![]() ![]() On the other hand, chronic insomnia may be more often related to intrinsic sleep disorders, primary insomnia, or chronic medical and psychiatric conditions, and may require a more extensive evaluation (including assessment of comorbid conditions) in order to delineate appropriate treatment. 5 The transient/ chronic distinction can be clinically relevant, inasmuch as transient insomnias often result from specific environmental or social events, such as shift work, death of a loved one, air travel, and noise, and may be more appropriately managed by addressing these stressors and by managing the insomnia directly (and often prophylactically). A 2005 National Institutes of Health (NIH) State-of-the-Science statement pointed out that time periods of various durations have been used to define chronic insomnia, ranging from 30 days to 6 months. One method is based on duration of symptoms, identifying insomnia as either chronic (long-term) or acute (transient). 6,12-15Īttempts have been made to subtype insomnia. 8 Some definitions are based solely on reports of nocturnal sleep disturbances, 9 whereas others include features such as associated daytime impairment (eg, fatigue, irritability, or reduced memory or concentration), 10 self-reported sleep dissatisfaction, 11 or other criteria. Three separate texts present diagnostic criteria for insomnia: 6 7 and. 5 Although all definitions of insomnia rely on its symptomatic presentation, a standard diagnostic definition does not exist. Many sources also add the presence of associated daytime impairments, such as fatigue, irritability, decreased memory and concentration, and pervasive malaise affecting many aspects of daytime functioning. The definition of insomnia is a complaint of disturbed sleep, manifested as difficulties in sleep initiation or sleep maintenance, and/or as early awakenings. ICD-10 Classification of Mental and Behavioural 3,4 However, research into the relationships between these findings is sorely lacking. Epidemiologic studies show that abnormal sleep patterns predict lower life expectancy, 2 and that insomnia frequently co-occurs with affective disorders, substance abuse, and other physical and psychological comorbidities. 1 Additionally, studies suggest that poor sleep contributes to ill health. Sleep accounts for one third of human life, yet scientific inquiry in this area is limited compared with other aspects of neuroscience. This article will provide an overview of insomnia, its prevalence and epidemiology, and guidelines for clinical assessment. Epidemiologic studies show that abnormal sleep patterns predict lower life expectancy, and that people with insomnia are more likely to develop affective disorders, substance abuse, and other adverse health outcomes. Additionally, the relationship between insomnia and other disease states is not always clear because it is often not possible to determine the cause-and-effect relationship between disorders. Although insomnia can be a primary condition, and can coexist with other disorders or be considered secondary to these disorders, the mechanisms producing it are not clearly defined. The elderly in particular are affected by insomnia, and it has been shown that women are more likely to have sleep difficulties than men. ![]() Although it is generally believed that 10% to 15% of the adult population suffers from chronic insomnia, and an additional 25% to 35% have transient or occasional insomnia, prevalence estimates vary because of inconsistent definitions and diagnostic criteria. ![]() Many questions remain unanswered with regard to our understanding of insomnia.
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