Insomnia Literature Review Visual Aid · insomnia disorder diagnosis in the DSM-5. Potential...
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RESEARCH POSTER PRESENTATION DESIGN © 2011 www.PosterPresentations.com Insomnia Disorder is a pervasive problem that affects 10-15% of the United States population and is characterized by difficulties initiating or staying asleep. The sleep disturbance caused by insomnia can account for significant impairment to an individual’s daytime functioning. Insomnia is typically comorbid with other conditions and is even among the diagnostic criteria for other major psychological disorders. This review summarizes the existing literature regarding insomnia disorder diagnosis in the DSM-5. Potential causes, functional consequences, treatment, and comorbidity with other conditions are topics addressed in this review. Insomnia Disorder: A Review of the Literature ABSTRACT INTRODUCTION METHODS The DSM-5 (2013) diagnostic criteria for insomnia disorder includes the following: A. A predominant complaint of dissatisfaction with sleep quantity or quality associated with one (or more) of the following symptoms: 1.Difficulty initiating sleep. 2.Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. 3.Early-morning awakening with inability to return to sleep. B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning. C. The sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months. E. The sleep difficulty occurs despite adequate opportunity for sleep. F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia). G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia. (pg. 362) Insomnia Subclasses 1.sleep-onset insomnia (difficulty initiating sleep) 2.sleep maintenance insomnia (difficulty staying asleep) 3.late insomnia (early-morning awakening with difficulty going back to sleep)(American Psychiatric Association, 2013). Causes According to the Mayo Clinic, insomnia can have several causes: 1. Stress – Concerns about work or school, deaths in the family, or divorce can lead to an overactive mind when trying to go to sleep. 2. Depression – The chemical imbalances in the brain associated with depression can make it difficult to relax enough to go to sleep. RESULTS DISCUSSION After a thorough review of the literature, it is clear that insomnia: •is a common condition that most everyone experiences at some point in his or her life. •produces significant impairments to daytime functioning and can cause a reduction in work productivity, work attendance, decreased cognition and mood, and increased susceptibility to other medical and psychological conditions. •is one of the least studied conditions in relation to its prevalence •causes many individuals to turn to self-help treatments that have not been shown to be efficacious in lieu of psychiatric or medical help (Kraus & Rabin, 2012). Because insomnia is a major risk factor for future psychiatric or medical illnesses, it is important that clinicians address a client’s sleep patterns during initial assessments (Ishak et al., 2012). Kraus and Rabin (2012) state: “Although chronic insomnia is a crisis placing substantial economic and social burdens on our society, it receives comparatively little, if any, public health or clinician attention” (p. 209). While CBT-I has been proven to be the most effective non-medical intervention, a shortage of trained clinicians, a lack of professional awareness, and poor insurance reimbursement prevents many patients from seeking the help they need (Kraus & Rabin, 2012). •More effective tools need to be developed that accurately assess a patient’s sleep patterns. •Little is known about the efficacy of CBT-I when insomnia occurs in the presence of other medical or psychiatric disorders (Smith et al., 2005). • Research that focuses on effective therapies for insomnia in the presence of other conditions and treatments for specific populations needs to be conducted (Krystal, 2005). • Furthermore, more clinically useful subtypes of insomnia need to be developed to allow for more personalized treatment (Krystal, 2005). REFERENCES Patrick Childs Wake Forest University Department of Counseling Insomnia (According to The Diagnostic and Statistical Manual of Mental Disorders – 5 th ed.) •Difficulty with sleep quality or quantity •Difficulty initiating sleep, difficulty maintaining sleep, or early morning awakenings with inability to return to sleep (American Psychiatric Association, 2013). Sleep-Wake Disorders The DSM-5 classifies insomnia disorder with 9 other disorders in a grouping called “Sleep-Wake Disorders” 1.insomnia disorder 2.hypersomnolence disorder 3.narcolepsy 4.breathing-related sleep disorders 5.circadian rhythm sleep disorders 6.non-REM (NREM) sleep arousal disorders 7.nightmare disorder 8.REM sleep behavior disorder 9.restless legs syndrome 10.substance- or medication-induced sleep disorder (American Psychiatric Association, 2013) The Numbers •Affects 10% to 15% of the U.S. population (Kraus & Rabin, 2012). •Estimated that 25% to 35% of individuals experience insomnia on a short-term or occasional basis (Soares, 2005). •Costs billions of dollars every year (Kraus & Rabin, 2012). Despite its high-prevalence, insomnia remains under-diagnosed and under-treated despite the broadening evidence of its negative health effects and the increasing availability of effective treatments (Roth, 2001). Insomnia Facts •Drastically affect a patient’s overall health, quality of life and cause disturbances to occupational and social functioning (Ishak et al., 2012). •Prevalence of insomnia is increasing over time and researchers have speculated that the aging population, longer workdays and additional work-stress are major causes for its increasing frequency (Roth, 2001). •Insomnia is more frequent in women than in men and it becomes more common as age increases (Ishak et al., 2012). •The most frequent comorbid condition with insomnia is major depressive disorder (MDD)(Drake et al., 2008). Sources found online through Wake Forest University Z. Smith Reynolds Library Z. Smith website Databases utilized: PsycINFO PubMed Science Direct Key words used in search “insomnia” “insomnia disorder” “insomnia treatment” “insomnia therapy” “sleep-wake disorders” “DSM-5” (were used exclusively or in together for more specific results) The inclusion criteria for literature were: • the book or article was published between 2000 and 2013 • the articles or texts were peer reviewed • contained insomnia-related information, relevant insomnia disorder issues, or known effective treatments for insomnia disorder. DSM-5 For the purposes of remaining current with the latest literature, this review references the DSM-5 diagnostic criteria for insomnia disorder. Causes (cont’d) 3. Medications – Prescription medications and over-the-counter drugs can interfere with sleep by disrupting an individual’s natural chemical balances and rhythms. 4. Caffeine, nicotine and alcohol – These substances are well- known stimulants and alcohol can have sedative effects but prevent the individual from entering “deep” sleep. 5. Medical conditions - Pain, breathing difficulties, arthritis, cancer, heart conditions, lung disease, gastro-esophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson’s disease and Alzheimer's disease are all associated with insomnia. 6. Change in environment or work schedule – Traveling or changing a work schedule can disrupt an individual’s circadian rhythm and metabolism, leading to sleep disturbances. (“Insomnia”, 2011) Treatment 1.Cognitive Behavioral Therapy for Insomnia (CBT-I) w Relaxation Training w Stimulus Control Therapy w Sleep Hygiene w Sleep Restriction Therapy w Sleep Compression w Paradoxical Intention Therapy (Perlis et al., 2011; Smith, Huang, & Manber, 2005; ) 2.Pharmacologic Therapies w Multi-billion dollar industry (Kraus & Rabin, 2012) w Shown to be efficacious in the short-torm w Easily cause dependecy (Lee-Chiong, 2006) 3.Self-Help Remedies – Most are not shown to be efficacious w Natural Supplements w Over-the-counter (OTC) drugs w Alcohol and consumption of certain foods (Morin, Beaulieu-Bonneau, LeBlanc, & Savard, 2005; Kraus & Rabin, 2012) Comorbidity Insomnia has been shown to be highly comorbid with: w Major Depressive Disorder (MDD) w Mania/Hypomania w Anxiety Disorders w Substance Abuse/Dependence Disorders (Ishak et al., 2012). RECOMMENDATIONS FOR FUTURE RESEARCH American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Drake, L. C., Schwartz, R. L., & Roth, T. R. (2008). The Evolution of Insomnia in Relation to Comorbidity. Psychiatric Annals, 38(9), 621-626. Retrieved from http://psychiatricannalsonline.com Insomnia. (2011). Retrieved November 10, 2013, from http://www.mayoclinic.com/health/insomnia/DS00187/DSECTION=causes Ishak, W. W., Bagot, K., Thomas, S., Magakian, N., Bedwani, D., Larson, D., Brownstein, A., & Zaky, C. (2012). Quality of Life in Patients Suffering from Insomnia. Innovations in Clinical Neuroscience, 9(10), 13-26. Kraus, S. S., & Rabin, L. A. (2012). Sleep America: Managing the crisis of adult chronic insomnia and associated conditions. Journal of Affective Disorders, 138, 192–212. doi:10.1016/j.jad.2011.05.014 Krystal, A.D. (2005). The effect of insomnia definitions, terminology, and classifications on clinical practice. Journal of the American Geriatrics Society. 53(7), S258–S263. doi: 10.1111/j.1532-5415.2005.53391.x Lee-Chiong, T.L. (2006). Sleep: A comprehensive handbook. Hoboken, NJ: John Wiley & Sons, Inc. Morin, C.M., Beaulieu-Bonneau, S., LeBlanc, M., & Savard, J. (2005). Self-help treatment for insomnia: A randomized controlled trial, Sleep 28(10), 1319-1327. Perlis, M., Aloia, M., & Kuhn, B. (2011). Behavioral treatments for sleep disorders: A comprehensive primer of behavioral sleep medicine interventions. Burlington, MA: Elsevier Inc. Roth, T. (2001). New developments for treating sleep disorders. The Journal of Clinical Psychiatry, 62 (Suppl. 10), 3-4. Smith, M.T., Huang, M.I., & Manber, R. (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25, 559-592. doi:10.1016/j.cpr.2005.04.004 Soares, C. N. (2005). Insomnia in women: an overlooked epidemic?. Archives of Women’s Mental Health, 8, 205–213. doi:10.1007/s00737-005-0100-1
Transcript of Insomnia Literature Review Visual Aid · insomnia disorder diagnosis in the DSM-5. Potential...
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RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentations.com
©2011PosterPresentations.com2117FourthStreet,[email protected]
Insomnia Disorder is a pervasive problem that affects 10-15% of the United States population and is characterized by difficulties initiating or staying asleep. The sleep disturbance caused by insomnia can account for significant impairment to an individual’s daytime functioning.
Insomnia is typically comorbid with other conditions and is even among the diagnostic criteria for other major psychological disorders. This review summarizes the existing literature regarding insomnia disorder diagnosis in the DSM-5. Potential causes, functional consequences, treatment, and comorbidity with other conditions are topics addressed in this review.
Insomnia Disorder: A Review of the Literature
ABSTRACT
INTRODUCTION
METHODS
The DSM-5 (2013) diagnostic criteria for insomnia disorder includes the following:A. A predominant complaint of dissatisfaction with sleep quantity or quality associated with one (or more) of the following symptoms:
1.Difficulty initiating sleep.
2.Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings.
3.Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
C. The sleep difficulty occurs atleast 3 nights per week.
D. The sleep difficulty is presentfor at least 3 months.
E. The sleep difficulty occursdespite adequate opportunity for sleep.
F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia. (pg. 362)
Insomnia Subclasses1.sleep-onset insomnia (difficulty initiating sleep)2.sleep maintenance insomnia (difficulty staying asleep)3.late insomnia (early-morning awakening with difficulty going back to sleep)(American Psychiatric Association, 2013).
CausesAccording to the Mayo Clinic, insomnia can have several causes:1. Stress – Concerns about work or school, deaths in the family, or divorce can lead to an overactive mind when trying to go to sleep.2. Depression – The chemical imbalances in the brain associated with depression can make it difficult to relax enough to go to sleep.
RESULTS
DISCUSSIONAfter a thorough review of the literature, it is clear that insomnia:•is a common condition that most everyone experiences at some point in his or her life.•produces significant impairments to daytime functioning and can cause a reduction in work productivity, work attendance, decreased cognition and mood, and increased susceptibility to other medical and psychological conditions.•is one of the least studied conditions in relation to its prevalence•causes many individuals to turn to self-help treatments that have not been shown to be efficacious in lieu of psychiatric or medical help (Kraus & Rabin, 2012).
Because insomnia is a major risk factor for future psychiatric or medical illnesses, it is important that clinicians address a client’s sleep patterns during initial assessments (Ishak et al., 2012).
Kraus and Rabin (2012) state: “Although chronic insomnia is a crisis placing substantial economic and social burdens on our society, it receives comparatively little, if any, public health or clinician attention” (p. 209).
While CBT-I has been proven to be the most effective non-medical intervention, a shortage of trained clinicians, a lack of professional awareness, and poor insurance reimbursement prevents many patients from seeking the help they need (Kraus & Rabin, 2012).
•More effective tools need to be developed that accurately assess a patient’s sleep patterns. •Little is known about the efficacy of CBT-I when insomnia occurs in the presence of other medical or psychiatric disorders (Smith et al., 2005).• Research that focuses on effective therapies for insomnia in the
presence of other conditions and treatments for specific populations needs to be conducted (Krystal, 2005).
• Furthermore, more clinically useful subtypes of insomnia need to be developed to allow for more personalized treatment (Krystal, 2005).
REFERENCES
PatrickChildsWakeForestUniversityDepartmentofCounseling
Insomnia (According to The Diagnostic and Statistical Manual of Mental Disorders – 5th ed.)•Difficulty with sleep quality or quantity•Difficulty initiating sleep, difficulty maintaining sleep, or early morning awakenings with inability to return to sleep (American Psychiatric Association, 2013).
Sleep-Wake DisordersThe DSM-5 classifies insomnia disorder with 9 other disorders in a grouping called “Sleep-Wake Disorders”1.insomnia disorder2.hypersomnolence disorder3.narcolepsy4.breathing-related sleep disorders5.circadian rhythm sleep disorders6.non-REM (NREM) sleep arousal disorders7.nightmare disorder8.REM sleep behavior disorder9.restless legs syndrome10.substance- or medication-induced sleep disorder(American Psychiatric Association, 2013)
The Numbers•Affects 10% to 15% of the U.S. population (Kraus & Rabin, 2012). •Estimated that 25% to 35% of individuals experience insomnia on a short-term or occasional basis (Soares, 2005).•Costs billions of dollars every year (Kraus & Rabin, 2012).Despite its high-prevalence, insomnia remains under-diagnosed and under-treated despite the broadening evidence of its negative health effects and the increasing availability of effective treatments (Roth, 2001).
Insomnia Facts•Drastically affect a patient’s overall health, quality of life and cause disturbances to occupational and social functioning (Ishak et al., 2012).•Prevalence of insomnia is increasing over time and researchers have speculated that the aging population, longer workdays and additional work-stress are major causes for its increasing frequency (Roth, 2001).•Insomnia is more frequent in women than in men and it becomes more common as age increases (Ishak et al., 2012). •The most frequent comorbid condition with insomnia is major depressive disorder (MDD)(Drake et al., 2008).
� Sources found online through Wake Forest University Z. Smith Reynolds Library Z. Smith website
Databases utilized:� PsycINFO � PubMed � Science Direct
Key words used in search� “insomnia” � “insomnia disorder”� “insomnia treatment” � “insomnia therapy”� “sleep-wake disorders” � “DSM-5”(were used exclusively or in together for more specific results)
The inclusion criteria for literature were:• the book or article was published between 2000 and 2013• the articles or texts were peer reviewed• contained insomnia-related information, relevant insomnia
disorder issues, or known effective treatments for insomnia disorder.
DSM-5For the purposes of remaining current with the latest literature, this review references the DSM-5 diagnosticcriteria for insomnia disorder.
Causes (cont’d)3. Medications – Prescription medications and over-the-counter drugs can interfere with sleep by disrupting an individual’s natural chemical balances and rhythms.4. Caffeine, nicotine and alcohol – These substances are well-known stimulants and alcohol can have sedative effects but prevent the individual from entering “deep” sleep.5. Medical conditions - Pain, breathing difficulties, arthritis, cancer, heart conditions, lung disease, gastro-esophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson’s disease and Alzheimer's disease are all associated with insomnia.6. Change in environment or work schedule – Traveling or changing a work schedule can disrupt an individual’s circadian rhythm and metabolism, leading to sleep disturbances. (“Insomnia”, 2011)
Treatment1.Cognitive Behavioral Therapy for Insomnia (CBT-I)w Relaxation Training w Stimulus Control Therapyw Sleep Hygiene w Sleep Restriction Therapyw Sleep Compression w Paradoxical Intention Therapy(Perlis et al., 2011; Smith, Huang, & Manber, 2005; )
2.Pharmacologic Therapiesw Multi-billion dollar industry (Kraus & Rabin, 2012)
w Shown to be efficacious in the short-tormw Easily cause dependecy (Lee-Chiong, 2006)
3.Self-Help Remedies – Most are not shown to be efficaciousw Natural Supplementsw Over-the-counter (OTC) drugsw Alcohol and consumption of certain foods (Morin, Beaulieu-Bonneau, LeBlanc, & Savard, 2005; Kraus & Rabin, 2012)
ComorbidityInsomnia has been shown to be highly comorbid with:w Major Depressive Disorder (MDD)w Mania/Hypomaniaw Anxiety Disorders
w Substance Abuse/Dependence Disorders (Ishak et al., 2012).
RECOMMENDATIONSFORFUTURERESEARCH
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Drake, L. C., Schwartz, R. L., & Roth, T. R. (2008). The Evolution of Insomnia in Relation to Comorbidity. Psychiatric Annals, 38(9), 621-626. Retrieved from http://psychiatricannalsonline.com
Insomnia. (2011). Retrieved November 10, 2013, from http://www.mayoclinic.com/health/insomnia/DS00187/DSECTION=causes
Ishak, W. W., Bagot, K., Thomas, S., Magakian, N., Bedwani, D., Larson, D., Brownstein, A., & Zaky, C. (2012). Quality of Life in Patients Suffering from Insomnia. Innovations in Clinical Neuroscience, 9(10), 13-26.
Kraus, S. S., & Rabin, L. A. (2012). Sleep America: Managing the crisis of adult chronic insomnia and associated conditions. Journal of Affective Disorders, 138, 192–212. doi:10.1016/j.jad.2011.05.014
Krystal, A.D. (2005). The effect of insomnia definitions, terminology, and classifications on clinical practice. Journal of the American Geriatrics Society. 53(7), S258–S263. doi: 10.1111/j.1532-5415.2005.53391.x
Lee-Chiong, T.L. (2006). Sleep: A comprehensive handbook. Hoboken, NJ: John Wiley & Sons, Inc.
Morin, C.M., Beaulieu-Bonneau, S., LeBlanc, M., & Savard, J. (2005). Self-help treatment for insomnia: A randomized controlled trial, Sleep 28(10), 1319-1327.
Perlis, M., Aloia, M., & Kuhn, B. (2011). Behavioral treatments for sleep disorders: A comprehensive primer of behavioral sleep medicine interventions. Burlington, MA: Elsevier Inc.
Roth, T. (2001). New developments for treating sleep disorders. The Journal of Clinical Psychiatry, 62 (Suppl. 10), 3-4.
Smith, M.T., Huang, M.I., & Manber, R. (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25, 559-592. doi:10.1016/j.cpr.2005.04.004
Soares, C. N. (2005). Insomnia in women: an overlooked epidemic?. Archives of Women’s Mental Health, 8, 205–213. doi:10.1007/s00737-005-0100-1
