![]() ![]() The International Classification of Sleep Disorders (ICSD), and its revised form ICSD-R (1997), also defined insomnia based on subjective sleep and daytime functioning complaints but, in contrast, attempted to identify subtypes based on “intrinsic” factors such as etiology (i.e., “psychophysiological”), age of onset (i.e., “idiopathic insomnia”), degree of discrepancy between objective sleep findings and subjective perception of sleep (i.e., “sleep state misperception”) or “extrinsic” environmental factors such as “inadequate sleep hygiene”, “food-allergy” or “altitude insomnia”. insomnia symptoms, i.e., poor sleep due to underlying, identifiable physical, emotional, or drug-related factors. ![]() ![]() 6 The latter change is an acknowledgement that chronicity is what differentiates insomnia as a disorder vs. 5 The DSM-5 has eliminated the different insomnia diagnoses in DSM-IV-TR to reintroduce overall diagnostic criteria for “insomnia disorder” with specification of comorbid mental and/or physical conditions, so that no causal attributions between insomnia and the physical/mental condition are made, and has extended the duration criterion from 1 month to 3 months. The DSM-IV-TR eliminated the overall diagnostic criteria for “insomnia disorders” as well as the frequency criterion, maintained the diagnoses of “primary insomnia”, “dysomnia NOS”, insomnia “related to another mental disorder”, “due to a general medical condition”, and introduced “substance-induced insomnia”. Sleep disorders were included for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R 4 in 1987 and provided overall diagnostic criteria for “insomnia disorders” based on the subjective complaints of difficulty initiating or maintaining sleep or of non-restorative sleep, occurring at least 3 times a week for at least 1 month, and associated daytime functioning complaints. This has led to view insomnia and its associated mental and physical health complaints as a minor problem from a public health perspective.Ī factor that may have contributed to this lack of firm association between insomnia and significant medical morbidity is the definitions used for this disorder and the lack of validated objective/biological markers. 3 However, the connection of insomnia with significant medical morbidity has not been examined until very recently. 1, 2 Also, about 4% of the population use sleeping pills in a regular basis. While 20-30% of the general population has poor sleep (i.e., insomnia symptoms of difficulty initiating or maintaining sleep, early morning awakening, or non-restorative sleep at any given time), another 8-10% of the population suffers from chronic insomnia. The prevalence of insomnia in the general population ranges between 8-40%, depending on the definition used. ![]() We propose that objective measures of sleep duration may become part of the routine evaluation and diagnosis of insomnia and that these two insomnia phenotypes may respond differentially to biological vs. Interestingly, both insomnia phenotypes are associated with mental health, although most likely through different pathophysiological mechanisms. In contrast, insomnia with normal sleep duration is associated with sleep misperception and cognitive-emotional arousal but not with signs of physiological hyperarousal or cardiometabolic or neurocognitive morbidity. Based on findings that insomnia with objective short sleep duration is associated with activation of both limbs of the stress system and other indices of physiological hyperarousal, which should affect adversely physical and mental health, we have recently demonstrated that this insomnia phenotype is associated with a significant risk of cardiometabolic and neurocognitive morbidity and mortality. In contrast to the association of insomnia with mental health, its association with physical health has remained largely unexplored until recently. ![]()
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