#Insomnia definition manual

Among younger individuals, difficulty falling asleep is often associated with a phase delay syndrome. 11 This is especially true among the elderly. Among the primary sleep disorders, restless legs syndrome (RLS), 10 periodic limb movement disorders (PLMD), and sleep-related breathing disorders (snoring, dyspnea, sleep apnea) often present with an insomnia symptom. Importantly, a variety of primary sleep disorders as well as circadian rhythm disorders are frequently comorbid with and often lead to insomnia. It is estimated that the majority of people with insomnia (approximately 75%вЂ“90%) have an increased risk for comorbid medical disorders, 7 such as conditions causing hypoxemia and dyspnea, gastroesophageal reflux disease, pain conditions, and neurodegenerative diseases. In fact, chronic illnesses are a significant risk for insomnia. It is important to recognize that these factors do not independently cause insomnia, but rather they are precipitants of insomnia in individuals predisposed to this disorder. 6 Comorbid medical disorders, 7 psychiatric disorders, 8 and working night or rotating shifts 9 all represent significant risks for insomnia.

Additionally, in women, insomnia is more prevalent with both the onset of menses and menopause. Importantly, the presence of comorbid medical conditions is also a significant contributor to the increased prevalence of insomnia in the elderly. While the cause of this increased risk in the elderly is not well defined, it may be due to the partial decline in functionality of sleep control systems that may contribute to insomnia in this older population. 3 Age and gender are the most clearly identified demographic risk factors, with an increased prevalence in women and older adults. Several well-identified risk factors for insomnia were reported by the State-of-the-Science Conference in June 2005.

#Insomnia definition manual

3 Finally, the application of more stringent diagnostic criteria, such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 4 which includes the additional requirements that insomnia symptoms persist for at least 1 month and do not exclusively occur in the presence of another sleep disorder, mental disorder, or the direct physiological effects of a substance or medical condition, yields current prevalence estimates of approximately 6%. 2 Conclusions from the NIH State-of-the-Science Conference held in June 2005 indicate that the addition of a diagnostic requirement that includes perceived daytime impairment or distress as a function of the insomnia symptoms results in approximately 10% prevalence of insomnia. A general consensus has developed from population-based studies that approximately 30% of a variety of adult samples drawn from different countries report one or more of the symptoms of insomnia: difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and in some cases, nonrestorative or poor quality of sleep. In the present discussion, the consequences of insomnia can not merely be the normal consequence of sleep loss.Д®stimates of the prevalence of insomnia depend on the criteria used to define insomnia and more importantly the population studied. What qualifies insomnia to be considered a disorder? A disorder is a condition associated with negative consequences, and importantly, these consequences are not a normal result of the condition but rather the result of some sort of pathological response. However, for the purpose of this paper, the term insomnia will be used as a disorder with the following diagnostic criteria: (1) difficulty falling asleep, staying asleep or nonrestorative sleep (2) this difficulty is present despite adequate opportunity and circumstance to sleep (3) this impairment in sleep is associated with daytime impairment or distress and (4) this sleep difficulty occurs at least 3 times per week and has been a problem for at least 1 month. 1 Thus, insomnia has been thought of both as a symptom and as a sign. Thus, the presence of a long sleep latency, frequent nocturnal awakenings, or prolonged periods of wakefulness during the sleep period or even frequent transient arousals are taken as evidence of insomnia. For example, in survey studies, insomnia is defined by a positive response to either question, вЂњDo you experience difficulty sleeping?вЂќ or вЂњDo you have difficulty falling or staying asleep?вЂќ In the sleep literature, insomnia is sometimes used as a term to describe the presence of polysomnographic evidence of disturbed sleep. Most often, insomnia is defined by the presence of an individual's report of difficulty with sleep. The term insomnia is used in a variety of ways in the medical literature and popular press.