Insomnia

5 Key excerpts on "Insomnia"

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  eBook - ePub

  Epidemiology of Sleep

  Age, Gender, and Ethnicity

  • Kenneth L. Lichstein, H. Heith Durrence, Brant W. Riedel, Daniel J. Taylor, Andrew J. Bush(Authors)
  • 2013(Publication Date)
  • Psychology Press

    (Publisher)

  This leads to an absurd range in the estimated prevalence of Insomnia across studies and makes the tasks of comparing and summarizing results across studies difficult. Definitions ranged from very inclusive to very restrictive. For example, on the inclusive end, Olson (1996) asked, “Have you had trouble sleeping?” and participants responded no, occasionally, often, or every night. In contrast, in the Liljenberg et al. (1988) investigation the definition of Insomnia required the following: (a) an experience of getting too little sleep, (b) difficulty in initiating or maintaining sleep, (c) sleep latency or length of time awake during the night exceeding 30 minutes, (d) daytime sleepiness, and (e) a subjective deficit in sleep time exceeding 1 hour. Not surprisingly, there was a vast difference in the rate of “Insomnia” reported in these two studies, with Olson (1996) finding that the prevalence of at least occasional Insomnia was 38.9%, whereas Liljenberg et al. (1988) found a 1.6% prevalence rate for Insomnia (4.8% when daytime sleepiness was excluded from the definition). Also, many studies considered difficulty falling asleep, awakenings during the night, and early-morning awakenings all to be indicators of Insomnia, whereas other studies excluded awakenings during the night from their definition of Insomnia (Foley et al., 1995; Maggi et al., 1998). Insomnia Definitions Not Based on Accepted Diagnostic Systems In general, definitions of Insomnia used by studies were not consistent with the prevailing diagnostic systems, the International Classification of Sleep Disorders (ICSD; American Sleep Disorders Association, 1990) and the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV ; American Psychiatric Association, 1994)

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  eBook - ePub

  Handbook of Evidence-Based Practice in Clinical Psychology, Adult Disorders

  • Michel Hersen, Peter Sturmey(Authors)
  • 2012(Publication Date)
  • Wiley

    (Publisher)

  comorbid rather than secondary diagnosis (Morin et al., 2006; National Institutes of Health, 2005).

  Demographic Variables

  Insomnia is among the most frequent complaints brought to the attention of health-care practitioners and the most prevalent of all sleep disorders in the general population. Epidemiological surveys indicate that 6% of the adult population meet diagnostic criteria for Insomnia, 12% report Insomnia symptoms with daytime consequences, and an additional 15% are dissatisfied with their sleep (Ohayon, 2002). Other estimates indicate that between 9% and 12% of the adult population complain of chronic Insomnia, with an additional 15% to 20% reporting occasional trouble sleeping (Ancoli-Israel & Roth, 1999; Gallup Organization, 1991; Mellinger, Balter, & Uhlenhuth, 1985). Insomnia is more prevalent among women, older adults, and patients with medical or psychiatric disorders (Ford & Kamerow, 1989; Simon & Von Korff, 1997). There is evidence, although preliminary given the cross-sectional method employed, that increased risk for Insomnia is associated with being divorced, separated, or widowed, having a stressful lifestyle, physical inactivity, irregular bedtimes, alcohol dependence, heavy caffeine use, and cigarette smoking (Edinger & Means, 2005).

  Impact of the Disorder

  Chronic Insomnia carries an important burden for the individual and for society, as evidenced by its negative psychosocial, occupational, health, and economic repercussions. For example, individuals with chronic sleep disturbances report more psychological distress and impairments of daytime functioning relative to good sleepers; they take more frequent sick leaves and utilize health-care resources more often than good sleepers. Persistent Insomnia significantly heightens the risk of accidents (Ohayon, Caulet, Philip, Guilleminault, & Priest, 1997), is associated with prolonged use of hypnotic medications, and longitudinal studies indicate that Insomnia heightens the risk of depression, anxiety, and substance-related problems (Becker, Brown, & Jamieson, 1991; Breslau, Roth, Rosenthal, & Andreski, 1996; Chang, Ford, Mead, Cooper-Patrick, & Klag, 1997; Ford & Kamerow, 1989; Mellinger et al., 1985; Simon & Von Korff, 1997; Vollrath, Wicki, & Angst, 1989; Weissman, Greenwald, Nino-Murcia, & Dement, 1997).

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  eBook - ePub

  Sleep Disorders Handbook

  A Handbook for Clinicians

  • Peretz Lavie, Giora Pillar, Atul Malhotra(Authors)
  • 2002(Publication Date)
  • CRC Press

    (Publisher)

  The available estimates suggest that roughly 20–35% of the general population has had difficulty sleeping in the previous year. Insomnia appears to be more common among women and among those of increasing age. Over 50% of elderly patients may complain of difficulties with nocturnal sleep. These figures may be even higher among hospitalized or institutionalized patients. This chapter presents the data available about the research into and the clinical aspects of Insomnia.

  Definition and diagnosis

  The definition of Insomnia is the perception of inadequate quantity or quality of sleep with associated daytime consequences. The definition is from the patient’s perspective and therefore diagnostic testing is not generally required because history alone is sufficient to establish the diagnosis. There are two general approaches to the classification of Insomnia based on either ‘lumpers’ or ‘splitters’. Many clinicians feel that the various different types of Insomnia have substantial overlap (see Table 28 ) and that the creation of artificial classification systems does not change clinical management. Others argue that Insomnia patients may have variable complaints depending on the specific type of Insomnia that they have and that classifying them may help guide therapy. We discuss each entity as distinct, but recognize that many patients have features of several forms of Insomnia.

  The four most common complaints of all forms of Insomnia are difficulties falling asleep, frequent awakenings from sleep, difficulties falling back to sleep after nocturnal awakenings and spontaneous early morning awakening. By definition, as mentioned above, these complaints must be associated with daytime symptoms (i.e. fatigue, impaired concentration or memory, etc.), i.e. an individual who sleeps only 5 hours per night and cannot sleep more (either as a result of delayed falling asleep or secondary to early morning awakening) will not be diagnosed as Insomniac if there is no daytime fatigue or impairment of daytime function. As mentioned in Chapter 2

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  eBook - ePub

  Cognitive-Behavioural Therapy for Insomnia (CBT-I) Across the Life Span

  Guidelines and Clinical Protocols for Health Professionals

  • Chiara Baglioni, Colin A. Espie, Dieter Riemann, Chiara Baglioni, Colin A. Espie, Dieter Riemann(Authors)
  • 2022(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  1 Introduction to Insomnia Disorder

  Dieter Riemann, Kai Spiegelhalder, Colin A. Espie, Dimitri Gavriloff, Lukas Frase and Chiara Baglioni

  Key points

  • Insomnia, encompassing day‐ and night‐time symptoms, is a frequent health complaint with manifold negative consequences for somatic and mental health and for quality of life.
  • The evaluation of Insomnia includes a clinical interview, a physical and psychiatric examination, sleep diaries and questionnaires. Technical procedures like actigraphy or polysomnography may be used in certain circumstances and differential‐diagnosis needs to evaluate medical and psychiatric co‐morbidities, as well as other sleep disorders.
  • Etiological and pathophysiological Insomnia concepts range from genetic and neurobiological to cognitive‐behavioural models.
  • Cognitive‐behavioural therapy for Insomnia (CBT‐I) is presently considered world‐wide as first line treatment.

  Learning objectives

  • To understand the importance of Insomnia for somatic and mental health and quality of life.
  • To be able to conduct an appropriate clinical evaluation including differential‐diagnosis of patients with Insomnia.
  • To understand the present illness concepts of Insomnia ranging from neurobiology to cognitive‐behavioural concepts.
  • To be familiar with the ingredients of CBT‐I and to understand why CBT‐I is presently the first line of treatment for Insomnia.

  Abstract

  The clinical picture of Insomnia encompasses day‐ and night‐time symptoms. Typical night‐time complaints are prolonged sleep latency, increased frequency of awakenings, difficulties getting back to sleep and early morning awakening. Day‐time sequelae encompass fatigue, tiredness, reduced attention, impaired cognition, irritability, nervousness, anxiety and mood swings, including dysphoric or even depressed mood. DSM‐5 (Diagnostic and Statistical Manual of the American Psychiatric Association, 5th edition), ICSD‐3 (International Classification of Sleep Disorders, 3rd edition) and ICD‐11 (International Classification of Diseases

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  Pathy's Principles and Practice of Geriatric Medicine

  • Alan J. Sinclair, John E. Morley, Bruno Vellas(Authors)
  • 2012(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  19 defines 11 subtypes of Insomnia, that is, disorders of initiating or maintaining sleep. However, in day-to-day practice, the technology required to diagnose each of them precisely limits the value of this system. It is, nevertheless, important to consider the type of Insomnia with which the patient presents. The main types are psychophysiological Insomnia (with psychosomatic arousal, excessive concern about sleep adequacy and somatized tension), inadequate sleep hygiene (where the sleep problem appears to be caused or maintained by dysfunctional practices around sleep) and sleep-state misperception (where the Insomnia diagnosis is not supported by objective findings).

  A wide range of medical conditions is associated with the Insomnias, including arthritis and cancer. Neurological problems such as dementia, RLS and Parkinson's disease are also associated with it and, in the elderly, congestive heart failure, asthma, gastroesophageal reflux, urinary incontinence, nocturia and benign prostatic hyperplasia are commonly comorbid with Insomnia. Depression is strongly linked with Insomnia in both directions, that is, as both cause and effect. Anxiety disorders, prevalent in the elderly, may in part be caused by bereavement, social changes and relocation, but Insomnia is associated with all of them. Overall, about 20% of patients with Insomnia have depression and about 90% of patients with depression report a sleep disturbance.7 There are several drugs that cause Insomnia, including alcohol, nicotine, CNS stimulants, β-blockers, corticosteroids, bronchodilators, calcium channel blockers and thyroid hormones. Alcohol is often used to induce sleep, but its effect is short-lived and leads to early waking. Adjusting the dose or time of day when medications are taken can improve a patient's Insomnia; for example, wake-promoting drugs could be taken earlier in the day and sedating drugs later.

  Evaluation of Insomnia should be based on a good sleep history, augmented by a sleep diary and a physical examination. Initially, medical and psychiatric problems should receive attention and, if the Insomnia remains, identification of an underlying cause should be attempted before direct treatment for Insomnia is indicated. Non-pharmacological treatments such as sleep hygiene and education integrated into a cognitive behavioural framework have been shown to be effective in the treatment of Insomnia10, 71 and should be considered first for chronic Insomnia to reduce polypharmacy especially in view of the other drugs commonly taken by the elderly.46

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