When to use this diagnosis

• Insomnia symptoms (difficulty initiating/maintaining sleep, early morning awakening, or nonrestorative sleep) causing distress or impairment, but insufficient duration/history to label as chronic.
• Presentation confounded by medical, psychiatric or substance factors where further assessment is needed.
• Useful as a working label to initiate brief interventions, review medications, provide safety advice and arrange follow‑up or specialist referral.

Core symptoms & impact

• Difficulty falling asleep, staying asleep, or waking too early despite adequate opportunity for sleep.
• Daytime impairment: fatigue, reduced concentration, mood disturbance, occupational or interpersonal problems.
• May be acute (days–weeks) or subacute when the full chronic duration criterion (≥3 months) is not yet met.

Assessment checklist

1. Sleep history: onset, duration, pattern (sleep latency, awakenings, early morning awakening), sleep opportunity and weekday/weekend patterns.
2. Medication/substance review: sedatives, stimulants, SSRIs, beta‑blockers, corticosteroids, alcohol and recreational drugs.
3. Comorbidity screen: depression, anxiety, PTSD, pain, restless legs, sleep‑disordered breathing and circadian rhythm disorders.
4. Use sleep diary for 1–2 weeks and consider actigraphy when sleep–wake patterns or shift work complicate the picture.
5. Assess safety: excessive daytime sleepiness, driving risk, occupational impairment and suicidality where relevant.

Immediate management — practical steps

• Provide sleep hygiene advice: consistent sleep schedule, minimise caffeine/alcohol, reduce screen time before bed and create a conducive sleep environment.
• Address reversible contributors: review and adjust sedating or activating medications when safe, treat pain or other medical causes and manage comorbid mood/anxiety disorders.
• Start brief behavioural interventions where appropriate: stimulus control (bed only for sleep/sex), sleep restriction therapy principles and relaxation techniques.
• Consider short‑term hypnotic prescription for severe distress or situational insomnia while arranging CBT‑I and follow‑up — use lowest effective dose for shortest time and plan to taper.

Evidence‑based treatment

Cognitive Behavioural Therapy for Insomnia (CBT‑I)

• CBT‑I is first‑line for chronic insomnia: includes sleep restriction, stimulus control, cognitive restructuring, relaxation training and sleep hygiene.
• Deliver via individual therapy, group programmes, guided self‑help or validated digital CBT‑I platforms when access to specialists is limited.

Pharmacologic options

• Short‑term use of hypnotics (z‑drugs, short‑acting benzodiazepines, low‑dose sedating antidepressants, or doxepin) may be considered for acute severe insomnia; monitor for tolerance, dependence and daytime sedation.
• Melatonin (immediate or prolonged‑release) can help with circadian misalignment or sleep initiation in some populations; use with attention to timing.
• Avoid long‑term hypnotic monotherapy—combine with CBT‑I and aim for gradual discontinuation plan.

Special populations & considerations

• Older adults: prefer non‑pharmacologic approaches; if medication required choose agents with lower fall/sedation risk and avoid long‑acting benzodiazepines.
• Shift workers: focus on scheduled sleep timing, light exposure strategies and short naps; consider melatonin for circadian adjustment.
• Comorbid psychiatric illness: treat mood/anxiety disorders in parallel—insomnia often improves with integrated management but may require targeted CBT‑I as residual symptom.

Key takeaways

• “Unspecified” is a pragmatic working diagnosis when insomnia is impairing but specificity or duration criteria are not yet established.
• Prioritise CBT‑I (or guided self‑help) as first‑line for persistent insomnia; use short‑term hypnotics judiciously and plan tapering.
• Investigate and treat comorbid sleep disorders, medical and psychiatric causes; refer to sleep or mental health specialists for complex or refractory cases.