Sleep is a necessary component for life, and a person's health is directly affected by the amount and quality of sleep that s/he receives. Insomnia has a direct relationship on a person's physical, emotional, and psychological health and will impact every area of his or her life. Insomnia is the most prevalent sleep disorder in the general population. According to the American Academy of Sleep Disorders, insomnia is the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment. Chronic insomnia is present for at least a month and may present itself with a variety of specific patient complaints and etiologies.
Insomnia is an important public health concern that requires accurate diagnosis and intervention because of its effect on the patient and the public at large. In the realm of conditions and diseases, those that affect not only the specific patient but others in the general population make up a small percentage of diseases. Insomnia is one of these because of how sleep deprivation affects a person's cognitive awareness, reflexive and reaction capability, and the physical impairment that can result in injury to self or to others.
Insomnia is primarily diagnosed by clinical evaluation through a thorough sleep history study as well as a detailed medical, substance, and psychiatric history study. The sleep history should cover all aspects of sleep complaints including: the inability to fall asleep, the inability to stay asleep, other sleep-related symptoms, and daytime consequences from the lack of sleep or poor quality of sleep. The history study allows for physicians to establish the type and evolution of insomnia through perpetuating factors, and identification of comorbid medical, substance, and/or psychiatric conditions.
The primary treatment goals for insomnia are to improve sleep quality and quantity, and to improve insomnia related daytime impairments. Insomnia symptoms occur in approximately 33-50% of the adult population, with distress or impairment occurring in 10-15% of those affected with insomnia. While helping patients gain quality and quantity of sleep is most certainly a goal, it is essential to recognize and treat comorbid conditions that commonly occur with insomnia. Depression, suicidal tendencies, chronic pain, and inappropriate alcohol or substance abuse must be identified and evaluated for treatment of insomnia to be effective. The ultimate goals of insomnia treatment include reduction of sleep and waking symptoms, improvement of daytime function, and the reduction of distress. Physicians must monitor patients with clinical evaluation, questionnaires, sleep logs, and continued sleep studies. A specific follow-up plan and time frame should be outlined with the patient for the evaluation to be accurate and treatment options to be adjusted.
Sleep is a necessary component in personal health, personal safety, and the safety of others. Insomnia must be evaluated and treated as a serious medical condition.
- AAHRQ 2017 Management of Insomnia Disorder in Adults Current State of the Evidence
- 2017 American Academy of Sleep Medicine Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomina in Adults
- Excessive Sleepiness Evidence
- Sleep Disorders in Neurodegenerative Disorders and Stroke
- Clinical guideline for the treatment of primary insomnia
- Management of Patients with Insomnia in Primary Care