![]() If the symptom of difficulty maintaining sleep was the defining factor, 11.5% of the sample was affected. When insomnia was defined by frequency (symptoms occurring at least three nights per week), 17% of randomly selected subjects from the population qualified for the diagnosis. This problem is demonstrated by the findings of a prevalence study from South Korea. Insomnia is a common symptom of many mental and physical disorders, and should be classified here in addition to the basic disorder only if it dominates the clinical picture.Īs a result of these differences in insomnia case definitions, estimates of insomnia prevalence have varied widely, from 10–40% ( Ford & Kamerow, 1989 Kuppermann et al., 1995 Ustun et al., 1996 Bixler et al., 1979 Simon & Von Korff, 1997 Mellinger et al., 1985 Ohayon, 2002 Ancoli-Israel & Roth, 1999). The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.Ī condition of unsatisfactory quantity and/or quality of sleep, which persists for a considerable period of time, including difficulty falling asleep, difficulty staying asleep, or early final wakening. The disturbance does not occur exclusively during the course of another mental disorder (e.g., Major Depressive Disorder, Generalized Anxiety Disorder, a delirium).ĥ. The sleep disturbance does not occur exclusively during the course of Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia.Ĥ. The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.ģ. The predominant complaint is difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month. At least one of the following forms of daytime impairment related to the nighttime sleep difficulty is reported by the patient: fatigue or malaise attention, concentration, or memory impairment social or vocational dysfunction or poor school performance mood disturbance or irritability daytime sleepiness motivation, energy, or initiative reduction proneness for errors or accidents at work or while driving tension, headaches, or gastrointestinal symptoms in response to sleep loss concerns or worries about sleep.ġ. The above sleep difficulty occurs despite adequate opportunity and circumstances for sleep.ģ. In children, the sleep difficulty is often reported by the caretaker and may consist of observed bedtime resistance or inability to sleep independently.Ģ. A complaint of difficulty initiating sleep, difficulty maintaining sleep, or waking up too early or sleep that is chronically unrestorative or poor in quality. Duration of insomnia (at least 1 month of symptoms) is noted in ICSD-2 and DSM IV-TR however frequency of symptoms is broached only in ICD-10. ICD-10 utilizes the broadest approach, categorizing insomnia based on underlying pathology: nonorganic insomnia and nonorganic disorder of the sleep-wake schedule ( World Health Organization, 1992) (see Table 2). The DSM IV-TR, on the other hand, separates out Primary Insomnia (insomnia symptoms associated with distress or daytime impairment) from other “dyssomnias,” such as a breathing-related sleep disorder ( American Psychiatric Association, 2000). These categories also contain insomnia due to a mental disorder, substance, or medical condition. Examples include Adjustment Insomnia (or, insomnia temporally related to an identifiable stressor) and Psychophysiological Insomnia (increased arousal and conditioned sleep difficulty) ( American Academy of Sleep Medicine, 2005 see Table 2). ICSD-2 subdivides insomnia into descriptive, etiologic categories. The three main diagnostic manuals, International Classification of Sleep Disorders (ICSD-2) ( American Academy of Sleep Medicine, 2005), Diagnostic and Statistic Manual (DSM IV-TR) ( American Psychiatric Association, 2000), and International Classification of Disease (ICD-10) ( World Health Organization, 1992), vary in their approach to defining insomnia (see Table 1). ![]() Do insomnia and depression co-exist in an individual as separate disorders? Or is insomnia only one symptom in the larger context of depression? Or did insomnia secondarily developed as a distinct disorder from a primary depressive disorder? An illustration of this idea is the overlap between insomnia and depression. ![]() This picture is further complicated by considerations of insomnia as either a comorbid condition as a symptom of a larger sleep, medical, or psychiatric disorder or as a secondary disorder ( Harvey, 2001). Insomnia has also been defined by subtypes based on frequency, duration (acute versus chronic) and etiology. Broadly speaking, insomnia has been viewed as a symptom and as a disorder in its own right. The prevalence of insomnia varies depending on the specific case definition.
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