Impact of Insomnia | DayAfterInsomnia™

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More Than a Symptom

Over the past several decades, insomnia has been studied more closely than ever.^2-4 With growing acknowledgment that insomnia can be more than a symptom, it became necessary to update the official diagnostic criteria.^2,3

Now, there is a distinction between insomnia symptoms and insomnia disorder.^3,4

Are you up for learning the latest about insomnia?

Approximately one-third of adults experience insomnia symptoms.⁴
6% to 10% meet the current diagnostic criteria for insomnia disorder.⁴

Insomnia disorder can now be diagnosed whether it occurs independently or is
comorbid with another medical condition or psychiatric disorder.⁴

This shift in diagnostic criteria highlights the need for an isolated focus on diagnosing and treating insomnia disorder, regardless of other psychiatric or medical conditions that may be present.³

Epidemiology and Diagnosis

You may already be aware that insomnia symptoms are widely experienced, but
insomnia disorder is underaddressed in the United States.^1,5-7 This could be due to
differing and varying perceptions of the disorder, its impact, and the role of treatment.⁸

Insomnia symptoms are more common in⁸:

Women

Middle-Aged
Adults

Elderly

Risk factors for insomnia disorder can include: mood and anxiety disorders, type 2 diabetes, cardiovascular disease, and arthritis.⁹

The major diagnostic criteria for insomnia disorder include⁴:

Symptoms
Difficulty falling asleep or
staying asleep or waking too
early in the morning that
leads to dissatisfaction with
sleep quantity or quality

Impairment
Sleep disturbance that leads to
impairment in social, work,
educational, behavioral, or other
areas of functioning, or that may
cause significant distress

Chronicity
Experiencing sleep difficulty
while having adequate
opportunity to sleep, at least
3 nights per week for at least
3 months
Next-Day Functional Impact
Inadequate sleep from insomnia can have next-day consequences¹:

Fatigue

Impaired Cognitive
Function and Memory

Daytime
Sleepiness
Because insomnia is a chronic condition, it can have a substantial impact on a person’s quality of life.

Patients with insomnia have reported reduced quality of life in the following areas^10,11:

Physical functioning

Physical health problems

Bodily pain

General health perceptions

Vitality

Social functioning

Emotional health problems

Mental health problems

The burden of insomnia has been calculated in studies as the number of quality-adjusted life-years
(QALYs) lost to insomnia. These studies reported that insomnia has a significantly higher QALY loss
than other medical conditions and psychiatric disorders, such as depression, arthritis, and other
health conditions.⁹
~67 billion Insomnia-related presenteeism and
annual loss of work performance^12,13 ~32.3 billion Insomnia-related accidents or errors^13,14

In the workplace, patients with insomnia have^10,15,16:

Higher risk of accidents

Higher rates of work absenteeism

Diminished job performance
For patients already being treated for insomnia, the next-day impact may be due to the residual effects of their insomnia medications. These effects can manifest as¹⁷:

Headache

Grogginess

Difficulty concentrating

Difficulty remembering

Approximately
of patients taking insomnia
medications reported experiencing
residual next-day effects.¹⁷
Medical and Psychiatric Impacts
If left untreated, insomnia may increase the risk of certain conditions, including:
Neurologic

Parkinson’s disease¹⁸

Dementia¹⁹

Alzheimer’s disease/cognitive impairment²⁰

Cardiovascular

Cardiovascular disease²¹

Heart attack²²

Stroke²¹

Heart failure²³

Inflammatory

Autoimmune disease²⁴

Asthma²⁵

Cancer

Breast cancer²⁶

Psychiatric

Major depressive disorder²⁷

Anxiety disorder²⁷

Bipolar disorder²⁸

Schizophrenia²⁸

PTSD in military personnel²⁹

Substance-related disorders²⁸

Alcohol abuse²⁷

Endocrine

Type 2 diabetes in patients with pre-diabetes³⁰

Chronic Pain

Chronic widespread musculoskeletal complaints³¹

Also, insomnia has been shown to increase the risk of mortality-related events:

Suicide attempts³²

All-cause mortality³³

Cardiovascular-related mortality^22,34

PTSD=posttraumatic stress disorder.

Treating both insomnia and a comorbidity individually may result in better outcomes than treating the comorbidity alone.^35,36
Pathophysiology

The sleep-wake cycle is regulated by sleep promotion and wake promotion pathways. Wake
promotion is regulated by orexin, a neuropeptide in the brain that plays a critical role in stabilizing
the switch from sleep to wake states.^37,38

Orexin physiology in the sleep-wake system³⁷

Sleep state

To enable sleep states,
neurons dampen wakefulness
via GABA neurotransmitter
and inhibit orexin activation of
wake-promoting neurons of
the brain.³⁷

= inhibition

= activation

Wake state

To enable wake states, increased orexin activates wake-promoting neurons. In turn, sleep-promoting neurons are inhibited.³⁷

= inhibition

= activation

When the sleep-wake system functions normally, as shown above, the 2 parts complement each other and result in healthy sleep patterns.³⁷

Insomnia is thought to be the result of one having a chronic state of hyperarousal. Patients who have insomnia may have overactive wake-promoting neurotransmitters that are independent of any psychological, medical, or drug-related stressors.^38,39

5-HT=serotonin; ACh=cholinergic; DA=dopamine; GABA=Gamma-amino butyric acid; His=histamine; NA=noradrenaline.

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The Impact of Insomnia

Consider asking your patients: How did you wake up?

Terms and Conditions

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Epidemiology and Diagnosis

Symptoms

Impairment

Chronicity

Approximately

The Impact
of Insomnia

Consider asking your patients:
How did you wake up?