These findings provide further evidence that the ISI is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.

Insomnia is a prevalent condition, although few people seek professional consultation for this condition. Despite regional differences in the prevalence and treatments used to manage insomnia, prescribed medications remain the most widely used therapeutic option.

Background: Although insomnia is a prevalent complaint with significant consequences on quality of life, health, and health care utilization, it often remains undiagnosed and untreated in primary care settings. Brief, reliable, and valid instruments are needed to facilitate screening for insomnia in general practice. This study examined psychometric indices of the Insomnia Severity Index (ISI) to identify individuals with clinically significant insomnia in primary care settings.Methods: A sample of 410 patients recruited from 6 general medical clinics completed the ISI before their appointment with a primary care physician. A subsample of 101 individuals also completed a semistructured clinical interview by telephone to determine the presence or absence of an insomnia disorder. Reliability and validity indices were computed, as was the discriminative capacity of each individual item. Convergence between ISI total score and the diagnosis derived from the interview was investigated. Receiver operator characteristic analyses were used to determine the optimal ISI cutoff score that correctly identified individuals with an insomnia disorder.Results: ISI internal consistency was excellent (Cronbach ␣ ‫؍‬ 0.92), and each individual item showed adequate discriminative capacity (r ‫؍‬ 0.65-0.84). The area under the receiver operator characteristic curve was 0.87 and suggested that a cutoff score of 14 was optimal (82.4% sensitivity, 82.1% specificity, and 82.2% agreement) for detecting clinical insomnia. Agreement between the ISI cut score and the diagnostic interview was moderate ( ‫؍‬ 0.62).Conclusions: These findings suggest that the ISI is a valid screening instrument for detecting insomnia among patients consulting in primary care settings. (J Am Board Fam Med 2013;26:701-710.)

These findings indicate that insomnia is often a persistent condition, in particular when it reaches the diagnostic threshold for an insomnia disorder.

Objective To examine the unique contribution of behavior therapy (BT) and cognitive therapy (CT) relative to the full cognitive behavior therapy (CBT) for persistent insomnia. Method Participants were 188 adults (117 women; M age = 47.4 years old, SD=12.6) with persistent insomnia (average of 14.5 years duration). They were randomized to eight, weekly, individual sessions consisting of BT (n = 63), CT (n = 65), or CBT (n = 60). Results Full CBT was associated with greatest improvements, the improvements associated with BT were faster but not as sustained and the improvements associated with CT were slower and sustained. The proportion of treatment responders was significantly higher in the CBT (67.3%) and BT (67.4%) relative to CT (42.4%) groups at post treatment, while 6-months later CT made significant further gains (62.3%), BT had significant loss (44.4%) and CBT retained its initial response (67.6%). Remission rates followed a similar trajectory, with higher remission rates at post treatment in CBT (57.3%) relative to CT (30.8%), with BT falling in between (39.4%); CT made further gains from post treatment to follow up (30.9% to 51.6%). All three therapies produced improvements of daytime functioning at both post treatment and follow up, with few differential changes across groups. Conclusions Full CBT is the treatment of choice. Both BT and CT are effective, with a more rapid effect for BT and a delayed action for CT. These different trajectories of changes provide unique insights into the process of behavior change via behavioral versus cognitive routes.