Insomnias: diagnosis, symptoms, therapy

1. Big picture

Insomnia is the most common sleep disorder. It is not defined only by “sleeping too little,” but by difficulty sleeping despite adequate opportunity, together with daytime impairment.

The key exam sentence:

Insomnia means difficulty initiating sleep, maintaining sleep, waking too early, or non-restorative sleep, despite adequate opportunity for sleep, with daytime consequences such as fatigue, poor concentration, mood disturbance, sleepiness, headache, or impaired work/school performance.

The most important clinical trap:

Do not treat every insomnia immediately with sleeping pills. First identify secondary causes such as depression, anxiety, pain, drugs, alcohol, caffeine, sleep apnea, restless legs syndrome, circadian rhythm disorder, or poor sleep hygiene.

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2. Definition

Insomnia is a complaint of:

• difficulty falling asleep;
• difficulty staying asleep;
• waking too early;
• sleep that is chronically non-restorative or poor quality.

This occurs despite:

• adequate time for sleep;
• adequate circumstances for sleep.

And it must cause daytime complaints such as:

• fatigue;
• attention or memory impairment;
• mood disturbance;
• irritability;
• daytime sleepiness;
• reduced motivation or initiative;
• tension headache;
• gastrointestinal complaints;
• social or occupational dysfunction;
• poor school performance.

So, for the exam:

Insomnia = night symptom + daytime consequence.

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3. Epidemiology

Insomnia is very common.

Lecture points:

• affects about 30–50% of the population;
• prevalence increases with age;
• more common in women;
• about one third of people have sleep complaints;
• prevalence may reach about 50% above 65 years.

Insomnia is clinically important because it increases risk of:

• accidents;
• mood disorders;
• cognitive complaints;
• cardiovascular and metabolic problems if chronic sleep loss is present;
• poor quality of life;
• medication misuse.

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4. Classification of insomnia

Insomnia can be classified by duration, cause, and clinical pattern.