Clinical Update on Epidemiology, Pathogenesis, and Nonpharmacological Treatment of Insomnia

Abstract

Scientific background: Insomnia is by far the most common form of

sleep disturbance. Most typically, insomnia has been defined as the

symptom of difficulty initiating or maintaining sleep and more rarely as

an inability to obtain restorative sleep. Insomnia disorders are most

often classified as either primary or secondary to other sleep, psychiatric,

or medical conditions, although it is often difficult in practice to

determine true causality of insomnia or there may be more than one

cause (comorbid conditions). Increasing age, female sex, and psychiatric

and medical disorders are consistent risk factors for insomnia. Insomnia

is associated with significant social, medical, and financial consequences

including impaired social functioning and quality of life, increased risk

for psychiatric disorders, and increased health care costs. The clinical

assessment of insomnia is based on a careful clinical interview, often

supplemented by sleep questionnaires, sleep logs, and psychological

testing. Polysomnography is indicated only in selected cases when

specific sleep pathologies are suspected.

Assessment: A large proportion of insomnia sufferers go undiagnosed,

and therefore untreated, by their doctors, and many of these patients

incur considerable personal, vocational, and health-related consequences

as a result. Insomnia can be triggered by a variety of precipitating events,

but when it becomes a chronic problem, psychological and behavioral

factors are almost always involved in perpetuating or exacerbating sleep

disturbances over time. Psychological and behavioral therapies for

primary insomnia include sleep restriction, stimulus control therapy,

relaxation training, cognitive strategies, and a combination of those

methods, referred to as cognitive behavior therapy of insomnia. Results

of the controlled clinical trials indicate that 70% to 80% of patients with

primary insomnia partially benefit from cognitive behavior therapy.

Although only 20% to 30% of patients become completely symptom

free and can be called as "good sleepers". The clinical studies showed

that sleep improvements are well maintained up to 2 years after

treatment completion.

C o n c l u s i o n: Despite evidence showing psychological and behavioral

approaches to be efficacious in the treatment of insomnia, in today’s

clinical practice, such therapies are not readily available and are not

widely used by doctors.