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

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.