How often do your patients complain of insomnia or the inability to fall and/or stay asleep? It may seem to be quite common in your practice, but according to 2 recent surveys, about 60% of health care professionals said they were unaware of severe cases of insomnia.1 Many times patients fail to effectively communicate the extent or severity of their condition. Patients tend to use general terms like being tired, lacking energy, or feeling “down” and/or “low.”2

Insufficient or poor-quality sleep may affect an individual’s ability, and can result in difficulty concentrating, diminished energy, memory impairment, body fatigue, and loss of productivity. Recently, the news has been awash with stories of air traffic controllers falling asleep on the job. I don’t know whether any of these individuals actually were suffering from insomnia or other sleep disturbances, but I believe it illustrates a point. Often a lack of sleep, even if it is not associated with insomnia, can carry over to a person’s job performance and can have a far-reaching effect.

Acute insomnia typically lasts between 1 night and a few weeks and is transient in nature. In patients with chronic insomnia, sleepless events occur more frequently (several nights a week) and can last a month or more. Chronic insomnia may be coupled with comorbidities ranging from sleep apnea to kidney disease and other medical or psychiatric disorders. Only about 25% of patients suffering from insomnia lack coexisting factors, and are characterized as having primary insomnia.3 


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There are numerous contributing factors for insomnia; data suggest that even genetics plays a role. Insomnia may also be linked to predicting future depression, anxiety, and alcohol abuse. Persistent or chronic insomnia left untreated is associated with a heightened risk of major depression.4 Studies also suggest that chronic insomnia disrupts the immune system, causing a shift in the from nighttime activity to daytime. Individuals suffering from chronic insomnia seem to have a reversal of cytokine activity (interleukin 6 and tumor necrosis factor). This activity tends to be higher during the day and lower at night compared with their healthy cohorts.5 What role if any this change in activity has with regard to immune responses still needs further research. 

For patients suffering from insomnia, it is important to have a complete physical history, and any psycho-social history can be invaluable. While some patients might indicate they are suffering from insomnia or sleep disturbances, often it is up to the practitioner to instigate a dialogue about patient sleep patterns. Early diagnosis and treatment may prevent future comorbid conditions.

Do you find cases of insomnia common in your practice? Are current medications the optimal way to treat patients suffering from insomnia?

Reference

  1. Sateia, M.J. et al. Evaluation of Chronic Insomnia. Sleep. 2000;23(2):1-66. http://www.aasmnet.org/resources/practiceparameters/review_chronicinsomnia.pdf
  2. Doghramji, P.P. Recognizing Sleep Disorders in a Primary Care Setting. Journal of Clinical Psychiatry.2004;65(16): 23–26 http://cat.inist.fr/?aModele=afficheN&cpsidt=16349165
  3. Winkelman, J.W. et al. Reduced Brain GABA in Primary Insomnia: Preliminary Data from 4T Proton Magnetic Resonance Spectroscopy (1H-MRS). Sleep. 2008;31(11):1499-1506. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579978/
  4. Baglioni, Chiara. et al. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders. 2011;135(1):10-19. http://www.ncbi.nlm.nih.gov/pubmed/21300408
  5. Vgontzas, A.N. et al. Chronic insomnia is associated with a shift of interleukin-6 and tumor necrosis factor secretion from nighttime to daytime. Metabolism: clinical and experimental. 2002;51(7):887-892. http://www.metabolismjournal.com/article/S0026-0495%2802%2900014-8/abstract