COMMENTARY

Getting to the Source of Your Patients' Insomnia

Matthew A. Goldenberg, DO

Disclosures

May 18, 2016

In This Article

Diagnosing a Widespread Condition

Roughly 30% of US adults have symptoms of insomnia.[1] Unfortunately, for as many as 20% of these patients, insomnia is a chronic condition, or at least one for which they have not undergone adequate evaluation and treatment.[2]

The first step in treating a patient with sleep problems is to make an accurate diagnosis. The Insomnia Severity Index can be used to help quantify the difficulty a patient has in falling asleep, staying asleep, and waking too early.[3] This index is also used to objectively measure the impact of interventions at follow-up visits.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), no longer distinguishes between "primary" and "secondary" insomnia. In other words, the diagnosis is no longer dependent on the cause, but rather on the symptom criteria that are present. This allows physicians to establish a diagnosis of insomnia regardless of the presence of medical and psychiatric conditions that often coexist with the insomnia disorder.

According to DSM-5, your patient has insomnia disorder, regardless of cause, if he or she meets the following criteria[4]:

1) Dissatisfaction with sleep quantity or quality, with one or more of the following:
  a) Difficulty initiating sleep
  b) Difficulty maintaining sleep
  c) Early morning awakening, with inability to return to sleep
2) Significant distress or impairment
3) Frequency of at least 3 nights per week
4) Duration of at least 3 months
5) Adequate opportunity for sleep
6) Not better explained by, nor occurring exclusively during the course of, another sleep/wake disorder
7) Not attributable to a substance
8) Coexisting mental and medical disorders do not adequately explain the predominant complaint of insomnia

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