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PubMed2004

Is insomnia best categorized as a symptom or a disease?

Insomnia, defined by difficulty falling asleep or remaining asleep, early morning awakening and/or non-restorative sleep, and daytime consequences, is an important public health issue with a significant negative impact on individuals' physical and social performance, ability to work and quality of life, as well as on society as a whole. Chronic insomnia warrants treatment in the majority of cases, but it is often under-treated. Primary insomnia occurs independently of other factors, and is possibly related to a general psychophysiologic hyperarousal. Other types of insomnia occur in association with various conditions such as psychiatric disorders, medical disorders (e.g., chronic pain, dysfunction and movement disorders), circadian rhythm disorders and medication or substance use. These types of insomnia are diagnosed more frequently in the clinic. As a result, insomnia is traditionally viewed and treated as a symptom rather than a disease, with the majority of therapies aimed at resolving underlying medical factors. However, it is important to clearly establish whether co-morbidities are causative for or simply co-exist with insomnia, in order to recommend the most appropriate treatment and optimize treatment outcomes. Difficulties still arise when categorizing insomnia subtypes. Here, we highlight some of the major challenges for future research in classifying both primary insomnia and insomnia related to or associated with various conditions, and their relevance to primary care.

Brain↗
PubMed2000

Familial incidence of insomnia.

This study evaluated the familial incidence of sleep disturbances among individuals with insomnia complaints. The sample consisted of 285 patients evaluated for insomnia at a sleep disorders clinic. All patients completed a sleep survey and underwent a semistructured clinical interview as part of their initial evaluation of insomnia. Information on the presence and nature of sleep disturbances among their family members (first- and second-degree relatives) was obtained from a sleep survey. The findings indicate that 35% of patients consulting for insomnia had a positive family history of sleep disturbances. Insomnia was the most common type of sleep disturbance identified (76%) and the mother was the most frequently afflicted family member. Reports of sleep disturbances among a family member were more prevalent when the onset of insomnia was before 40-years-old than when it was later in life. A positive family history was slightly higher when the insomnia complaint involved sleep-onset difficulties relative to sleep-maintenance or mixed insomnias. Although the present findings suggest that a positive family history of insomnia may be a potential risk factor for insomnia, it is unclear whether this reflects a genetic predisposition or a social learning phenomenon.

Adult↗
PubMed2000

Subjective measurement of insomnia and quality of life in depressed inpatients.

Insomnia and major depressive episodes (MDE) have each been associated with quality of life (QOL) deficits. In this study we examined insomnia as an independent predictor of QOL deficits during MDE, and used a secondary analysis of cross-sectional data. The study was based at the inpatient psychiatric ward and included 88 adults (mean age 53; 78% women). We assessed insomnia severity with the 21-item Hamilton Rating Scale for Depression (HRSD) and the Beck Depression Inventory (BDI). Measurements of QOL in the week prior to admission included activities of daily living (ADLs), instrumental ADLs (IADLs), daily living and role functioning, and relation to self and colleagues (the last two both subscales of the Basis 32). Linear regression models used the insomnia items as independent variables and the QOL measures as the dependent variables, after adjusting for age and nonsleep related depression severity. The results showed that 93% of patients endorsed insomnia on the observer-rated HRSD, and 97% endorsed sleep disturbance in the self-rated BDI. However, the insomnia items on the HRSD and BDI showed poor concurrent validity. Increasing severity of insomnia on the HDRS was associated with better QOL, while increasing severity of insomnia on the BDI was associated with worse QOL. We conclude that the BDI and HRSD do not produce equivalent measures of insomnia severity in depressed inpatients, and each insomnia measure has a unique relationship with QOL.

Adult↗
PubMed2002

Insomnia and global sleep dissatisfaction in Finland.

The purpose of this study is to assess the prevalence of insomnia symptoms and diagnoses in the general population of Finland. A total of 982 participants, aged 18 years or older and representative of the general population of Finland, were interviewed by telephone using the Sleep-EVAL system. The participation rate was 78%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and International Classification of Sleep Disorders (ICSD), associated and sleep/mental disorders and daytime consequences. The overall prevalence of insomnia symptoms occurring at least three nights per week was 37.6%. Difficulty initiating sleep were mentioned by 11.9% of the sample, difficulty maintaining sleep by 31.6%, early morning awakenings by 11.0% and non-restorative sleep by 7.9% of the sample. Global dissatisfaction with sleep was found in 11.9% of the sample. Daytime consequences (fatigue, mood changes, cognitive difficulties or daytime sleepiness) were reported by 39.9% of participants with insomnia symptoms and 87.6% of those with sleep dissatisfaction. A deterioration of sleep in summer or winter was associated with more complaints of sleep dissatisfaction. Prevalence of any DSM-IV insomnia diagnosis was 11.7%. More specifically, DSM-IV diagnosis of primary insomnia had a prevalence of 1.6% and DSM-IV diagnosis of insomnia related to another mental disorder was at 2.1%. Insomnia was a symptom of another sleep disorder in about 16% of cases and of a mental disorder in about 17% of cases. As reported in other Nordic studies, sleep quality was worse in summer. Insomnia symptomatology was common and was reported by more than a third of Finnish participants. Compared with other European countries studied with the same methodology (France, the UK, Germany, and Italy), the prevalence of DSM-IV insomnia diagnosis was 1.5 to two times higher in Finland.

Adolescent↗
PubMed2006

Characterization of insomnia in patients with essential hypertension.

INTRODUCTION: Insomnia may increase risk of cardiovascular events. There is little data available reporting the prevalence and clinical relevance of insomnia in patients with essential hypertension. Therefore, the aim of the study was to investigate the relationship between insomnia and different clinical and biochemical parameters in essential hypertension patients. METHODS: Four hundred and thirty-two patients (mean age 47+/-13 years; 253 male, 179 female) with essential hypertension were screened for insomnia using the athens Insomnia Scale (AIS). Several variables including age, sex, known duration of hypertension, body mass index, creatinine, left ventricular mass index, coexisting disorders, smoking status and alcohol use were analysed. Twenty-four-hour ambulatory blood pressure measurements (ABPM) were performed. RESULTS: Among patients included in the study, 207 subjects (mean age: 49+/-13 years; 47.9%) had an AIS score of 15 or higher and were identified as insomniacs. Insomnia was more frequent in women than in men (60.9% vs 38.7%, p<0.001) and was reported more frequently in patients with coronary artery disease. Subjects with insomnia were older and had longer duration of hypertension. There were no differences between insomniacs and non-insomniacs in ABPM parameters. A relationship was found between the number of antihypertensive drugs and insomnia frequency. There were correlation between AIS score and age (r=0.21; p<0.001) and duration of hypertension (r=0.22; p<0.001). In the sub-group of untreated essential hypertension patients, there were negative correlations between AIS score and night fall in systolic and diastolic blood pressure. CONCLUSION: Our results showed that insomnia is common in patients with essential hypertension and indicate an association between insomnia and gender, known duration of hypertension and number of hypertensive drugs taken. Untreated essential hypertension insomniacs were characterized by less pronounced nocturnal fall in both systolic and diastolic blood pressure compared with non-insomniacs.

Adult↗
PubMedDate not supplied

Sleep maintenance insomnia: strengths and weaknesses of current pharmacologic therapies.

BACKGROUND: Although insomnia is highly prevalent, sleep disturbances often go unrecognized and untreated. When insomnia is recognized, considerable emphasis has been placed on improving sleep onset; however, there is growing evidence that improving sleep maintenance is an equally important treatment goal. METHODS: A MEDLINE literature search was performed using the search parameters "insomnia," "zolpidem," "zaleplon," "flurazepam," "estazolam," "quazepam," "triazolam," and "temazepam," as these agents are FDA-approved for the treatment of insomnia. Per reviewer comments, the search criteria was later expanded to include lorazepam. A literature search using the terms "trazodone" and "insomnia" was also performed, as this is the second-most commonly prescribed agent for treating insomnia. Sleep efficacy endpoints from randomized, placebo-controlled clinical trials in adult populations and key review articles published between 1975 and 2004 were included in this review. As only one randomized placebo-controlled trial evaluated trazodone use in primary insomnia, the trazodone search was expanded to include all clinical trials that evaluated trazodone use in insomnia. Relevant texts and other articles that evaluated side effect profiles of these agents were also included, one of which was published in January of 2005. In all publications, impact of treatment on sleep maintenance parameters (wake time after sleep onset, number of awakenings) and measures of next-day functioning were evaluated, in addition to sleep onset parameters (sleep latency, time to sleep onset/induction) and sleep duration data (total sleep time). RESULTS: Many of the currently available agents used to treat insomnia, including the antidepressant trazodone, the non-benzodiazepine hypnotics zolpidem and zaleplon, and some of the benzodiazepines, have not consistently demonstrated effectiveness in promoting sleep maintenance. Furthermore, the benzodiazepines with established sleep maintenance efficacy are associated with next-day sedation, the risk of tolerance and dependence, or both. CONCLUSIONS: New agents that offer relief of sleep maintenance insomnia without residual next day impairment while improving next day function are needed. Several compounds currently under development may offer clinicians a more effective and safer treatment for this common disorder.

Acetamides↗
PubMed1997

Trazodone is only slightly faster than fluoxetine in relieving insomnia in adolescents with depressive disorders.

This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone in relieving insomnia associated with depressive disorders in adolescents (aged 13-17 years). We reviewed the hospital charts of consecutively admitted adolescents with a depressive disorder and insomnia, who received one of three treatments: fluoxetine (20 +/- 2.2 mg), trazodone (71 +/- 32 mg), or a fluoxetine-trazodone combination (fluoxetine 29 +/- 2.2 mg, trazodone 68 +/- 29 mg). Each treatment was examined in 20 patients. Insomnia was defined as a change in sleep patterns characterized by decreased total sleep time that was sufficient to cause clinical concern, and insomnia resolution was defined as sleep starting by midnight and lasting 6 hours. Mean time to resolution of insomnia was significantly faster in adolescents treated with trazodone rather than fluoxetine (2.5 vs. 5.1 days, p < 0.05). Trazodone seemed to save only about 3 days and insomnia resolved in all subjects by the 11th day of antidepressant treatment. Median time to insomnia resolution was 2 days (range 1-5 days) in the trazodone group and 4 days (range 1-11 days) in the fluoxetine group. This difference between trazodone and fluoxetine, although statistically significant, was generally not clinically significant in the management of insomnia associated with depressive disorders in adolescents. The resolution of insomnia was not faster for treatment with a combination of fluoxetine and trazodone in comparison to fluoxetine monotherapy. Insomnia resolution was slightly later in older children. These clinical findings await confirmation by a controlled study. Both drugs seemed effective in ameliorating sleep symptoms in this sample, although it is likely that they produced these changes by different mechanisms.

Adolescent↗
PubMed2003

Complaints of poststroke insomnia and its treatment with mianserin.

We assessed the prevalence and associations of symptoms of insomnia in patients with acute ischemic stroke, and evaluated whether mianserin as a sedative antidepressant is beneficial in the treatment of poststroke insomnia. One hundred consecutively hospitalized patients were randomized to receive 60 mg/day of mianserin (n = 51) or placebo for 1 year in a double-blind trial with a 6-month follow-up after the therapy. Symptoms of insomnia were assessed with the three insomnia-related items of the Hamilton Depression Scale; patients were defined as insomniacs if any of these items was positive. Complaints of insomnia occurred in 68% of patients on admission, and in 49% at 18 months, and they were as frequent in all subgroups of patients. From 2 months, symptoms of insomnia were associated independently with depression. Living alone before stroke (at 0 and 2 months) and age (at 12 months) were other independent predictors of insomnia. The rate of recovery as evaluated by the insomnia score was more rapid in patients on mianserin than in those on placebo. At 2 months, the scores were significantly different favoring mianserin treatment (1.3 vs. 0.8, p = 0.02). We conclude that insomnia is a common complaint after ischemic stroke. Mianserin had a beneficial influence on the recovery from symptoms of insomnia, even though the intensity of poststroke depression was low.

Age Factors↗
PubMed2001

Insomnia, self-medication, and relapse to alcoholism.

OBJECTIVE: This study was an investigation of the frequencies of insomnia and its self-medication with alcohol in a group of alcoholic patients, as well as the relationship of these variables to alcoholic relapse. METHOD: The subjects were 172 men and women receiving treatment for alcohol dependence. They completed a sleep questionnaire, measures of alcohol problem severity and depression severity, and polysomnography after at least 2 weeks of abstinence. RESULTS: On the basis of eight items from the Sleep Disorders Questionnaire, 61% of the subjects were classified as having symptomatic insomnia during the 6 months before treatment entry. Compared to patients without insomnia, patients with insomnia were more likely to report frequent alcohol use for sleep (55% versus 28%), had significantly worse polysomnographic measures of sleep continuity, and had more severe alcohol dependence and depression. Among 74 alcoholics who were followed a mean of 5 months after treatment, 60% with baseline insomnia versus 30% without baseline insomnia relapsed to any use of alcohol, a significant difference. Insomnia remained a robust predictor of relapse after application of logistic regression analysis to control for other variables. A history of self-medicating insomnia with alcohol did not significantly predict subsequent relapse. CONCLUSIONS: The majority of alcoholic patients entering treatment reported insomnia symptoms. Given the potential link between insomnia and relapse, routine questions about sleep in clinical and research settings are warranted.

Adult↗
PubMed2005

Diagnosis and treatment of chronic insomnia: a review.

OBJECTIVE: Insomnia has high prevalence rates and is associated with significant personal and socioeconomic burden, yet it remains largely underrecognized and inadequately treated. METHODS: A PubMed search for English-language articles covering randomized controlled trials published between 1970 and 2004 was conducted. Search terms used were "insomnia," "behavioral therapy," and the generic names of agents commonly used to treat insomnia (the Food and Drug Administration-approved benzodiazepines and nonbenzodiazepines, trazodone, and over-the-counter agents). RESULTS: Evidence from epidemiologic studies, physician surveys, and clinical studies suggests that numerous patient and physician factors contribute to the fact that the needs of patients with insomnia remain unmet, including low reporting of insomnia by patients, limited physician training, and office-based time constraints, as well as misconceptions about the seriousness of insomnia, the advantages of treatment, and the risks associated with hypnotic use. Nonpharmacologic therapies produce long-lasting and reliable changes among people with chronic insomnia and have minimal side effects. Pharmacologic therapies have proven effective with improving wake time after sleep onset and sleep maintenance and reducing the number of nighttime awakenings. However, pharmacologic therapy has a greater chance of producing side effects. No conclusive evidence exists to favor either pharmacologic therapy or behavioral therapy. CONCLUSIONS: Insomnia is particularly challenging for clinicians because of the lack of guidelines and the small number of studies conducted in patient populations with behavioral and pharmacologic therapies. Current treatment options do not address the needs of difficult-to-treat patients with chronic insomnia, such as the elderly, and those with comorbid medical and psychiatric conditions. More research is necessary to determine the long-term effects of insomnia treatments.

Acetamides↗
PubMed2005

An international survey of insomnia: under-recognition and under-treatment of a polysymptomatic condition.

BACKGROUND: Due to its high prevalence, considerable impact on well-being, and high medical and societal costs, insomnia represents an important healthcare challenge. Despite this, the prevalence of this condition is under-recognized and many sufferers do not receive adequate treatment. OBJECTIVE: This international survey investigated the prevalence and characteristics of insomnia in the general population in France. Italy, Japan and the USA to better understand why insomnia is under-recognized and under-treated. RESEARCH DESIGN AND METHODS: Type, frequency, natural history of night- and day-time symptoms, and attitudes of people regarding the nature and treatment of insomnia was quantitatively assessed from a representative sample of the general population aged > 18 years in each of the four countries. A survey of an extensive series of standardized 10-15-min interviews was conducted over the telephone by professional interviewers. RESULTS: Insomnia was reported by 37.2% of respondents in France and Italy, 6.6% in Japan, and 27.1% in the USA. The mean number of symptoms reported per patient was two, with sleep maintenance insomnia the most predominant symptom (73%), followed by difficulty falling asleep (61%), and poor sleep quality (48%). Daytime fatigue and impaired concentration and attention were the most commonly reported next-day symptoms as a result of poor sleep. The majority of individuals with sleep problems reported being 'somewhat' or 'very' bothered by their symptoms, and reported that their sleep problems impacted on their daily quality of life either 'somewhat' or 'a lot'. Among individuals with a history of insomnia, the rate of reporting insomnia symptoms to physicians was generally low and of those who did consult a physician, few were prescribed any medication. CONCLUSIONS: The results of this study suggest that in Europe, Japan and the USA, the burden of insomnia on sufferers is considerable. Many respondents took no action to alleviate their insomnia symptoms despite the poor sleep impacting on their daily quality of life either 'somewhat' or 'a lot'.

Adult↗
PubMed2006

Recent developments in the classification, evaluation, and treatment of insomnia.

Sleep/wake complaints, and specifically insomnia, are some of the more common problems encountered in the outpatient setting. Despite its prevalence, few clinicians are experts at diagnosing and treating this entity. Additionally, diagnosis and treatment of insomnia is a time-intensive process (often the initial interview takes at least 1 h, depending on the complexity of the insomnia). With a conservative estimate of the annual cost of insomnia between dollar 92.5 and dollar 107.5 billion dollars, it is becoming clear that insomnia has significant medical and public health implications. A problem that has hampered insomnia research is the lack of a standard definition of insomnia for use in research, as well as guidelines for assessment. In recent years, there have been important advances in the classification, evaluation, and treatment of insomnia with efforts to establish greater consensus in how to define and measure insomnia. Cognitive behavioral and pharmacologic therapies have been shown to be effective treatment approaches. Insomnia is a complex entity, often multifactorial in its etiology; and as research and clinical guidelines are established and validated (leading to better data interpretation), continued enhancement of our understanding of this disorder is expected.

Cognitive Behavioral Therapy↗
PubMed2004

Management and evolution of insomnia complaints among non-substance-misusers in a Swiss remand prison.

QUESTIONS UNDER STUDY: Insomnia is a frequent though rarely investigated problem among prisoners. The study's aim was to examine the clinical management of insomnia complaints in non-substance-misusing (NSM) prisoners (quality of medical consultation, effectiveness of drug prescription), and the risk of leaving prison with ongoing hypnotic prescription which might provoke withdrawal symptoms and encourage further hypnotic use outside prison. METHODS: Retrospective study of the medical records of 112 NSM prisoners complaining of insomnia at medical consultation over a one year period at the outpatient-service of the Champ-Dollon remand prison (Geneva, Switzerland). We examined insomnia management by the general practitioners (anamnestic and clinical evaluation documented in the record), type, duration and effectiveness of treatment. RESULTS: The 112 records show a prescription of hypnotics to 111 patients (80% benzodiazepines or Zolpidem), a limited documented insomnia work-up (anamnestic information about sleep habits, sleep latency and previous hypnotic use for less than a third of the patients, about the impact of insomnia, such as fatigue, on daily activity in only 7%). In more than 60% of the patients, insomnia complaints persisted for more than 3 weeks. In 41 (37%) patients, improvement (defined subjectively based on patients' complaints) was complete, in 20 (18%) absent, and in 34 (30%) incomplete while taking the prescribed hypnotics. Patients without or with only partial improvement of insomnia received the highest number of hypnotics (mean 2.4, vs. 1.4 for patients with total improvement, 95% CI of the difference: 0.7-1.4). 55% of the 112 prisoners left prison with hypnotics still being prescribed. CONCLUSIONS: Our results show that prison physicians' evaluation for insomnia was incomplete. Drug prescription did not seem to have been an effective treatment for insomnia complaints in a sizeable number of patients. Many prisoners leave the prison with benzodiazepine prescription still ongoing and could be at risk for continued hypnotic use following imprisonment.

Adult↗
PubMed1999

Insomnia in primary care patients.

STUDY OBJECTIVES: To determine the prevalence and characteristics of insomnia in primary care patients, to examine patients' help-seeking behavior, and to compare the frequency of insomnia in primary care patients to the general population. METHODS: 286 patients from primary care clinics in San Diego, California (n = 96), and in Haleiwa and Honolulu, Hawaii (n = 190) participated. Sleep study questionnaires were distributed by front desk receptionists to all patients over 18 years of age upon arrival at the clinic for an appointment with the physician. Completed questionnaires were collected at the clinic or returned by mail. Comparisons were made by using nonparametric statistics. A logistic regression analysis using backward elimination was done to develop a model showing predictors of who would consult with the physician about a sleep problem. RESULTS: The prevalence of insomnia in primary care patients was 69%, with 50% reporting occasional insomnia and 19% reporting chronic insomnia. As expected, patients with chronic insomnia had the most severe sleep complaints as well as the poorest daytime functioning, and exhibited the most help-seeking behaviors. The four predictors of discussing insomnia with a physician were how patients felt physically, number of years of insomnia, age, and income. CONCLUSIONS: The primary care population has a higher prevalence of insomnia than the general population, probably because of concomitant psychiatric and medical illnesses. Although many of the characteristics of the sleep complaints are easily detected, most patients with insomnia are not treated effectively.

Adolescent↗
PubMed2000

Public health and insomnia: economic impact.

There seems to be a lack of understanding between practitioners and patients on the topic of insomnia. One adult out of four complains of insomnia; however only one insomniac out of four has ever complained about it to their practitioner during a visit made for another problem and only one out of twenty has come to discuss specifically the problem of his or her insomnia. Only a few patients with insomnia take a treatment for it. This gap between the patient's feeling and the practitioner's answer has to be better understood if we want to know why insomnia seems to be so prevalent and what impact it has on society. One aspect may be a question of definition. Insomnia may be considered an ordinary complaint (after one poor night) or as a chronic disease. Practitioners have poor knowledge about sleep disorders and may be embarrassed about coping with an impairment they never specifically learned to manage. The second aspect concerns the impact of insomnia on daytime alertness and performance. While patients usually complain of an impaired daytime functioning with a feeling of fatigue, sleepiness, and risk of mistakes, many studies of insomniacs do not reveal any increased sleepiness or decrease of performance (measured by objective tests) the day following a poor night. Practitioners may therefore find it difficult to understand the real impact of insomnia on daytime functioning. The third aspect is related to the large co-morbidity between insomnia and psychiatric diseases, especially depression and anxiety. It does make it harder for practitioners to define whether the sleep impairment suffered by their patient is the cause for other symptoms or the consequence of an underlying disease. Thus, it makes it all the more difficult for the practitioner to determine which treatment is the most appropriate. These aspects have to be clarified if one wants to estimate the real impact of insomnia on society. It could be useful to both practitioners and patients to have a better understanding on the relationship between poor sleep and daily lives.

Absenteeism↗
PubMedDate not supplied

[Childhood insomnia].

AIMS: This work reviews the causes of insomnia in children and attempts to show the difficulties involved in performing a diagnosis to differentiate it from other sleep disorders. METHOD: Insomnia is a disorder in which the sufferer has difficulty in falling or staying asleep. There are multifactorial causes involved in the aetiology of childhood insomnia. In order to understand and diagnose insomnia in childhood it is necessary to have a good knowledge of the mechanisms involved in the genesis of sleeping and waking. We must also take the possible existence of other types of disorders into consideration. Insomnia appears as an imbalance between the systems that maintain the waking state and those that are in charge of activating sleep generating systems. In children, this imbalance depends on the state of functional immaturity peculiar to each age. Rather than a shortage of sleep, childhood insomnia takes the form of a lack of matching between the child s own rhythm or need to sleep and his or her family or social environment. Insomnia is most frequently caused by environmental, behavioural and psychological factors. A correct diagnosis of childhood insomnia has to be based on determining a procedure to differentiate it from parasomnias or motor disorders affecting waking and sleep. CONCLUSIONS: Identifying the causes of childhood insomnia, differentiating it from real insomnia and other sleep disorders, and resolving it are no simple matter because of the influence exerted by the environment and the child s behaviour on how he or she sleeps.

Age Factors↗
PubMed2006

New solutions for treating chronic insomnia: an introduction to behavioral sleep medicine.

Insomnia is one of the most frequent complaints brought to primary care physicians and research suggests insomnia's prevalence is on the rise. Insomnia evaluation and treatment can be a time-intensive process that puts significant demands on a busy medical practice. To date, hypnotic medications are the most frequently prescribed treatment for insomnia and have been demonstrated to be efficacious for the treatment of acute insomnia. Cognitive-behavioral treatment (CBT) has been found to be just as effective as hypnotics for the treatment of acute insomnia and more effective for the treatment of chronic insomnia. CBT is now recognized as a first-line intervention for chronic insomnia, yet is underutilized. Many patients and healthcare providers are unaware of the efficacy of CBT for insomnia and currently there are few qualified providers. To address this need, the American Academy of Sleep Medicine (AASM) has developed a new subspeciality to train providers in the provision of CBT for insomnia as well as other sleep disorders.

Adult↗
PubMed1995

The natural history of insomnia and its relationship to respiratory symptoms.

BACKGROUND: Although insomnia is a frequent complaint among patients, epidemiologic study has been limited. Researchers have reported a wide range in the prevalence of this complaint in a variety of selected populations. Other parameters, such as incidence and remission rates, have not been reported. METHODS: Subjects of the Tucson (Ariz) Epidemiologic Study of Obstructive Lung Disease were asked questions about trouble sleeping in the 1984-1985 (survey I) and 1990-1992 (survey II) surveys. Answers were analyzed along with responses to questions about age, sex, respiratory symptoms, and drug and alcohol use for sleep. RESULTS: The prevalence of insomnia was similar in both surveys, 34.4% in survey I and 34.1% in survey II. Women had a higher prevalence of insomnia than men in both surveys, and insomnia was more common among older subjects (50.6% of the women aged 65 years or older had insomnia in survey II). In addition, the incidence of new insomnia in survey II was higher in the same groups. Grouping subjects by respiratory symptoms, we found that the prevalence of insomnia was significantly related to cough, dyspnea, or wheeze. Furthermore, subjects with persistent or new respiratory symptoms at survey II were less likely to have remission of insomnia by that survey (31.6% vs 51.5%; P < .05; odds ratio, 0.43) and more likely to develop new insomnia (28.6% vs 14.5%; P < 05; odds ratio, 2.36) than subjects with either no symptoms or disappearance of their symptoms by survey II. CONCLUSIONS: In our population, insomnia is a common dynamic complaint whose frequency waxes and wanes in association with respiratory symptoms.

Adult↗