INSOMNIA - 09/09/11
Riassunto |
Insomnia is a complaint of unsatisfactory sleep. Traditionally, insomnia is subdivided into four categories—difficulties falling asleep, mid-sleep awakenings, early morning awakenings, and nonrestorative sleep. There is vast overlap among categories, however, and most insomniacs fit into more than one.29 A better way to divide insomnia is into transient insomnia (lasting a few days), short-term insomnia (lasting weeks), and chronic insomnia (lasting months and years). Because sleep needs vary from about 4 hours per night to about 9 hours per night among healthy individuals, insomnia cannot be diagnosed by the amount of sleep a person receives. Insomnia is distinguished from healthy short sleep by daytime consequences such as feelings of restlessness, irritability, or impaired social and occupational functioning.30 If you sleep poorly at night but feel well during the day, you are not an insomniac but a person with a low need to sleep.
The prevalence of insomnia varies with its definition. In the United States, about one third of adults report occasional difficulties with sleeping; about 10% rate their sleep problems as chronic and serious.55 Similar data are reported from other parts of the world.62 Insomnia complaints are about 1.3 times more likely in women than in men and they increase with age, with patients over 65 years old complaining about 1.5 times more about insomnia than those under 65.37
The consequences of insomnia are many. Most insomniacs complain bitterly about their impairments in daytime functioning, ability to concentrate, memory, and mood.2 It is much harder to find objective, laboratory documented impairment: On psychomotor tests, insomniacs may be more variable and slower than good sleepers in some reaction time tests23, 49 and there may be some impairment in the Romberg test39 and in remembering previously learned material.40 Although most insomniacs complain about increased daytime sleepiness and fatigue, they take longer to fall asleep during daytime naps than normal sleepers—i.e., they seem hyperalert.59
Insomniacs are more likely to drop out of difficult jobs and they receive fewer promotions than good sleepers.32 Insomnia is clearly a risk factor for the reoccurrence of depression.13 Insomniacs seek out ineffective and potentially harmful treatments such as over-the-counter (OTC) medications and alcohol (40% have tried OTCs or alcohol for their insomnia).15 In the elderly, an inability to sleep or at least to remain in bed at night is among the most frequent reasons for admission to nursing homes.
Walsh et al61 estimated the direct cost of insomnia in 1991 in the United States at about $11 billion. That includes costs of medical care, both for self treatment borne by the patient and cost borne by organized health care providers, insurance companies, and other payers. Roth55 estimated the overall economic costs of insomnia in the United States at about $30 to $35 billion. In addition to Walsh's direct costs, that includes associated costs to society such as decreased work productivity.
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| Address reprint requests to Peter J. Hauri, PhD, Mayo Sleep Disorders Center, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 |
Vol 19 - N° 1
P. 157-168 - marzo 1998 Ritorno al numero
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- HYPOVENTILATION SYNDROMES
- Samuel Krachman, Gerard J. Criner
- NARCOLEPSY AND IDIOPATHIC HYPERSOMNOLENCE
- Kah Lin Choo, Christian Guilleminault
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