#Maintenance insomnia treatment manuals

Currently, insomnia is mostly characterized by the common phenotypes of sleep onset insomnia (SOI insomnia, difficulty falling asleep), sleep maintenance insomnia (SMI insomnia, difficulty staying asleep), early morning awakenings insomnia (EMA insomnia), and a combination of those. Previous dichotomization of insomnia in primary and secondary (or comorbid) insomnia has been abandoned with the new editions of the DSM-5 and ICSD-3. The symptoms occur for at least 3 nights per week for at least 3 months and occur despite an adequate sleep environment. Complaints include fatigue, exhaustion, lack of energy, daytime sleepiness, cognitive impairment (e.g., attention, concentration, and memory), mood swings (e.g., irritability, dysphoria), impaired occupational functioning and impaired social functioning.

The disturbed sleep is associated with stress, psychological strain and suffering, as well as impairment in social, occupational, and other important areas of functioning.

Main characteristics of insomnia include dissatisfaction with sleep quantity and quality with one or more of the following symptoms: difficulties initiating sleep, difficulties maintaining sleep (frequent or prolonged awakenings with problems returning to sleep again), and early morning awakening (occurring earlier than desired after a total sleep time of only 3–5 h with the inability to return to sleep).

#Maintenance insomnia treatment manuals

Common diagnostic manuals include the ICSD-3 (International Classification of Sleep Disorders, 3 rd Edition, American Academy of Sleep Medicine 2014) and the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition, American Psychiatric Association 2013) ( 4, 5). About 30–50% of the US adult population exhibit insomnia symptoms, 15–20% display a short-term insomnia of 3 months ( 1– 3). Insomnia is one of the most frequent sleep disorders with continuously increasing prevalence. This study is part of a specific Research Topic introduced by Frontiers on the heterogeneity of insomnia and its comorbidity and will hopefully inspire more research in this area. We suggest adding them to anamnesis to help differentiate the severity of insomnia and initiate further research, leading to a better understanding of the severity of insomnia and individualized therapy. We aimed to describe specific characteristics of insomnia with a simple questionnaire, containing questions (e.g., ability to fall asleep during the day, effects of non-medical therapy methods, symptom stability) not yet commonly asked and of unknown clinical relevance as yet. Alternative non-medical treatments were effective in fewer than 10% of cases.Ĭonclusion: Our specific cohort displayed a long history of suffering and the sleep specialist is usually not the first point of contact. SMI (sleep maintenance insomnia) symptoms were most frequent, but only prevalence of EMA (early morning awakening) symptoms significantly increased from 40 to 45% over time. Over one third were not able to fall asleep during the day. About 40–50% mentioned a trigger (most frequently psychological triggers), a history of being bad sleepers to begin with, a family history of sleep problems, and a negative progression of insomnia. They had suffered from symptoms for about 12 ± 11 years before seeing a sleep specialist. Results: A cohort of 456 insomnia patients was described (56% women, mean age 52 ± 16 years). A 14-item insomnia questionnaire on symptoms, progression, sleep history and treatment, was part of the clinical routine.

Methods: Patients visiting the sleep center and indicating self-reported signs of insomnia were examined by a sleep specialist who confirmed an insomnia diagnosis. Including a comprehensive literature review, this study also introduces new phenotypical relevant parameters by describing a specific insomnia cohort. Objectives: The identification of clinically relevant subtypes of insomnia is important.

3Department of Biology, Saratov State University, Saratov, Russia.

2Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Seehof, Germany.

1Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Ingo Fietze 1, Naima Laharnar 1 *, Volker Koellner 2 and Thomas Penzel 1,3