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VOLUME 19 , ISSUE 2 ( April-June, 2024 ) > List of Articles

REVIEW ARTICLE

Insomnia: An Update on Epidemiology, Diagnosis and Non-pharmacological Management

Athul Francis

Keywords : Adolescents, Cognitive behavior therapy in insomnia-I, Functional outcomes of sleep, Insomnia, Insufficient sleep, Sleep medicine, Sleep quality

Citation Information : Francis A. Insomnia: An Update on Epidemiology, Diagnosis and Non-pharmacological Management. Indian Sleep Med 2024; 19 (2):18-22.

DOI: 10.5005/jp-journals-10069-0131

License: CC BY-NC 4.0

Published Online: 19-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Insomnia is defined as a condition in which a person finds it difficult to fall or stay asleep. It is usually associated with significant impairment in daytime function and adversely affects the quality of life of the individual. Insomnia is often found in individuals with psychiatric illness and it has been reported that insomnia may be a risk factor for hypertension, diabetes, depression, anxiety, substance use disorders, and suicidal tendencies. As insomnia is associated with poor quality of life, increased rates of road traffic accidents, and adverse health consequences, early detection and treatment of this condition is warranted. It is recommended that treatment be targeted specifically to address insomnia whenever it is present, including when it occurs along with physical or psychiatric conditions. Several treatment options are available for Insomnia. This paper reviews the various studies on insomnia with special emphasis on diagnosis and various non-pharmacological treatments like cognitive behavior therapy in insomnia (CBT-I).


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  1. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd edition. Darien: American Academy of Sleep Medicine; 2014. pp. 20–24.
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition. Arlington: American Psychiatric Association; 2013. pp. 25–30.
  3. Roth T, Coulouvrat C, Hajak G, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders. Biol Psychiatry 2011;69(6):592–600. DOI: 10.1016/j.biopsych.2010.10.023.
  4. Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev 2002;6(2):97–111. DOI: 10.1053/smrv.2002.0186.
  5. Ohayon MM, Reynolds CF. Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the international classification of sleep disorders (ICSD). Sleep Med 2009;10(9):952–960. DOI: 10.1016/j.sleep.2009.07.008.
  6. Morin CM, LeBlanc M, Bélanger L, et al. Prevalence of insomnia and its treatment in Canada. Can J Psychiatry 2011;56(9):540–548. DOI: 10.1177/070674371105600905.
  7. Drake CL, Pillai V, Roth T. Stress and sleep reactivity: A prospective investigation of the stress diathesis model of insomnia. Sleep 2014;37(8):1295–1304. DOI: 10.5665/sleep.3916.
  8. Breslau N, Roth T, Rosenthal L, et al. Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young adults. Biol Psychiatry 1996;39(6):411–418. DOI: 10.1016/0006-3223(95)00188-3.
  9. Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011;135(1–3):10–9. DOI: 10.1016/j.jad.2011.01.011.
  10. Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk. J Psychiatr Res 2006;40(8):700–708. DOI: 10.1016/j.jpsychires.2006.07.008.
  11. Johnson EO, Chilcoat HD, Breslau N. Trouble sleeping and anxiety/depression in childhood. Psychiatry Res 2000;94(2):93–102. DOI: 10.1016/s0165-1781(00)00145-1.
  12. Fernandez-Mendoza J, Vgontzas AN, Liao D, et al. Insomnia with objective short sleep duration and incident hypertension: The Penn State Cohort. Hypertension 2012;60(4):929–935. DOI: 10.1161/HYPERTENSIONAHA.112.193268.
  13. Pigeon WR, Pinquart M, Conner K. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry 2012;73(9):e1160–e1167. DOI: 10.4088/JCP.11r07586.
  14. Vgontzas AN, Liao D, Bixler EO, et al. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009;32(4):491–497. DOI: 10.1093/sleep/32.4.491.
  15. Parthasarathy S, Vasquez MM, Halonen M, et al. Persistent insomnia is associated with mortality risk. Am J Med 2015;128(3):268–275. DOI: 10.1016/j.amjmed.2014.10.015.
  16. Koski K, Luukinen H, Laippala P, et al. Risk factors for major injurious falls among the home dwelling elderly by functional abilities. A prospective population-based study. Gerontology 1998;44(4): 232–238. DOI: 10.1159/000022017.
  17. Avidan AY, Fries BE, James ML, et al. Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes. J Am Geriatr Soc 2005;53(6):955–962. DOI: 10.1111/j.1532-5415.2005.53304.x.
  18. Stone KL, Blackwell TL, Ancoli-Israel S, et al. Sleep disturbances and risk of falls in older community-dwelling men: The outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study. J Am Geriatr Soc 2014;62(2):299–305. DOI: 10.1111/jgs.12649.
  19. Kessler RC, Berglund PA, Coulouvrat C, et al. Insomnia, comorbidity, and risk of injury among insured Americans: results from the America Insomnia Survey. Sleep 2012;35(6):825–834. DOI: 10.5665/sleep.1884.
  20. Krystal AD. A compendium of placebo-controlled trials of the risks/benefits of pharmacological treatments for insomnia: The empirical basis for U.S. clinical practice. Sleep Med Rev 2009;13(4):265–274. DOI: 10.1016/j.smrv.2008.08.001.
  21. National Institutes of Health. National Institutes of Health state of the science conference statement on manifestations and management of chronic insomnia in adults. Sleep 2005;28(9):1049–1057. DOI: 10.1093/sleep/28.9.1049.
  22. Edinger JD, Wyatt JK, Stepanski EJ, et al. Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses. Arch Gen Psychiatry 2011;68(10):992–1002. DOI: 10.1001/archgenpsychiatry.2011.64.
  23. Vgontzas AN, Liao D, Pejovic S, et al. Insomnia with objective short sleep duration is associated with type 2 diabetes: A population-based study. Diabetes Care 2009;32(11):1980–1985. DOI: 10.2337/dc09-0284.
  24. Fernandez-Mendoza J, Calhoun S, Bixler EO, et al. Insomnia with objective short sleep duration is associated with deficits in neuropsychological performance: A general population study. Sleep 2010;33(4):459–465. DOI: 10.1093/sleep/33.4.459.
  25. Johnson EO. Epidemiology of insomnia: From adolescence to old age. Sleep Med Clin 2006;1(3):305–317. DOI: 10.1016/j.jsmc.2006. 06.006.
  26. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 1985;42(3):225–232. DOI: 10.1001/archpsyc.1985.01790260019002.
  27. Roth T. Insomnia: Definition, prevalence, etiology, and consequences. J Clin Sleep Med 2007;3(Suppl 5):S7–S10. PMID: 17824495.
  28. Leger D, Guilleminault C, Dreyfus JP, et al. Prevalence of insomnia in a survey of 12,778 adults in France. J Sleep Res 2000;9(1):35–42. DOI: 10.1046/j.1365-2869.2000.00178.x.
  29. Morin CM, Bélanger L, LeBlanc M, et al. The natural history of insomnia: A population-based 3-year longitudinal study. Arch Intern Med 2009;169(5):447–453. DOI: 10.1001/archinternmed.2008.610.
  30. Beaulieu-Bonneau S, LeBlanc M, Mérette C, et al. Family history of insomnia in a population-based sample. Sleep 2007;30(12):1739–1745. DOI: 10.1093/sleep/30.12.1739.
  31. Kim K, Uchiyama M, Okawa M et al. An epidemiological study of insomnia among the Japanese general population. Sleep 2000;23(1):41–47. PMID: 10678464.
  32. Ohayon M. Epidemiological study on insomnia in the general population. Sleep 1996;19(Suppl 3):S7–S15. DOI: 10.1093/sleep/19.suppl_3.s7.
  33. Bixler EO, Kales A, Soldatos CR, et al. Prevalence of sleep disorders in the Los Angeles metropolitan area. Am J Psychiatry 1979;136(10): 1257–1262. DOI: 10.1176/ajp.136.10.1257.
  34. Maggi S, Langlois JA, Minicuci N, et al. Sleep complaints in community-dwelling older persons: Prevalence, associated factors, and reported causes. J Am Geriatr Soc 1998;46(2):161–168. DOI: 10.1111/j.1532-5415.1998.tb02533.x.
  35. Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep 1995;18(6):425–432. DOI: 10.1093/sleep/18.6.425.
  36. Weissman MM, Bland RC, Canino GJ, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996;276(4):293–239. PMID: 8656541.
  37. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989;262(1):1479–1484. DOI: 10.1001/jama.262.11.1479
  38. Henderson S, Jorm AF, Scott LR, et al. Insomnia in the elderly: Its prevalence and correlates in the general population. Med J Aust 1995;162(1):22–24. DOI: 10.5694/j.1326-5377.1995.tb138406.x.
  39. Tamura H, Nishida T, Tsuji A, et al. Association between excessive use of mobile phone and insomnia and depression among Japanese adolescents. Int J Environ Res Publ Health 2017;14(7):701. DOI: 10.3390/ijerph14070701.
  40. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral-perspective on insomnia treatment. Psychiatr Clin North Am 1987;10(4):541–553. PMID: 3332317.
  41. Brainard GC, Hanifin JP, Greeson JM, et al. Action spectrum for melatonin regulation in humans: Evidence for a novel circadian photoreceptor. J Neurosci 2001;21(16):6405–6412. DOI: 10.1523/JNEUROSCI.21-16-06405.2001.
  42. Yang C-M, Spielman AJ, Glovinsky P. Nonpharmacologic strategies in the management of insomnia. Psychiatr Clin North Am 2006;29(4):895–919. DOI: 10.1016/j.psc.2006.09.005.
  43. Ebben MR, Spielman AJ. Non-pharmacological treatments for insomnia. J Behav Med 2009;32(3):244–254. DOI: 10.1007/s10865-008-9198-8.
  44. Gislason T, Almqvist M. Somatic diseases and sleep complaints. An epidemiological study of 3,201 Swedish men. Acta Med Scand 1987;221(5):475–481. PMID: 3496735.
  45. Stoschitzky K, Sakotnik A, Lercher P, et al. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol 1999;55(2):111–115. DOI: 10.1007/s002280050604.
  46. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):487–504. PMID: 18853708.
  47. Valipour A, Lothaller H, Rauscher H, et al. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: A clinical population study using the sleep disorders questionnaire. Sleep 2007;30(3):312–319. DOI: 10.1093/sleep/30.3.312.
  48. Theorell-Haglow J, Miller CB, Bartlett DJ, et al. Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults – What do we know? A clinical update. Sleep Med Rev 2018;38:28–38. DOI: 10.1016/j.smrv.2017.03.003.
  49. Morgenthaler T, Alessi C, Friedman L, et al. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep 2007;30(4):519–529. DOI: 10.1093/sleep/30.4.519.
  50. Hyde M, O'Driscoll DM, Binette S, et al. Validation of actigraphy for determining sleep and wake in children with sleep disordered breathing. J Sleep Res 2007;16(2):213–216. DOI: 10.1111/j.1365-2869.2007.00588.x.
  51. Hedner J, Pillar G, Pittman SD, et al. A novel adaptive wrist actigraphy algorithm for sleep-wake assessment in sleep apnea patients. Sleep 2004;27(8):1560–1566. DOI: 10.1093/sleep/27.8.1560.
  52. Martin JL, Hakim AD. Wrist actigraphy. Chest 2011;139(6):1514–1527. DOI: 10.1378/chest.10-1872.
  53. Gruwez A, Libert W, Ameye L, et al. Reliability of commercially available sleep and activity trackers with manual switch-to-sleep mode activation in free-living healthy individuals. Int J Med Inform 2017;102:87–92. DOI: 10.1016/j.ijmedinf.2017.03.008.
  54. Ko PR, Kientz JA, Choe EK, et al. Consumer sleep technologies: A review of the landscape. J Clin Sleep Med 2015;11(12):1455–1461. DOI: 10.5664/jcsm.5288.
  55. Krystal AD, Edinger JD, Wohlgemuth WK, et al. NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. Sleep 2002;25(6):630–640. PMID: 12224842.
  56. Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14(6):540–545. DOI: 10.1093/sleep/14.6.540.
  57. Morin CM, Belleville G, Bélanger L, et al. The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011;34(5):601–608. DOI: 10.1093/sleep/34.5.601.
  58. Morin CM, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep 2007;30(11):1547–1554. DOI: 10.1093/sleep/30.11.1547.
  59. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatr Res 1989;28(2):193–213. DOI: 10.1016/0165-1781(89)90047-4.
  60. Koffel EA, Koffel JB, Gehrman PR. A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Med Rev 2015;19:6–16. DOI: 10.1016/j.smrv.2014.05.001.
  61. van Straten A, van der Zweerde T, Kleiboer A, et al. Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Med Rev 2018;38:3–16. DOI: 10.1016/j.smrv.2017.02.001.
  62. Wu JQ, Appleman ER, Salazar RD, et al. Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: A meta-analysis. JAMA Intern Med 2015;175(9):1461–1472. DOI: 10.1001/jamainternmed.2015.3006.
  63. Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 2006;25(1):3–14. DOI: 10.1037/0278-6133.25.1.3.
  64. Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002;159(1):5–11. DOI: 10.1176/appi.ajp.159.1.5.
  65. Seyffert M, Lagisetty P, Landgraf J, et al. Internet-delivered cognitive behavioral therapy to treat insomnia: A systematic review and meta-analysis. PLoS One 2016;11(2):e0149139. DOI: 10.1371/journal.pone.0149139.
  66. Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2016;165(2):125–133. DOI: 10.7326/M15-2175.
  67. Manber R, Carney C. Treatment plans and interventions for insomnia: A case formulation approach. New York: Guilford; 2015. pp. 103–117.
  68. Edinger J, Carney C. Overcoming insomnia: A cognitive-behavioral therapy approach. Oxford: Oxford University Press, 2015. pp. 45–50.
  69. Edinger JD, Wohlgemuth WK, Radtke RA, et al. Cognitive behavioral therapy for treatment of chronic primary insomnia: A randomized controlled trial. JAMA 2001;285(14):1856–1864. DOI: 10.1001/jama.285.14.1856.
  70. Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 National Health Interview Survey data. Arch Intern Med 2006;166(16):1775–1782. DOI: 10.1001/archinte.166.16.1775.
  71. Haack M, Scott-Sutherland J, Santangelo G, et al. Pain sensitivity and modulation in primary insomnia. Eur J Pain 2012;16(4):522–533. DOI: 10.1016/j.ejpain.2011.07.007.
  72. Colombo C, Benedetti F, Barbini B, et al. Rate of switch from depression into mania after therapeutic sleep deprivation in bipolar depression. Psychiatry Res 1999;86(3):267–270. DOI: 10.1016/s0165-1781(99)00036-0.
  73. Trauer JM, Qian MY, Doyle JS, et al. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Ann Intern Med 2015;163(3);191–204. DOI: 10.7326/M14-2841.
  74. Geiger-Brown JM, Rogers VE, Liu W, et al. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis. Sleep Med Rev 2015;23:54–67. DOI: 10.1016/j.smrv.2014.11.007.
  75. Ho FY, Chan CS, Tang KN. Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials. Clin Psychol Rev 2016;43:90–102. DOI: 10.1016/j.cpr.2015.09.005.
  76. Belleville G, Cousineau H, Levrier K, et al. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev 2011;31(4):638–652. DOI: 10.1016/j.cpr.2011.02.004.
  77. Ye YY, Zhang YF, Chen J, et al. Internet-based cognitive behavioral therapy for insomnia (ICBT-I) improves comorbid anxiety and depression–A meta-analysis of randomized controlled trials. PLoS One 2015;10(11):e0142258. DOI: 10.1371/journal.pone.0142258.
  78. Espie CA, Emsley R, Kyle SD, et al. Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being and sleep-related quality of life: A randomized clinical trial. JAMA Psychiatry 2019;76(1):21–30. DOI: 10.1001/jamapsychiatry. 2018.2745.
  79. Krystal AD, Prather AA. Should internet cognitive behavioral therapy for insomnia be the primary treatment option for insomnia?: Toward getting more SHUTi. JAMA Psychiatry 2017;74(1):15–16. DOI: 10.1001/jamapsychiatry.2016.3431.
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