Daytime insomnia impact varies by subtype

By Lucy Piper, Senior medwireNews Reporter

Insomnia's daytime impact appears to be greatest among those patients who have trouble both initiating and maintaining sleep, those with poor mental health, and those with childhood onset of the disorder, findings from the Great British Sleep Survey suggest.

The survey is based on the new detailed DSM-5 criteria, which reflects a shift toward coding insomnia whenever diagnostic criteria are met, irrespective of whether there is a coexisting psychiatric, medical, or other sleep disorder.

"The new diagnostic entity of insomnia disorder highlights that significant sleep disturbance merits independent clinical attention, regardless of additional comorbidities," say the researchers, led by Colin Espie, from the University of Glasgow Sleep Centre in the UK.

"A therapeutic focus on how to cope with and minimize daytime symptoms could enhance 'traditional' cognitive-behavioral therapy for insomnia," the team suggests.

Of 11,129 survey respondents, 10,625 were included in the final analysis. Among these individuals, 5083 had insomnia, with 83% suffering with the condition for over a year and 45% for more than 6 years.

Insomnia patients experienced greater impairment in daytime functioning when compared with individuals without the disorder assessed after infrequent nights of poor sleep. The between group differences were large for energy, mood, concentration, relationships, and work functioning, and energy and mood were the most greatly affected.

Insomnia patients with a mixed subtype of the three core symptoms difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening exhibited the greatest impairment, while there was no significant difference among the other four subtypes (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and nonrestorative sleep).

Insomnia had an even greater daytime impact among those with a comorbid mental health condition, particularly with regard to concentration, mood , and getting through work. And for the 25% of insomnia patients with childhood onset, the impact on mental health, energy, mood, concentration, and ability to get through work was greater than for those with adult onset.

"We found substantial daytime effects for people with all insomnia subtypes when compared with normal sleepers," Espie et al write in the Journal of Clinical Psychiatry.

"It seems appropriate then to emphasize DSM-5 ID [insomnia disorder] can be characterized by poorer sleep and poorer daytime well-being. It seems likely that the combination of these experiences will drive clinical complaint.

"This interaction requires greater attention in practice, if we are to properly treat ID," they conclude.

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