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PubMed2002

Symptom reports in severe chronic insomnia.

STUDY OBJECTIVES: To describe patterns and severities of the daytime and nighttime symptoms of chronic insomnia patients. DESIGN: Exploratory chart review from clinicians' evaluation summaries, a self-report screening instrument, the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, the Epworth Sleepiness Scale, and the Hopkins Symptom Checklist-90 (HSCL90). SETTING: A regional sleep disorders referral clinic. PATIENTS OR PARTICIPANTS: 94 patients with chronic insomnia (DSM-IV code 307.42), classified into the subgroups "Primary Insomnia," "Depression-Related," "Anxiety-Related," and "Other". INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Frequent symptoms occurred not only in nocturnal domains (e.g., sleep disturbances, environmental sensitivity), but also in daytime domains (e.g., cognitive difficulties, sleepiness). Compared to primary insomnia patients, those with depression-related insomnia endorsed more severe symptoms. All subgroups endorsed a generally similar symptom profile when single symptoms were considered in isolation. When considered conjointly, severe symptoms typical of depression and generalized social alienation had a high negative predictive value for primary insomnia. The number of severe symptoms on the HSCL90 was related to fewer sleep hours in the nonprimary insomnia subgroup but not in the primary insomnia subgroup. CONCLUSIONS: Patients with chronic insomnia report significant daytime as well as nighttime symptoms. Depression-related and primary insomnias were separable only by some highly characteristic symptoms of depression. Diagnostic subgroups of insomnia patients may vary in how their overall distress relates to diminished self-reported sleep. Nighttime and daytime symptoms need to be assessed together when measuring insomnia severity.

Adult↗
PubMed2003

Insomnia causes, consequences, and therapeutics: an overview.

There is growing interest in insomnia both from the perspective of recent advances in clinical management as well as research aimed at elucidating its pathophysiology. This theoretical overview of insomnia describes the negative impact, etiological considerations, and pharmacological and behavioral treatments for the disorder, with an emphasis on areas receiving increased research attention. Insomnia, the most prevalent sleep disorder, affects 10-15% of the general population. In population-based studies severe insomnia has been shown to last for a median of 4 years. In addition, insomnia has a significant negative impact on an individual's work, physical, and social performance as well as overall quality of life. Furthermore, the economic cost of insomnia related to lost productivity, work-related accidents, absenteeism, and health-care costs are enormous. There is increasing evidence linking the precipitation of insomnia to stress, and converging evidence from cognitive, endocrine, neurological, and behavioral domains provide clear evidence for hyper-arousal in insomnia. However, there remains no consensus regarding the specific etiological mechanisms of this disorder. Although the pathophysiology of primary insomnia remains an enigma, numerous treatments both pharmacological and behavioral have been developed and found to be efficacious in controlled studies. Despite the wide availability of pharmacological treatments and increased knowledge of behavioral interventions, the vast majority of individuals with insomnia do not appear to be receiving adequate treatment. The inadequate treatment of insomnia leads to several important and under-recognized consequences including subsequent development of psychiatric disease and increased substance use.

Aged↗
PubMed2005

Relationship between chronic painful physical condition and insomnia.

BACKGROUND: A chronic painful physical condition (CPPC) can be a major cause of sleep disturbances. Few community-based surveys examined the specific relationship between these two conditions. METHODS: Eighteen thousand, nine hundred and eighty participants aged 15 years or older from five European countries (the United Kingdom, Germany, Italy, Portugal and Spain) and representative of approximately 206 millions Europeans were interviewed by telephone. The interview included questions about sleeping habits, health, sleep and mental disorders. Painful physical conditions were ascertained through questions about medical treatment, consultations and/or hospitalizations for medical reasons and a list of 42 diseases. A painful physical condition was considered chronic when it lasted at least six months. Insomnia symptoms were defined as difficulty initiating or maintaining sleep or non-restorative sleep, present at least three nights per week, lasting at least one month, and accompanied by daytime consequences. RESULTS: (1) The point prevalence of at least one CPPC was set at 17.1% (95% CI: 16.5-17.6%) in the sample. (2) Difficulty initiating sleep was found in 5.1% (95% CI: 4.8-5.4%) of the sample, disrupted sleep in 7.5% (95% CI: 7.2-7.9%); early morning awakenings in 4.8% (95% CI: 7.2-7.9%) and non-restorative sleep in 4.5% (95% CI: 4.2-4.8%). (3) More than 40% of individuals with insomnia symptoms reported at least one CPPC. (4) CPPC was associated with more frequent difficulty or inability to resume sleep once awake and a shorter sleep duration. (5) In middle-aged subjects (45-64 years of age), CPPC was associated with longer insomnia duration. At any age, insomnia with CPPC was associated with a greater number of daytime consequences (average of four consequences) than in insomnia without CPPC (average of 2.3 consequences). (6) In multivariate models, CPPC, especially backaches and joint/articular diseases, were at least as importantly associated with insomnia than were mood disorders with odds ratios ranging from 4.1 to 5.0 for backaches and from 3.0 to 4.8 for joint/articular diseases. CONCLUSIONS: CPPC is associated with a worsening of insomnia on several aspects: a greater number of insomnia symptoms, more severe daytime consequences and more chronic insomnia situation. CPPC plays a major role on insomnia. Its place as major contributive factor for insomnia is as much important as mood disorders.

Adolescent↗
PubMed2002

Sleep duration, insomnia and behavioral problems among Chinese adolescents.

This study examined the associations among sleep duration, insomnia, and behavioral problems in a sample of 1359 Chinese adolescents. Participants completed a self-administrated questionnaire that included questions on sleep duration and insomnia symptoms and the Youth Self-Report of Child Behavior Checklist. It was found that adolescents who complained of insomnia reported sleep duration only half an hour shorter than did those without insomnia. Sleep duration did not differ among adolescents reporting three different types of insomnia (difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening). Adolescents with insomnia reported more behavioral problems than did those without complaints of insomnia. After adjustment for age and sex, sleep duration of less than 7 h a day was significantly associated with most behavioral problems in those without complaints of insomnia but with only a few behavioral problems in adolescents reporting insomnia. Results suggest that sleep duration in adolescents with insomnia is short, but not as short as reported in previous clinical studies. Insomnia and short sleep duration are associated with a wide range of behavioral and emotional problems in adolescents.

Adolescent↗
PubMed2003

Insomnia, alcoholism and relapse.

Insomnia and alcoholism are significantly associated in community surveys and patient samples. Insomnia occurs in 36-72% of alcoholic patients and may last for weeks to months after initiating abstinence from alcohol. Some correlates of insomnia in alcoholic patients are identical to those observed in non-alcoholic insomniacs, including anxiety and depression, tobacco smoking, and the use of alcohol to aid sleep. Other studies suggest that as the severity of alcoholism increases, so does the likelihood of insomnia in alcoholic patients. In the sleep laboratory, alcoholic patients who complain of insomnia have disrupted sleep continuity when compared to alcoholic patients without insomnia complaints. Recently sober alcoholics are also more likely than non-alcoholics to have sleep-disordered breathing and increased periodic leg movements, which might contribute to insomnia in some alcoholic patients. The co-occurrence of insomnia and alcoholism is clinically significant because alcoholism can exacerbate the adverse consequences of insomnia (e.g. mood changes and performance decrements) and because insomnia among patients entering treatment for alcoholism has been significantly associated with subsequent alcoholic relapse. Baseline polysomnographic correlates of subsequent relapse include prolonged sleep latency, decreased sleep efficiency and total sleep time, increased rapid eye movement sleep pressure, and decreased slow wave sleep. Whether treatment of insomnia in alcoholic patients reduces relapse rates is unknown, but preliminary treatment guidelines that accommodate the special characteristics of alcoholic patients are provided, with a goal to reduce daytime impairment and psychological distress.

Acetylcholine↗
PubMed2004

Cancer pain, fatigue, distress, and insomnia in cancer patients.

Insomnia is common among cancer patients, occurring in approximately 30% to 50% of the cancer population. The interactions between cancer pain, insomnia, fatigue, and depression/anxiety are complex, warranting treatment plans that focus not only on the relief of specific symptoms to improve quality of life but also on the impact of treatment on other related symptoms. Pain is one of the most common symptoms experienced by cancer patients and is one of the primary factors that precipitate insomnia in this population. Fatigue is also commonly reported by cancer patients, with a prevalence of nearly 80% in some tumor types. Cancer-related fatigue occurs most often after surgery, chemotherapy, radiotherapy, or immunotherapy and has been reported by cancer patients to be the major obstacle to normal functioning and a good quality of life. Insomnia in cancer patients often occurs in association with psychological disorders such as depression or anxiety. Sleep disturbances are associated with aberrant patterns of cortisol secretion, such as those found in insomnia, which are known to significantly depress the immune system, particularly the cells of the immune system responsible for mounting a defense against tumors. Evidence suggests that management of insomnia through a combination of pharmacologic and nonpharmacologic means can have a positive impact not only on insomnia but also on related symptoms and, consequently, on overall health and quality of life. Although the treatment of insomnia in cancer patients can improve cancer-related fatigue, immune functioning, and overall quality of life, insomnia in the context of cancer is still undertreated. Physicians should use hypnotic agents appropriately and be aware of the reduced potential for producing tolerance and dependence with the nonbenzodiazepine hypnotic agents. The management of insomnia in cancer patients should include a global treatment plan designed to address not only the underlying sleep disturbance but also the related symptoms that may contribute to insomnia or occur as a result of it.

Combined Modality Therapy↗
PubMed2006

Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years.

STUDY OBJECTIVES: To compare age-group differences in somatic/psychiatric comorbidity, impact, and pharmacotherapy associated with sleep disturbance across a broad adult age range. DESIGN: Cross-sectional national mental health survey. SETTING: Adults living in private households in England, Scotland, and Wales. PARTICIPANTS: 8,580 people aged 16 to 74 years. MEASUREMENTS AND RESULTS: Insomnia (4 symptom/syndrome definitions), depression, generalized anxiety disorder, and daytime fatigue were defined from the revised Clinical Interview Schedule. Any insomnia was reported by 37% of the sample, moderate insomnia by 12%, insomnia with fatigue by 13%, and symptoms fulfilling diagnostic criteria for primary/secondary insomnia by 5%. All categories of insomnia were associated with mental disorders, worse physical health, and fatigue to a similar degree in all decade age groups. The associations between insomnia categories and separated, divorced, or widowed marital status were strongest in younger participants. Insomnia categories were of longer reported duration and more strongly associated with worse physical health-related quality of life (SF-12) in older age groups. For participants with any definition of insomnia, benzodiazepine hypnotics were more commonly reported in older age groups. CONCLUSIONS: The association between insomnia and impaired quality of life is most pronounced in older age groups. Associations with physical and mental health status and those with daytime fatigue do not vary in strength between age groups. Older people with insomnia in this population were more likely to be taking benzodiazepine hypnotics.

Adolescent↗
PubMed2002

Acute efficacy of fluoxetine versus sertraline and paroxetine in major depressive disorder including effects of baseline insomnia.

This study assessed whether fluoxetine, sertraline, and paroxetine differ in efficacy and tolerability in depressed patients and the impact of baseline insomnia on outcomes. Patients (N = 284) with DSM-IV major depressive disorder were randomly assigned in a double-blind fashion to fluoxetine, paroxetine, or sertraline for 10 to 16 weeks of treatment. Using the Hamilton Rating Scale for Depression (HAM-D) sleep disturbance factor score, patients were categorized into low (<4) or high (>or=4) baseline insomnia subgroups. Changes in depression and insomnia were assessed. Safety assessments included treatment-emergent adverse events (AEs), reasons for discontinuation, and AEs leading to discontinuation. In addition, AEs were evaluated within insomnia subgroups to determine emergence of activation or sedation. Depression improvement, assessed with the HAM-D-17 total score, was similar among treatments in all patients (p = 0.365) and the high (p = 0.853) and low insomnia (p = 0.415) subgroups. Insomnia improvement, assessed with the HAM-D sleep disturbance factor score, was similar among treatments in all patients (p = 0.868) and in the high (p = 0.852) and low insomnia (p = 0.982) subgroups. Analyses revealed no significant differences between treatments in the percentages of patients with substantial worsening, any worsening, worsening at endpoint, or improvement at endpoint in the HAM-D sleep disturbance factor in either insomnia subgroup. Treatments were well tolerated in most patients. No significant differences between treatments in the incidence of AEs suggestive of activation or sedation were seen in the insomnia subgroups. These data show no significant differences in acute treatment efficacy and tolerability across fluoxetine, sertraline, and paroxetine in major depressive disorder patients. Improvement in overall depression and in associated insomnia was achieved by most patients regardless of baseline insomnia.

Acute Disease↗
PubMed2006

Insomnia as a risk factor for onset of depression in the elderly.

There are at least 9 studies that provide evidence that insomnia is a significant risk factor for recurrent and new onset major depressive disorder (MDD), two of which suggest that this association also exists specifically for the elderly. In this study, archival data from a community sample of healthy elderly participants were used to assess the extent to which insomnia predicts future illness in this age cohort. Out of the 147 participants with no prior history of mental illness, 66 participants were classified as having no insomnia, 47 had indeterminate insomnia, and 34 had persistent insomnia. Twelve participants developed MDD during the 1-year follow-up period. Two had no insomnia, 4 had indeterminate insomnia, and 6 had persistent insomnia. Persistent insomnia with onset of depression occurred only in female participants and was significantly associated with middle insomnia. These data suggest that elderly participants with persistent insomnia are at greater risk for the development of new onset depression.

Aged↗
PubMed1998

Prevalence of insomnia: a survey of the enrollees at five managed care organizations.

The purpose of the study was to assess the prevalence of and factors associated with insomnia among enrollees of managed care organizations (MCOs). A survey was distributed either by mail or during a clinic visit to 7,500 enrollees of five MCOs in the United States. The survey included a sleep questionnaire, demographic questions, and questions about medical encounters and prescription drug use. Three levels of insomnia (none; level I--difficulty initiating or maintaining sleep; level II--insomnia with daytime dysfunction) were defined from the responses. Comorbidities were determined by proxy from prescription drug use reported by respondents. A total of 3,447 survey responses were received, yielding a response rate of 46%. Level I and level II insomnia was reported by 13.5% and 32.5% of the respondents, respectively. Level II insomnia increased with decreasing education, income, and age and was more prevalent in women and non-Caucasians. Insomnia was significantly correlated with all daytime sleepiness and most nighttime disturbances factors. Fifty-two percent of all respondents reported at least one comorbid condition. Respondents with multiple comorbidities reported level II insomnia more frequently than those with no comorbidities. Only 0.9% of clinic visitors were seeing a physician specifically for sleep problems. Of those with level I and level II insomnia, only 5.5% and 11.6%, respectively, were taking prescription medications specifically for sleep problems; 11.2% and 21.4%, respectively, were taking over-the-counter medications for sleep. Insomnia occurs in MCO enrollees at rates comparable to those found in the general population. However, few patients with insomnia are actually being treated for their condition. Proper evaluation, diagnosis, and treatment of insomnia are warranted.

Adult↗
PubMed1999

Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years.

To determine incidence and remission rates of insomnia in older adults and associated risk factors. Three-year longitudinal study, 1982-198--East Boston, MA; New Haven, CT; Iowa and Washington counties, IA. Participants were 6,899 men and women aged 65 years and older. Self-reported difficulty falling asleep or early morning arousal (insomnia), along with physician diagnosis of heart disease, stroke, cancer, diabetes, or hip-fracture, self-report of physical disability, depressive symptomatology, perceived health status, and use of medications ascertained at both baseline and three-year follow-up. Nearly 15% of the 4,956 participants without symptoms of insomnia at baseline reported chronic difficulty falling asleep or early morning arousal at follow-up, suggesting an annual incidence rate of approximately 5%. Incident insomnia was associated with depressed mood, respiratory symptoms, fair to poor perceived health, and physical disability. In multivariate analyses, these risk factors explained the higher incidence of insomnia among those with medical conditions such as heart disease, stroke, and diabetes. Other factors associated with an increased risk of insomnia included use of prescribed sedatives, and widowhood. Only 7% of the incident cases of insomnia occurred in the absence of associated risk factors. Of the nearly 2,000 survivors with chronic insomnia at baseline, almost half no longer reported symptoms upon follow-up and were more likely to report improved self-perceived health compared to those who continued to report symptoms. Chronic disease, depressed mood, physical disability, poor perceived health, widowhood, and use of sedatives are associated with development and remission of insomnia symptoms. Because the vast majority of incident cases of insomnia were among persons with one or more of these risk factors, these data do not support a model of incident insomnia caused by the aging process per se.

Aged↗
PubMed2026

Integrative multi-omics profiling of insomnia-related molecular features reveals microbiome, immune, and therapy-relevant heterogeneity in colorectal cancer.

Emerging evidence implicates insomnia as a potential risk factor in carcinogenesis, potentially involving systemic inflammation, circadian disruption, and microbiome alterations. However, the molecular associations linking insomnia-related features to colorectal cancer (CRC), particularly with respect to tumor biology, immune microenvironmental states, and therapy-relevant phenotypes, remain largely unexplored. Multi-omics integration of genomic, transcriptomic, and microbiome data from 3,026 CRC patients across seven independent cohorts, including a large, well-annotated Clinical Omics study of Colorectal Cancer in China (COCC) cohort, enabled insomnia-based molecular classification through unsupervised non-negative matrix factorization (NMF) clustering. The insomnia subtype (IS) was biologically characterized via pathway enrichment, immune deconvolution, microbial profiling, and single-cell transcriptomics. Furthermore, an insomnia score (ISscore) was developed and validated in multiple cohorts for risk stratification and assessment of treatment-response-related indicators in CRC. Unsupervised clustering revealed two distinct molecular subtypes (IS1/IS2), with IS2 demonstrating significantly poorer survival. IS2 exhibited marked activation of EMT/angiogenesis pathways versus cell cycle activation in IS1. The IS2 microenvironment showed increased immunosuppression-related infiltration and exhausted T cell signatures, together with intratumoral microbiome variation characterized by depletion of Ruminococcaceae UCG-002 and enrichment of Hungatella/Selenomonas. The ISscore system stratified survival risk and was associated with computational indicators of immunotherapy response. Single-cell analysis nominated PPIA-BSG as a potential cell-cell communication signal involving high-ISscore tumor cells, CXCL12+ endothelial cells, and CLEC9A+ dendritic cell subsets. This multi-omics characterization of insomnia-CRC interplay suggests that insomnia-related molecular features are associated with an immunologically distinct and microbiome-altered tumor ecosystem. The ISscore provides a reproducible framework for capturing insomnia-related molecular heterogeneity, supporting risk stratification and future evaluation of therapy-relevant phenotypes.IMPORTANCEChronic insomnia affects millions, but it is not typically considered a cancer risk factor. Our study, analyzing vast biological data from over 3,000 colorectal cancer patients, uncovers a potential link between a person's predisposition to insomnia and their risk of developing this disease. This suggests that the biological pathways related to sleep may play a role in cancer development. Understanding this connection opens up new avenues for identifying individuals at higher risk and developing novel prevention strategies for colorectal cancer.

colorectal cancer↗
PubMed1993

Prevalence and treatment of insomnia in general practice. A longitudinal study.

The aim of the study was to assess prevalence and treatment modalities of insomnia in general practice. To investigate the course of insomnia, a longitudinal study design was adopted. Two thousand five hundred and twelve patients (age 18-65 years) were investigated with a questionnaire in general practice (T1). Four months later (T2) and again 2 years later (T3) a questionnaire was sent to all patients who had complained about severe insomnia at the time of the first inquiry. To assess insomnia, operationalized diagnostic criteria were applied (DSM-III-R). Eighteen point seven percent suffered from severe, 12.2% suffered from moderate and 15% suffered from mild insomnia. In the course of 2 years insomnia appeared as a chronic health problem. A high comorbidity of severe insomnia was found with chronic somatic and psychiatric disorders, especially with depression. Of the severely insomniac patients, 23.9% used prescribed hypnotics habitually, mainly benzodiazepines. The use of prescribed hypnotics remained rather stable during the whole study period. More than half of the patients reported a daily use of the hypnotics for 1-5 years or longer, but only 22% of the severely insomniac patients reported at the time of the third inquiry a significant improvement of insomnia due to the administration of sleeping pills. Thus, the long-term administration of benzodiazepine hypnotics seems to be an inadequate treatment strategy in chronic insomnia. Whether the occurrence of rebound insomnia after benzodiazepine withdrawal may be one of the main factors for chronic hypnotic use requires discussion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Ramelteon for the treatment of insomnia.

BACKGROUND: Insomnia is a common sleep disorder with a significant potential for deleterious effects on activities of daily living, productivity, and overall quality of life. Ramelteon, a highly selective agonist for melatonin subtypes 1 and 2 receptors, is a hypnotic agent approved by the US Food and Drug Administration (FDA) for the treatment of insomnia characterized by difficulty falling asleep. OBJECTIVE: This article reviews the pharmacokinetic properties, efficacy, and tolerability of ramelteon in the treatment of insomnia characterized by difficulty falling asleep. METHODS: Relevant articles were identified through searches of MEDLINE (1966 to July 2006), International Pharmaceutical Abstracts (January 1970 to July 2006), EMBASE Drugs and Pharmacology (1980 to third quarter 2006), and Current Contents/Clinical Medicine (2005 week 32 to 2006 week 31). Search terms included ramelteon, TAK-375, melatonin agonist, melatonin receptor agonist, insomnia, and sleep disorders/drug therapy (MeSH). RESULTS: A literature search revealed 12 randomized, controlled clinical trials that examined the efficacy or tolerability of ramelteon. In addition, 17 studies were reviewed for pharmacology and pharmacokinetic data. The references of the clinical trials and recent review articles were examined to ensure the comprehensiveness of the literature search. In 2 trials of patients with primary insomnia, patients treated with ramelteon 4 to 32 mg had significant reductions in latency to persistent sleep (LPS) compared with placebo (P < 0.001). Additionally, improvements in total sleep time (TST) were observed (P < 0.001), although increases in TST were noted only on nights 1-2 of the second study. Similarly, improvement in sleep efficiency was reported only on nights 1-2 of the second trial (P < 0.001). In elderly patients with primary insomnia, significant reductions in subjective LPS were observed with ramelteon 4 and 8 mg (P = 0.008); however, average subjective LPS was >70 minutes. Mean reported TST was significantly increased in the 4-mg group (P = 0.004). A second study in elderly patients found decreases in LPS with ramelteon 4 mg (P < 0.001) and 8 mg (P < 0.01), as well as significant increases in TST (P < 0.05 and P < 0.01, respectively). Sleep efficiency improved for patients treated with 4 mg (P < 0.05) and 8 mg (P < 0.01). Overall, the mean decrease in LPS reported in trials of ramelteon ranged from 10 to 19 minutes, and the mean increase in TST was 8 to 22 minutes. The most common adverse events observed with ramelteon included headache (7%), dizziness (5%), somnolence (5%), fatigue (4%), and nausea (3%). No evidence of cognitive impairment, rebound insomnia, withdrawal effects, or abuse potential was noted. CONCLUSIONS: Based on this review, ramelteon, the first FDA-approved melatonin receptor agonist, represents a pharmacologic option for the treatment of insomnia characterized by difficulty falling asleep. In patients with insomnia, treatment with ramelteon was generally well tolerated and resulted in modest but statistically significant decreases in LPS. In the absence of published trials comparing ramelteon with other sedative-hypnotic agents, it is not yet possible to determine its efficacy relative to other therapeutic options for insomnia.

Adolescent↗
PubMed2005

Assessing insomnia severity in depression: comparison of depression rating scales and sleep diaries.

Depression and sleep researchers typically assess insomnia severity differently. Whereas depression researchers usually assess insomnia with items on depression symptom inventories, sleep researchers usually assess the subjective experience of insomnia with sleep diaries. The present manuscript utilizes baseline data from 397 participants in a large multi-site chronic depression study to assess agreement between these two methodologies. The results indicate that the early, middle, and late insomnia items of the Hamilton Rating Scale for Depression (HRSD(24)) and the Inventory of Depression Symptoms - Self Report (IDS-SR(30)) are highly correlated with the weekly mean values of time to sleep onset, time awake after sleep onset, and time awake prior to the planned wake-up obtained from prospective sleep diaries. Results also reveal significant correspondence between the weekly-mean of daily sleep efficiency, an accepted measure of sleep continuity (the ratio between reported time asleep and time in bed), and the insomnia scale scores of the HRSD(24) and the IDS-SR(30) (the mean score on the three insomnia items of each depression measure). Unit increments in HRSD(24) scores for early, middle and late insomnia were associated with significant increases in unwanted minutes awake for corresponding periods on sleep diaries. Similar relationships were found for early insomnia on the IDS-SR(30) but not for middle and late insomnia. Overall, with few exceptions, findings revealed substantial agreement between the HRSD(24), IDS-SR(30) and prospective sleep diary data. The study supports the validity of the sleep items and sleep subscales of the HRSD(24) and the IDS-SR(30) as global measures of insomnia severity in depression. Conventional sleep assessment procedures can complement depression scales by providing additional information about specific aspects of sleep in depression.

Adult↗
PubMed2005

Emerging research on the treatment and etiology of secondary or comorbid insomnia.

Secondary insomnia is defined as difficulty initiating or maintaining sleep that occurs as a consequence of another primary medical or psychiatric disorder. This distinction from primary insomnia has been thought to be important from a diagnostic standpoint so that treatment for secondary insomnia can appropriately target the primary disorder. By convention, treating insomnia directly has only been recommended with primary insomnia. However, a number of recent studies of cognitive-behavioral treatment for a wide range of secondary insomnias have demonstrated that this approach is an effective treatment in this population. These results are not predicted by the traditional conceptualization of secondary insomnia. Results of epidemiological research also argue against viewing insomnia that is comorbid with another disorder as being caused by that disorder. A revised model is needed to understand insomnia that is comorbid with medical and/or psychiatric illness, in addition to re-evaluating standard treatment protocols for comorbid insomnia.

Arousal↗
PubMed2001

What are the contributing factors for insomnia in the general population?

Lack of a systematic assessment of insomnia has led to large variations in its reported prevalence in the general population. This study aims to provide new guidelines to assess insomnia prevalence. A cross-sectional telephone survey using the Sleep-EVAL system was done with 24,600 general population-based subjects 15 years and older representative of general populations (France, the UK, Germany, Italy, Portugal, and Spain) consisting of 251,405,391 inhabitants. The overall participation rate was 81.0%. Within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptomatology for insomnia, 27.2% (95% confidence interval: 26.6-27.8%) of the sample reported difficulty initiating sleep (DIS) (10.1%) or maintaining sleep (DMS) (disrupted sleep (DS): 18.0%; early morning awakening (EMA): 10.9%) or nonrestorative sleep (NRS) (8.9%) at least three times per week; 48.5% of them were concomitantly suffering of a DSM-IV sleep/mental disorder. A factor analysis identified several variables strongly related to each of the major factors of insomnia allowing: (1) The narrowing of the definition of insomnia: the prevalence of insomnia decreased to 16.8% with 64.5% of insomnia subjects having a DSM-IV sleep/mental disorder; (2) The identification of a sleep-deprived (voluntary or not) group without insomnia symptoms, representing 2.1% (1.9-2.3%) of the sample. Interestingly, the latter group closely matched the definition of insufficient sleep syndrome as described by the International Classification of Sleep Disorders (ICSD). Using more delineated criteria to assess insomnia increases the recognition of subjects complaining about sleep. Classifications should be amended to improve the correct identification of insomnia. Sleep-deprived subjects should also not be neglected.

Adolescent↗
PubMed2003

Insomnia: epidemiology, characteristics, and consequences.

Insomnia is a symptom of difficulty initiating and maintaining sleep or experiencing nonrefreshing sleep and is associated with daytime consequences. Although insomnia is typically secondary to a medical, psychiatric, circadian, or sleep disorder, it can also be a primary disorder. Primary insomnia is estimated to occur in 25% of all chronic insomnia patients. It is hypothesized to be a disorder of hyperarousal, which has been supported by research on the autonomic nervous system and hypothalamic-pituitary-adrenal axis function. Chronic insomnia is prevalent in 10% of the adult population. Age, sex, medical and psychiatric disease, and shift work all represent an increased risk of chronic insomnia. The morbidity of insomnia varies as a function of etiology. While transient insomnia produces sleepiness and impairment in psychomotor performance, chronic insomnia is associated with absenteeism, frequent accidents, memory impairment, and greater health care utilization. The most consistent impact of insomnia is a high risk of depression.

Age Distribution↗