Several medications and over-the-counter preparations can also interfere with sleep. Insomnia may also result from one of several medical conditions such as hyperthyroidism, congestive heart failure, chronic obstructive pulmonary disease, dementia, and pain-related conditions. Up to 35%-40% of all insomnia cases are associated with an underlying psychopathology, with affective and anxiety disorders being the commonest comorbid disorders (Ford & Kamerow, 1989 Breslau et al., 1996).
Idiopathic insomnia presents an insidious onset during childhood, unrelated to psychosocial stressors or medical disorders, and is very persistent throughout the adult life. Paradoxical insomnia involves a genuine complaint of little or no sleep that is not corroborated by objective evidence of sleep disturbances. Psychophysiological insomnia is the most classic form of insomnia and is the result from the repeated pairings of situational (bed/bedroom) and temporal (bedtime) stimuli, normally associated with sleep, with conditioned cognitive, emotional and/or physiologic arousal. The International Classification of Sleep Disorders recognizes at least three different subtypes of primary insomnia: psychophysiological, paradoxical, and idiopathic insomnia (American Academy of Sleep Medicine, 2005 AASM). Insomnia may be a primary sleep disorder or it may manifest itself as a co-occurring condition with another psychiatric, medical, or another sleep disorder (National Institutes of Health NIH, 2005). 2.1 Psychological and behavioral interventionsĮtiology/Pathophysiology Primary vs. 1.3 The role of psychological factors and life events. Chronic insomnia is also associated with reduced quality of life, decreased productivity, increased absenteeism from work, and increased risk for depression. Common sleep-loss related daytime problems include difficulties with attention, concentration, memory, and completion of tasks, and negative mood. Approximately one third of the adult population reports insomnia symptoms, whereas about 10% suffer from an insomnia disorder (Ohayon, 2002).Īlong with subjective complaints of poor sleep, individuals with insomnia are often distressed about their sleep and also report significant fatigue and impairments of their daytime functioning. Insomnia may be transient, episodic, or persistent over time (Morin & Espie, 2003). These complaints may involve problems with falling asleep initially at bedtime (initial insomnia), waking up in the middle of the night and having difficulty going back to sleep (middle insomnia), waking up too early in the morning with an inability to sleep until planned rise time (late insomnia), or a perception of non restorative sleep. Insomnia entails a spectrum of complaints reflecting dissatisfaction with the quality, duration, or continuity of sleep. Geneviève Belleville, Université du Québec à Montréal, Montréal, CANADA Morin, Laval University, Quebec, CANADAĭr. 
This process is experimental and the keywords may be updated as the learning algorithm improves.Dr. These keywords were added by machine and not by the authors. While this may not be essential for (in general) clinical practice or (in specific) for the determination of when CBT-I is indicated, a formal and complete definition will allow clinical researchers to conduct more productive investigations when the entity under study may be evaluated in its “chemically pure” form. Perhaps what remains to be accomplished, from a definitional point of view, is for scholars and scientists to complete the characterization of this important disorder by providing for the formulation of a definition which formally lays out the research diagnostic criteria for insomnia.
The various classification systems provide us the wherewithal to differentiate types of insomnia by both the presenting complaint and the factors that are thought to precipitate or perpetuate the illness. We are fortunate to have several nosologies that recognize insomnia as an independent or primary disorder.
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