratory only with no medical management.
• B. Focus on sleep hygiene alone and ignore comorbidity.
• C. Treat underlying comorbidity, implement CBT-I, and choose sleep aids with favorable safety profiles; coordinate care with psychiatry.
• D. Use high-dose sedatives irrespective of safety.

Answer: (C)

When insomnia occurs with suspected comorbidity such as depression, the best approach is to manage both the underlying condition and the sleep problem in an integrated way. Treating the depression or other comorbidity can directly improve sleep and reduce overall symptom burden, and it helps prevent insomnia from persisting even after sleep-focused tools are started. At the same time, implement cognitive behavioral therapy for insomnia (CBT-I), which addresses the thoughts and behaviors that perpetuate poor sleep and is the most effective non-drug treatment for chronic insomnia, even when mood disorders are present. If medications are considered, choose sleep aids with favorable safety profiles and use the lowest effective dose, always mindful of potential interactions with antidepressants and other treatments. Coordinating care with psychiatry ensures that the depression is optimally treated, medications are managed safely, and sleep interventions align with the psychiatric plan. Relying only on sleep labs without addressing comorbidity misses a key piece of the puzzle, and focusing solely on sleep hygiene or using high-dose sedatives ignores the need for evidence-based treatment and can pose safety risks.