8.10 Insomnia Disorder

Insomnia: Overview and Characteristics

A person with insomnia experiences a consistent difficulty in falling or staying asleep, making insomnia the most common sleep disorder.

Key Characteristics

Difficulty in:
- Falling asleep
- Staying asleep
Common Experiences:
- Long delays between bedtime and sleep onset
- Frequent awakenings during the night
- Trouble returning to sleep

Diagnostic Criteria

Symptoms must occur for at least three nights a week for a minimum duration of one month (Roth, 2007).

Psychological Impact

Increased anxiety about inability to fall asleep is common, creating a self-perpetuating cycle:
- Increased anxiety leads to increased physiological arousal
- Higher levels of arousal make falling asleep more difficult
Chronic insomnia is often linked to feelings of overtiredness and can be associated with symptoms of depression.

Figure 1. Insomnia is often accompanied by feelings of anxiety and frustration.

Etiology of Insomnia

Several factors may contribute to the development of insomnia, including:

Age
Drug use
Exercise
Mental status
Bedtime routine

Treatment Approaches

Treatment options for insomnia can be classified into pharmacological and non-pharmacological methods. People suffering from insomnia might consider:

Limiting stimulant drugs (e.g., caffeine)
Increasing physical exercise during the day

Pharmacological Treatments

While many people might turn to over-the-counter (OTC) or prescribed sleep medications, caution is advised as these can lead to dependence and potentially worsen insomnia over time.

Common pharmacological treatments include:

Benzodiazepines: while effective, they may lead to withdrawal syndromes, particularly related to rapid eye movement (REM) sleep rebound.
Benzodiazepine-like agents:
- Zolpidem
- Zaleplon
- These have fewer side effects while maintaining good efficacy.
Sedating antidepressants
OTC sleep products: (e.g., sedating antihistamines)

Understanding Sleep and Disorders

An understanding of the electrophysiological and neurochemical correlates of the stages of sleep is essential for defining and understanding sleep disorders.

Excessive Daytime Sleepiness

Often associated with:

Obstructive sleep apnea
Depression
Medications (e.g., amphetamines) can be used to induce daytime alertness.

Parasomnias

Includes disorders of arousal and REM sleep.

Impact of Chronic Medical Illnesses

Chronic medical illnesses may exacerbate symptoms during specific sleep stages. Furthermore, various medications can influence sleep stages, potentially leading to sleep disorders or worsening the effects of chronic conditions on sleep.

Psychotherapy for Insomnia

Certain forms of psychotherapy, notably Cognitive Behavioral Therapy (CBT), can assist individuals suffering from insomnia.

Focus of CBT

Addresses cognitive processes and problem behaviors.
Treatment may include:
- Stress management techniques
- Modifications to problematic behaviors (e.g., excessive time spent awake in bed)

Efficacy of CBT

CBT has been shown to be particularly effective in treating insomnia (Savard, Simard, Ivers, & Morin, 2005; Williams, Roth, Vatthauer, & McCrae, 2013).

Cognitive Therapies

Help patients identify disruptive thought patterns
Evaluate the validity of these thoughts
Replace harmful thoughts through strategies such as:
- Shifting attention
- Decatastrophizing
- Reappraisal