Summary Despite its high prevalence and burden, insomnia is often trivialized, under-diagnosed, and under-treated in practice. Little information is available on the subjective experience and perceived consequences of insomnia, help-seeking behaviors, and treatment preferences. The use of qualitative approaches (e.g., ethnography, phenomenology, grounded theory) may help gain a better understanding of this sleep disorder. The present paper summarizes the evidence derived from insomnia studies using a qualitative research methodology (e.g., focus group, semi-structured interviews). A systematic review of the literature was conducted using PsycINFO and Medline databases. The review yielded 22 studies and the quality of the methodology of each of them was evaluated systematically using the CASP appraisal tool. Selected articles possess at least a very good methodological rigor and they were categorized according to their main focus: “Experience of insomnia”, “Management of insomnia” and “Medicalization of insomnia”. The main findings indicate that: 1) insomnia is often experienced as a 24-hour problem and is perceived to affect several domains of life, 2) a sense of frustration and misunderstanding is very common among insomnia patients, which is possibly due to a mismatch between patients’ and health care professionals’ perspectives on insomnia and its treatment, 3) health care professionals pay more attention to sleep hygiene education and medication therapies and less to the patient’s subjective experience of insomnia, and 4) health care professionals are often unaware of non-pharmacological interventions other than sleep hygiene education. An important implication of these findings is the need to develop new clinical measures with a broader scope on insomnia and more targeted treatments that take into account the patient’s experience of insomnia. Greater use of qualitative approaches in future research may produce novel and more contextualized information leading to a more comprehensive understanding of insomnia.

RESUMOEste artigo descreve um estudo de caso etnográfi co realizado com Sávio, 20 anos, diagnosticado com transtorno somatoforme na Psiquiatria de um hospital público de Fortaleza. Durante o ano de 2005, foram realizadas visitas semanais ao seu bairro, com o objetivo de compreender a experiência vivida do estigma no seu cotidiano. A lente fenomenológica "mundana" atuou na leitura de seu mundo vivido/lebenswelt. O conteúdo foi compreendido na perspectiva da Antropologia da Experiência; a etnografi a foi o método de pesquisa. Os resultados mostraram que o estigma está presente no bairro e nas relações cotidianas de Sávio. O autoestigma foi a marca mais relevante geradora de sofrimento psíquico. Palavras-chave: Estigma. Doença mental. Sofrimento psíquico. ABSTRACTThis work describes an ethnographic case study with Sávio, 20-year-old, diagnosed with somatoform disorder at the Psychiatry of a public hospital in Fortaleza. During 2005, weekly visits were done in Sávio's community, aiming at the comprehension of the lived experience of stigma in his daily world, using the Merleau-Ponty's phenomenology on the reading of his lived world/lebenswelt. The content was understood under the Anthropology of Experience; Ethnography was the research method used. The results showed that the stigma is present in Sávio's community and daily relations. The auto-stigma was observed as the most relevant sign as generating of psychic suffering.

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Centre interuniversitaire d'études sur les lettres, les arts et les traditions -

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