Chronic Insomnia

Chronic Insomnia

Hajak Göran, Riemann Dieter

European Psychiatric Review 2008;1(1):36-9

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Definition of Chronic Insomnia
Insomnia is the complaint that sleep is difficult to initiate or maintain, or that it is non-refreshing or non-restorative.1–3 Insomnia is a distressing condition that affects the ability not only to sleep adequately at night, but also to function effectively during one’s desired waking time. In clinical practice, insomnia is most often recognised by the presence of an individual’s report of difficulty with sleeping. The World Health Organization, along with national health authorities, states that insomnia is among the most prevalent health problems worldwide, affecting up to one-third of the world population at least once in their lifetime.4–6

Chronic insomnia is a highly prevalent condition that underlines the fact that sleep difficulties may result in an actual disorder.7,8 Various minimum durations have been used to distinguish acute from chronic insomnia, most of them ranging from 30 days to six months.9 There is considerable agreement among experts that treatment is required in those patients exhibiting a full-blown disorder, as defined by the standard criteria provided in standard diagnostic manuals of psychiatry or sleep medicine (see Table 1).

Shift in Approach to Insomnia
Insomnia may be classified according to specific symptoms (i.e. difficulties initiating sleep or maintaining sleep), duration (acute versus chronic) or aetiology (primary versus secondary).10 Recent research has led to a shift in our understanding of insomnia,8,9,11,12 which may have implications for the treatment of insomnia in Europe. The American National Institute of Health issued a statement regarding the nature and management of chronic insomnia based on the findings of an independent panel of sleep experts.9 This consensus statement reflects the evolving trend of considering insomnia as a disorder and not merely a symptom. Also, the experts state that insomnia rarely occurs in isolation, but rather is typically co-morbid with other conditions. This statement necessitates a change in approach to treatment: rather than simply treating the primary disorder, in which case the symptoms of insomnia may go unaddressed, there is now a push to acknowledge the existence of chronic insomnia as a disorder that itself merits treatment.12 Substantiation that insomnia is a disorder is based on data indicating that insomnia is associated with pathophysiological changes and results in morbidity, as evidenced by impairment in foundation and quality of life.9 In fact, in addition to difficulties with sleep, the diagnosis of insomnia includes reports of daytime impairment or distress related to the night-time sleep difficulty. These impairments may include, but are not limited to, problems such as fatigue, memory impairment, mood disturbances, proneness for errors, tension headaches and gastrointestinal symptoms in response to sleep loss.10,13

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