From the Guidelines
Neurological Symptoms of Chronic Insomnia
Chronic insomnia is associated with significant neurological symptoms, including fatigue, poor cognitive function, and mood disturbance.
- These symptoms can cause clinically significant distress or impairment in daily life, affecting work, social relationships, and overall well-being 1.
- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines insomnia disorder as a predominant symptom of difficulty with sleep initiation, difficulty maintaining sleep, or early-morning waking with inability to return to sleep, causing clinically significant distress or impairment in activities, occurring at least 3 nights per week for 3 months or more 1.
- Older adults are more likely to report problems with waking after sleep onset (difficulty maintaining sleep), while younger adults are more likely to report problems with sleep onset latency (time to fall asleep) 1.
- Chronic insomnia can also increase the risk of developing psychiatric disorders, such as mood disorders, and can have adverse effects on chronic pain populations and cardiovascular disease 1.
- The treatment of chronic insomnia aims to improve sleep and alleviate distress or dysfunction caused by the disorder, using psychological therapy, pharmacologic therapy, or a combination of both 1.
From the Research
Neurological Symptoms of Chronic Insomnia
The neurological symptoms of chronic insomnia can be complex and varied, often manifesting as a result of underlying neurological diseases or conditions. Some of the key symptoms and associated conditions include:
- Difficulty initiating or maintaining sleep, and poor subjective sleep quality despite adequate opportunity and circumstances for sleep 2, 3
- Daytime dysfunction, including excessive daytime sleepiness (EDS) and fatigue, which can impact quality of life and increase the risk of accidents 4
- Motor deficits, pain, depression, and anxiety, which can contribute to insomnia and other sleep problems 2, 5
- Neurodegenerative, inflammatory, traumatic, or ischemic changes in sleep-regulating brainstem and hypothalamic nuclei, leading to changes in neurotransmitters and insomnia symptoms 2, 6
Associated Neurological Conditions
Chronic insomnia can be associated with a range of neurological conditions, including:
- Neurodegenerative movement disorders, such as Parkinson's disease 2, 5
- Multiple sclerosis, which can cause insomnia symptoms up to 10 years before other symptoms appear 2
- Traumatic brain injury, which can lead to insomnia and other sleep disorders 2, 5
- Epilepsies, which can cause insomnia and other sleep problems, particularly in children 2
- Dementia, which can cause insomnia and other sleep disorders, and can be treated with trazodone, light therapy, and physical exercise 2, 5
Treatment Options
Treatment options for chronic insomnia associated with neurological conditions can include:
- Cognitive behavioral therapy (CBT), which is considered a first-line treatment for insomnia 2, 5, 3
- Pharmacologic treatments, such as hypnotics, sedating antidepressants, and melatonin, which can be effective in treating insomnia symptoms 2, 5
- Lifestyle modifications, such as improving sleep hygiene and reducing stress, which can help alleviate insomnia symptoms 4