From the Guidelines
Nonorganic sleep disorder refers to a sleep disturbance that occurs without an identifiable physical or medical cause, and is primarily related to psychological, behavioral, or environmental factors, such as stress, anxiety, depression, poor sleep habits, or traumatic experiences.
Definition and Characteristics
Nonorganic sleep disorders include insomnia, hypersomnia, nightmares, and sleep terrors, and are distinct from organic sleep disorders, which stem from physical conditions like sleep apnea or restless leg syndrome. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, insomnia disorder is defined 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.
Treatment Options
Treatment for nonorganic sleep disorders typically involves addressing the underlying psychological issues through cognitive behavioral therapy for insomnia (CBT-I), stress management techniques, and establishing healthy sleep hygiene practices. CBT-I is generally regarded as the treatment of choice, with the most evidence available in the literature and a Strong recommendation from the American Academy of Sleep Medicine 1. Other potentially useful interventions include brief behavioral therapy for insomnia (BTIs), sleep restriction therapy, stimulus control, and relaxation therapy, which have received Conditional recommendations due to limited evidence.
Key Considerations
When discussing treatment options for chronic insomnia disorder, patients should be reminded that psychological and behavioral insomnia therapies typically produce gradual improvements in insomnia symptoms, but the benefits are durable beyond the end of treatment 1. Clinicians should consider comorbid medical and psychiatric conditions that may change the balance of benefits vs harms, and help set realistic expectations before starting treatment. In-person one-on-one delivery of CBT-I by a trained CBT-I provider is the most widely evaluated delivery method and is generally considered the best available treatment, but other delivery modalities, such as internet-based programs, may also be effective and should be discussed with patients based on availability, affordability, and patient preferences.
From the Research
Definition of Nonorganic Sleep Disorder
- Nonorganic sleep disorder refers to a type of sleep disorder that is not caused by any underlying medical or neurological condition 2.
- It is a frequent sleep disorder that has a high comorbidity with other psychiatric illnesses, such as anxiety disorders, depressive episodes, and schizophrenia 2.
Characteristics of Nonorganic Sleep Disorder
- Nonorganic sleep disorders can manifest as insomnia, hypersomnia, or other sleep-related problems 2, 3.
- Patients with nonorganic sleep disorders often experience significant reductions in health-related quality of life, including physical and psychological well-being, occupational functioning, and overall quality of life 3.
- Sleep laboratory investigations have shown that nonorganic sleep disorders can be characterized by changes in sleep architecture, such as alterations in sleep stage distribution and sleep fragmentation 2.
Treatment of Nonorganic Sleep Disorder
- Cognitive-behavioral therapy for insomnia (CBT-i) is a highly effective treatment for nonorganic insomnia, with results equivalent to sleep medication and fewer side effects 4, 5.
- CBT-i can help patients with nonorganic sleep disorders learn how to support and promote their body's natural sleep mechanism, leading to long-term improvements in sleep quality 4.
- Melatonin supplementation has also been shown to be effective in improving sleep quality and duration in patients with nonorganic sleep disorders, with significantly fewer side effects compared to traditional pharmaceutical therapies 6.