What are the symptoms of chronic insomnia?

From the Guidelines

Chronic insomnia is characterized by symptoms of difficulty initiating or maintaining sleep, or early-morning waking with inability to return to sleep, occurring at least 3 nights per week for 3 months or more, and causing clinically significant distress or impairment in activities.

Key Symptoms

• Difficulty with sleep initiation
• Difficulty maintaining sleep
• Early-morning waking with inability to return to sleep

Diagnostic Criteria

These 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 1.

Prevalence and Demographics

Approximately 6% to 10% of adults have insomnia that meets diagnostic criteria, with a higher prevalence in women and older adults 1. Older adults are more likely to report problems with waking after sleep onset (difficulty maintaining sleep) than they are to report problems with sleep onset latency (time to fall asleep) 1.

Associated Consequences

Chronic insomnia is associated with numerous adverse effects on function, health, and quality of life, including fatigue, poor cognitive function, mood disturbance, and distress or interference with personal functioning 1.

From the Research

Symptoms of Chronic Insomnia

The symptoms of chronic insomnia can be categorized into nighttime and daytime symptoms.

• Nighttime symptoms include:
  • Difficulty initiating sleep 2
  • Difficulty maintaining sleep 2
  • Poor quality of sleep 3, 2
• Daytime symptoms include:
  • Fatigue 3
  • Mood disturbances 3
  • Cognitive disturbances 3
  • Impairments in daily activities 3
  • Interpersonal relationship problems 3

Prevalence and Characteristics

Chronic insomnia is a common sleep disorder, affecting 6% to 10% of adults in the general population 4.

• It is often comorbid with other conditions, such as hypertension, cardiac disease, and breathing problems 4
• Chronic insomnia can have serious consequences, including increased risk of depression and hypertension 5
• It is a multifactorial and individualized disorder, with cognitive and physiologic factors contributing to its etiology 6

Diagnosis and Treatment

Chronic insomnia is a clinical diagnosis, fulfilled by specific criteria, including difficulty initiating or maintaining sleep, inability to sleep despite having adequate opportunities, and negative daytime effects due to lack of sleep 2.

• Cognitive behavioral therapy is considered a first-line treatment for chronic insomnia 2, 5
• Non-drug strategies, such as cognitive behavior therapy, are recommended for managing chronic insomnia 5
• Pharmacologic treatments, such as hypnotic medications, may be used as adjunctive therapy for patients with ongoing symptoms 5, 6