WASHINGTON — Insomnia is a disorder of hyperarousal rather than one of sleep deprivation, Thomas Roth, Ph.D., said at the annual meeting of the American Academy of Clinical Psychiatrists.
Because 90% of people with insomnia have other comorbid conditions, insomnia was seen as a symptom rather than an independent disorder until 2005. That's when the National Institute of Mental Health declared that insomnia met the criteria for a disorder, which include impairment in function and quality of life that is associated with specific symptoms and rooted in physiology.
When treating a patient who complains of chronic sleep problems, be sure to ask these key questions, Dr. Roth said in an interview:
▸ What is the nature of the nighttime sleep problems (difficulty falling asleep, difficulty staying asleep)?
▸ What is the nature of daytime consequences (daytime sleepiness, impaired function)?
▸ What is the frequency and duration of symptoms?
▸ Does the patient have any comorbid medical or psychiatric conditions?
Prevalence data are limited, but about 30% of the general population has some type of disturbed sleep, said Dr. Roth, director of research and chief of sleep medicine at the Henry Ford Hospital in Detroit.
Many patients with insomnia report that the daytime impairment and distress resulting from insomnia are more frustrating for them than their difficulty sleeping at night. Psychiatrists may be able to address these complaints.
Chronic pain is a common comorbidity in insomnia patients. “The less you sleep, the more sensitive you are to pain,” Dr. Roth said. Sleep loss increases the body's inflammatory response and heightens pain sensitivity, and several studies have shown that increasing total sleep time can decrease pain sensitivity.
Treatment of insomnia remains a challenge, but recognition of the role of hyperarousal and the frequency of comorbidities allows for new therapeutic targets, including some sedating antidepressants.
Depending on the nature and severity of the sleep impairment, many patients can benefit from sleep aids immediately, Dr. Roth said.