Insomnia

Insomnia is a sleep disorder in which the patient has difficulty falling asleep or staying awake.

Insomnia is defined as the complaint of inadequate or insufficient sleep despite adequate opportunity. The specific complaint about sleep quality varies among patients. Patients may complain of difficulty falling asleep (“sleep onset insomnia”) or difficulty staying asleep (“sleep maintenance insomnia”), or both. A distinct complaint that is particularly common among the elderly is of early morning awakening, in which patients awake before the desired time and are unable to return to sleep.

An important factor in assessing the patient with an insomnia complaint is the extent to which the sleep problem adversely affects waking function. Most patients with insomnia describe difficulties with alertness the following day, but, in many, the effects on waking function may be more subtle. Some patients report problems with psychomotor function (slowed reaction times, clumsiness), others with higher cognitive function (concentration, memory). Still others may describe difficulty with regulation of mood. The presence of functional impairment during wakefulness is an important criterion in assessing the need for treatment of the patient with insomnia.

Insomnia is further classified according to the clinical context in which it occurs. “Primary insomnia” is used to describe a complaint of insomnia that occurs in isolation, absent precipitating or potentiating medical or psychiatric conditions. Primary insomnia appears to have its roots in early childhood, and available data suggest a strong genetic component. It is thought to represent a lifelong condition that predisposes to recurrent episodes of symptomatic insomnia in times of stress or illness.

“Comorbid insomnia” is used to describe the much more common clinical setting in which insomnia presents in the setting of chronic medical or psychiatric conditions that may themselves be contributing to sleep disruption and sleep quality complaints. “Comorbid” is used to describe this relationship, rather than the older term “secondary”, to reflect 1) the likelihood that many of these patients have underlying primary insomnia pathophysiology; and 2) the growing evidence that insomnia specifically, and sleep disruption more generally, may contribute to both the genesis and persistence of medical and psychiatric disease. The term “secondary insomnia” is now reserved for sleep complaints that clearly arise as a consequence of an identifiable insult, such as certain medicines, caffeine, tobacco, and alcohol.

Finally, insomnia can be classified as either acute or chronic, depending on the duration of symptoms. Chronic insomnia implies that the patient is experiencing symptoms for at least 3 nights a week for at least a month. Acute insomnia lasts for a shorter period of time, but can still be harmful to a person's health.

Epidemiology

Click on the link above to view epidemiologic information related to insomnia. This will include information which relates to the incidence and distribution of insomnia across a population. This will also include information regarding the prevalence of insomnia across a population in relation to specific factors, such as ethnicity, age, gender, etc...

Symptoms & Diagnosis

Click on the link above to view information regarding the diagnosis of insomnia. This will describe the preferential methods used to identify patients who suffer from insomnia.

Treatment

Click on the link above to view information regarding the treatment of insomnia. This will describe the latest techniques used to help treat patients suffering from insomnia, as well as the rate of success and possible implications of using the respective treatment.

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