ICD-10 Code: G47.00
Insomnia disorder is part of a cluster of diagnoses called the sleep-wake disorders. Sleep-wake disorders are a group of psychiatric conditions that include:
These disorders are broadly characterized by disruptions in sleep and wakefulness. Individuals with insomnia disorder have frequent difficulty falling asleep or staying asleep. Individuals with hypersomnolence disorder feel excessively sleepy during the day, despite obtaining what for most people would be a full night of sleep. Individuals with parasomnias such as non-rapid eye movement sleep arousal disorder and nightmare disorder experience unusual behaviors while sleeping, such as sleep walking, or vivid and disturbing dreams or night terrors.
Some sleep-wake disorders, including insomnia disorder and hypersomnolence disorder, are associated with disturbances in the amount of time the individual spends asleep (too much or too little) or the times at which the individual sleeps (often outside of the desired sleeping window). Other disorders, such as the parasomnias, are not associated with disturbances in the quantity or timing of sleep per se, but are instead associated with behavioral disturbances during sleep or frequent highly distressing dreams.
Insomnia disorder is a psychiatric disorder that affects approximately 6% of adults. Insomnia disorder is characterized by a dissatisfaction with the quantity or quality of sleep related to one or more of the following:
Occasional sleep difficulties are fairly common in adults. Therefore, insomnia disorder is diagnosed only when the sleep difficulty occurs at least three nights per week for a period of three months or longer. Insomnia disorder often co-occurs with medical conditions and other mental disorders. However, insomnia disorder should only be diagnosed if the insomnia is not adequately explained by the co-occurring condition and if the insomnia is severe enough to warrant independent clinical attention. Finally, insomnia disorder is diagnosed only if the individual is significantly distressed or impaired by the insomnia or resulting daytime symptoms.
Insomnia disorder severity can range from mild to severe. In the short term, insomnia disorder can lead to daytime symptoms such as irritability or impaired concentration that may impair role functioning. In the long term, severe untreated insomnia disorder can lead to physical and mental health complications, including major depressive disorder and cardiac disease.
Most individuals with insomnia disorder experience comorbid physical and/or mental health conditions, some of which may be exacerbated by the insomnia disorder or share a bidirectional causal relationship with insomnia.
Insomnia disorder has been linked to abnormalities of brain function which are thought to contribute to symptoms. In particular, evidence points to hyperarousal in the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and central nervous system. In addition, cognitive factors (such as worrying excessively about sleep or its negative consequences) and behavioral factors (such as arousal-related conditioning of sleeping areas) have been proposed to maintain insomnia. The disorder has a genetic component, although having a genetic predisposition to insomnia disorder does not necessarily mean that someone will develop insomnia disorder.
Insomnia disorder is treatable. Published treatment guidelines for insomnia disorder include those from theAmerican Academy of Sleep Medicine, the Society of Clinical Psychology, and the National Institute for Clinical Excellence.
First Line Treatments
Clinical research and practice guidelines suggest that the following treatments are effective:
Second Line Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.