Clinical Features, Diagnosis, and Differential Diagnosis
Chronic insomnia disorders (CID) are often a final common pathway for many people who initially develop sleeplessness in the context of acute stressors (e.g., pain, job loss), but then acquire a form of “learned” sleeplessness as they become increasingly
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Clinical Features, Diagnosis, and Differential Diagnosis Mary B. O’Malley and Edward B. O’Malley
Abstract Chronic insomnia disorders (CID) are often a final common pathway for many people who initially develop sleeplessness in the context of acute stressors (e.g., pain, job loss), but then acquire a form of “learned” sleeplessness as they become increasingly over-concerned about their unsatisfying sleep patterns. Patients report reduced total sleep time, with increased sleep latency (greater than 30 min), or increased wake after sleep onset time, though these findings are not always corroborated on PSG studies. Patients with this form of chronic insomnia are often vexed by its seemingly unpredictable nature from night to night, but to be diagnosed symptoms must be present on three or more nights per week, for more than 3 months (ICSD-3). This chapter summarizes the clinical features of this disorder, the approach to diagnostic assessment, including the use of newer sleep apps and other technologies, and differential diagnosis. Keywords Chronic insomnia • Psychophysiological insomnia • Diagnostic criteria • Beliefs and attitudes about sleep • Sleep apps
Introduction Chronic insomnia disorder (CID) in adults is essentially a diagnosis of exclusion though there are many clinically specific findings. The essential feature of CID is a pattern of sleep disturbance that may have a non-determinate beginning but that
M.B. O’Malley, M.D., Ph.D. (*) Berkshire Medical Center, Pittsfield, MA, USA e-mail: [email protected] E.B. O’Malley, Ph.D. Your Optimal Nature, Great Barrington, MA, USA © Springer International Publishing Switzerland 2017 H.P. Attarian (ed.), Clinical Handbook of Insomnia, Current Clinical Neurology, DOI 10.1007/978-3-319-41400-3_3
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usually evolves over time as a result of psychological distress that triggers unhelpful behaviors and physiological arousal. Patients report reduced total sleep time, with increased sleep latency (greater than 30 min), or increased wake after sleep onset time though these findings are not always corroborated on PSG studies. Patients with this form of chronic insomnia are often plagued by its seemingly unpredictable nature from night tonight, but to be diagnosed symptoms must be present on three or more nights per week for more than 3 months. This chapter summarizes the current understanding of this disorder and the clinical features underlying accurate diagnosis that are crucial for successful treatment. CID diagnosis in children is covered in another chapter in this volume.
Clinical Features Chronic insomnia is a final common pathway for many people who have experienced a lifelong difficulty obtaining sleep, or initially develop sleeplessness in the context of acute stressors (e.g., pain, job loss). Common to all insomnia subtypes however is the ensuing “learned” helplessness and maladaptive behaviors leading to over-concern about their unsatisfying sleep patterns. The essential feature of chronic insomnia disorder is persistent diffi
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