Insomnia: Epidemiology, Subtypes, and Relationship to Psychiatric Disorders
Dissatisfaction with sleep quantity or quality is a common complaint in the general population, and these symptoms considerably influence the expression, consequence, and outcome of distress in patients with psychiatric disorders. The prevalence of insomn
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Insomnia: Epidemiology, Subtypes, and Relationship to Psychiatric Disorders Jonathan A. E. Fleming
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Epidemiology
Insomnia, as defined by the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) (American Psychiatric Association 2013), is a complaint of dissatisfaction with sleep quantity or quality that is associated with difficulty initiating and/or maintaining sleep. It is an occasional complaint even among the best sleepers but is considered a disorder when it occurs frequently (at least three nights per week), persists (for at least 3 months), and causes clinically significant distress in important areas of functioning. Many epidemiological studies have been conducted to document the prevalence of insomnia and have reported widely varying rates from 5% to 50% of the populations surveyed (Ohayon 2002). These rates shrink as stringency—frequency of complaint, chronicity, associated impairments, and diagnostic criteria—is applied: population estimates consistently show that about one third of adults report insomnia symptoms alone; between 10% and 15% have daytime impairment from disrupted sleep and between 6% and 10% meet criteria for DSM-V-defined insomnia disorder (ID) (American Psychiatric Association 2013). These epidemiological studies have significantly influenced criterion-based diagnostic systems (Ohayon et al. 2012) such as the DSM-V, its three predecessors, and the International Classification of Sleep Disorders (AASM 2005). In clinical practice, distinguishing between insomnia symptoms alone, insomnia with or without daytime impairment, and ID is necessary for both accurate diagnosis and appropriate treatment. Six sociodemographic variables are known to affect the prevalence of insomnia: gender, age, marital status, education, occupational status, and income. Females report J. A. E. Fleming Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected] © Springer-Verlag GmbH Germany, part of Springer Nature 2018 H. Selsick (ed.), Sleep Disorders in Psychiatric Patients, https://doi.org/10.1007/978-3-642-54836-9_6
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more insomnia symptoms, associated daytime impairments, and dissatisfaction with sleep than males, and they are twice as likely as males to meet criteria for insomnia diagnoses (Ohayon 2002). Both community (Maggi et al. 1998) and large population-based epidemiologic studies (Ohayon 2002) show that impaired sleep performance is common in the elderly; 15–45% of noninstitutionalized elderly report difficulties initiating sleep, 20–65% report disrupted sleep, and 15–45% report early-morning awakening. However, in a 3-year follow-up of over 9000 community-dwelling adults over age 65 (Foley et al. 1999), about 50% of those with chronic insomnia at baseline no longer had symptoms, and this improvement in sleep was associated with an improvement in overall health suggesting—as have other studies (Ohayon et al. 2004; Foley et al. 1995)—that it is the accompaniments of aging (loss of physical f
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