Manifestations and Management of Chronic Insomnia in Adults: Evidence Report/Technology Assessment, Number 125

Abstract

Insomnia, or inability to sleep, is the most commonly reported sleep problem in the industrialized world. 1 Estimates suggest that between 40 and 70 million Americans are affected by either intermittent or chronic sleep problems, representing approximately 20 percent of the population. 2 The Sleep in America Poll, conducted by the National Sleep Foundation, revealed that almost 50 percent of people surveyed had complaints of frequent insomnia, but only 6 percent were formally diagnosed. 3 Moreover, approximately, 30 to 35 percent of respondents complained of nightly insomnia. 3 The most prevalent symptoms of insomnia, experienced at least a few nights a week by people with insomnia, include waking up feeling unrefreshed (34 percent) and being awake often during the night (32 percent). 3 The symptoms of difficulty falling asleep and waking up too early are less common, but still experienced at least a few nights a week by about one-fourth of adults with insomnia (23 to 24 percent). 3 Risk Factors for Insomnia Although some risk factors and etiologies of insomnia have been identified, the nature of the relationships has not been fully elucidated. Some risk factors for insomnia that have emerged from data related to insomnia include female gender 3 and old age. 4 Additional risks factors include less education, unemployment, separation or divorce, and medical illness. 1 Insomnia may be primary or secondary to other sleep problems and may be associated with a number of co-morbidities. An association has been found between insomnia and psychiatric (depression and anxiety) and psychological disorders. 4 There is increasing evidence that chronic insomnia may predispose individuals to the development of psychiatric disorders. 5-6 Persistent insomnia increases the risk of depression, substance abuse, and anxiety disorders. Environmental factors such as irregular sleep schedules, use of caffeine or other stimulants, co-morbid medical conditions, and/or shift work may also predispose vulnerable individuals to insomnia. Consequences of Insomnia Insomnia has significant direct and indirect effects on the health and wellness of affected individuals. Insomnia has been correlated with frequent use of medical services, 7-8 chronic health problems, 9-10 increased drug use, 7-8 and perceived poor health, 11 and has been associated with medical problems including heart disease, 12 hypertension, 13 and musculoskeletal problems. 12 The daytime consequences of chronic insomnia often include increased healthcare utilization, increased risk of depression, 14 poor memory, reduced concentration, poor work performance, and perceived or real risk of failure at work. 15 The economic implications of insomnia and

Treating Complicated Grief: Effects on Sleep Quality

“…Behavioral changes associated with bereavement and/or CG and disrupted social rhythms (Brown et al, 1996) may underlie sleep disturbance in CG. The effects of sleep disturbance, whether it occurs in the absence of other conditions (e.g., primary insomnia) or in the context of another medical or psychiatric contrition or comorbid insomnia, have received increasing attention in recent years (Buscemi et al, 2005;Kripke, Garfinkel, Wingard, Klauber, & Marler, 2002;Schwartz, McDowell Anderson, Cole, Cornoni-Huntley, Hays, & Blazer, 1999;D. J. Taylor, Lichstein, & Durrence, 2003).…”

Sleep problems in breast cancer survivors 1–10 years posttreatment

“…The importance of understanding sleep disturbances in cancer populations has been highlighted by national agencies and professional societies (Colten & Altevogt, 2007). The U.S. Department of Health and Human Services has recognized sleep disorders as warranting further scientific investigation, with cancer named specifically as a high-priority research focus (Buscemi et al, 2005).…”

How mindfulness changed my sleep: focus groups with chronic insomnia patients

“…Clinical guidelines for treatment of chronic insomnia recommend multi-dimensional programs which combine relaxation training, stimulus control, sleep restriction and sleep hygiene (changing sleep habits) within a program of cognitive behavioral therapy (CBT-I) to address the dysfunctional beliefs and behaviors about sleep that perpetuate insomnia, however access to CBT-I is severely limited by a lack of sleep specialists [ 3 , 6 ]. Instead, most patients are untreated or take sedative hypnotics for years without addressing the underlying causes of their insomnia and despite troublesome side effects [ 7 ]. Amidst calls for innovative treatments and alternative delivery methods to expand access to care and accelerate improvements in treatment, mindfulness-based stress reduction (MBSR) has emerged as a promising therapy for chronic insomnia [ 8 , 9 ].…”