From the Guidelines
Insomnia can have severe effects on both physical and mental health, including increased risk of depression, anxiety disorders, and physiological consequences such as elevated blood pressure and increased risk of heart disease, stroke, and diabetes, as noted in studies 1. The most immediate impacts of insomnia include daytime fatigue, irritability, difficulty concentrating, and reduced cognitive performance. Chronic insomnia leads to more serious consequences such as weakened immune function and higher susceptibility to illnesses.
Key Effects of Insomnia
- Daytime fatigue and irritability
- Difficulty concentrating and reduced cognitive performance
- Increased risk of depression and anxiety disorders
- Weakened immune function
- Higher susceptibility to illnesses
- Physiological consequences such as elevated blood pressure and increased risk of heart disease, stroke, and diabetes
Treatment Approaches
Treatment typically involves addressing underlying causes, improving sleep hygiene, cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment, as recommended by the American College of Physicians 1, and sometimes short-term use of medications like zolpidem (5-10mg), eszopiclone (1-3mg), or trazodone (25-100mg) when appropriate.
Important Considerations
- Insomnia symptoms must cause clinically significant functional distress or impairment, be present for at least 3 nights per week for at least 3 months, and not be linked to other sleep, medical, or mental disorders, as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1.
- The goal of treatment for insomnia is to improve sleep and alleviate distress or dysfunction caused by the disorder, with CBT-I being a strongly recommended initial treatment approach 1.
From the Research
Insomnia Effects
- Insomnia can have significant adverse effects on an individual's quality of life, including cognitive impairment, reduced immune function, metabolic imbalance, and exacerbation of psychiatric conditions 2.
- The effects of insomnia can be far-reaching, contributing to a variety of medical problems, and can be acute, intermittent, or chronic 3.
- Insomnia disorder is a common condition, affecting up to 30% of the general adult population, and can be present in up to 50% of adults reporting regular difficulty falling asleep or staying asleep 4, 2.
Treatment Options
- Cognitive Behavioral Therapy for Insomnia (CBT-i) is a highly effective treatment for chronic insomnia, producing results equivalent to sleep medication, with no side effects, fewer episodes of relapse, and long-term improvements 5, 2.
- CBT-i incorporates several key components, including sleep consolidation, stimulus control, cognitive restructuring, sleep hygiene, and relaxation techniques 2.
- Pharmaceutical treatments, such as trazodone, can be used in combination with CBT-i to improve treatment outcomes, including increased slow wave sleep duration 6.
Treatment Efficacy
- Studies have shown that CBT-i can significantly improve sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency in adults with chronic insomnia 5, 4.
- CBT-i has been found to be an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes, and can be used as a first-line treatment 5, 3.
- The efficacy of CBT-i can be sustained over time, with long-term improvements in sleep quality and duration 5, 2.