J Korean Neuropsychiatr Assoc.  2020 Feb;59(1):2-12. 10.4306/jknpa.2020.59.1.2.

Recent Advances in Diagnosis and Treatment of Insomnia Disorder

Affiliations
  • 1Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. ksj7126@skku.edu

Abstract

The diagnostic concepts of insomnia are controversial. New diagnostic criteria of insomnia disorder have been published in the International Classification of Sleep Disorders (ICSD-3) and the Diagnostic and Statistical Manual of Mental Disorder (DSM-5). Both the ICSD-3 and DSM-5 did not accept the concept of secondary and primary insomnia. According to the ICSD-3 and DSM-5, insomnia disorder can be diagnosed, even with a comorbid mental or sleep disorder. The medical, psychiatric, and sleep history are essential for the diagnosis of insomnia disorder. Polysomnography can be helpful for differential diagnoses or the clinical subtyping of insomnia disorder. Recently, the European and American Sleep Society published clinical guidelines for the treatment of insomnia. Both guidelines strongly recommended non-pharmacological treatment (e.g., cognitive behavioral disorder for insomnia) as a treatment of choice for insomnia. Pharmacological treatments for insomnia are weakly recommended only for a short time. New non-pharmacological and pharmacological treatments for insomnia disorder are being developed and studied.

Keyword

Insomnia; Diagnosis; Treatment

MeSH Terms

Classification
Diagnosis*
Diagnosis, Differential
Mental Disorders
Polysomnography
Sleep Initiation and Maintenance Disorders*
Sleep Wake Disorders

Reference

1). American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed.Darien, IL: American Academy of Sleep Medicine;2014.
2). American Psychiatry Association. Diagnostic and statistical manual of mental disorders, 5th edition: DSM-5. Arlington, VA: American Psychaitry Association;2013.
3). Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017; 13:307–349.
Article
4). Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017; 26:675–700.
Article
5). American Academy of Sleep Medicine. International classification of sleep disorders, revised: diagnostic and coding manual. Chicago, IL: American Academy of Sleep Medicine;2001.
6). Castelnovo A, Ferri R, Punjabi NM, Castronovo V, Garbazza C, Zucconi M, et al. The paradox of paradoxical insomnia: a theoretical review towards a unifying evidence-based definition. Sleep Med Rev. 2019; 44:70–82.
Article
7). Krystal AD, Edinger JD, Wohlgemuth WK, Marsh GR. NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. Sleep. 2002; 25:630–640.
8). Rezaie L, Fobian AD, McCall WV, Khazaie H. Paradoxical insomnia and subjective-objective sleep discrepancy: a review. Sleep Med Rev. 2018; 40:196–202.
9). Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO. Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder. Sleep Med Rev. 2013; 17:241–254.
Article
10). Fernandez-Mendoza J. The insomnia with short sleep duration phenotype: an update on it's importance for health and prevention. Curr Opin Psychiatry. 2017; 30:56–63.
11). Benjamins JS, Migliorati F, Dekker K, Wassing R, Moens S, Blank-en TF, et al. Insomnia heterogeneity: characteristics to consider for data-driven multivariate subtyping. Sleep Med Rev. 2017; 36:71–81.
Article
12). Galbiati A, Sforza M, Fasiello E, Castronovo V, Ferini-Strambi L. Impact of phenotypic heterogeneity of insomnia on the patients' response to Cognitive-Behavioral Therapy for Insomnia: current perspectives. Nat Sci Sleep. 2019; 11:367–376.
13). Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4:487–504.
Article
14). Benca RM, Buysse DJ. Reconsidering insomnia as a disorder rather than just a symptom in psychiatric practice. J Clin Psychiatry. 2018; 79:me17008ah1c.
Article
15). Currie SR, Clark S, Rimac S, Malhotra S. Comprehensive assessment of insomnia in recovering alcoholics using daily sleep diaries and ambulatory monitoring. Alcohol Clin Exp Res. 2003; 27:1262–1269.
Article
16). Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep. 2006; 29:1415–1419.
17). Cheung JMY, Ji XW, Morin CM. Cognitive behavioral therapies for insomnia and hypnotic medications: considerations and controversies. Sleep Med Clin. 2019; 14:253–265.
18). Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA. 2001; 285:1856–1864.
19). Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999; 281:991–999.
20). Bjorvatn B, Waage S, Pallesen S. The association between insomnia and bedroom habits and bedroom characteristics: an exploratory cross-sectional study of a representative sample of adults. Sleep Health. 2018; 4:188–193.
Article
21). van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: a metaanalysis of longterm effects in controlled studies. Sleep Med Rev. 2019; 48:101208.
Article
22). Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: a systematic literature review and metaanalysis. Sleep Med Rev. 2019; 49:101230.
Article
23). Boland E, Goldschmied J, Kayser MS, Gehrman PR. Precision medicine for insomnia. Sleep Med Clin. 2019; 14:291–299.
Article
24). Drerup ML, Ahmed-Jauregui S. Online delivery of cognitive behavioral therapy-insomnia: considerations and controversies. Sleep Med Clin. 2019; 14:283–290.
25). Buenaver LF, Townsend D, Ong JC. Delivering cognitive behavioral therapy for insomnia in the real world: considerations and controversies. Sleep Med Clin. 2019; 14:275–281.
26). Arnedt JT, Cuddihy L, Swanson LM, Pickett S, Aikens J, Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. Sleep. 2013; 36:353–362.
Article
27). Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C, et al. Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year followup: a randomized clinical trial. JAMA Psychiatry. 2017; 74:68–75.
28). Luik AI, van der Zweerde T, van Straten A, Lancee J. Digital delivery of cognitive behavioral therapy for insomnia. Curr Psychiatry Rep. 2019; 21:50.
Article
29). Seyffert M, Lagisetty P, Landgraf J, Chopra V, Pfeiffer PN, Conte ML, et al. Internet-delivered cognitive behavioral therapy to treat insomnia: a systematic review and metaanalysis. PLoS One. 2016; 11:e0149139.
Article
30). Salvemini A, D'Onofrio G, Ciccone F, Greco A, Tullio A, Addante F, et al. Insomnia and information and communication technologies (ICT) in elderly people: a systematic review. Med Sci (Basel). 2019; 7:70.
Article
31). Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011; 171:887–895.
Article
32). Gunn HE, Tutek J, Buysse DJ. Brief behavioral treatment of insomnia. Sleep Med Clin. 2019; 14:235–243.
Article
33). Troxel WM, Conrad TS, Germain A, Buysse DJ. Predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in older adults. J Clin Sleep Med. 2013; 9:1281–1289.
Article
34). Ellis JG. Cognitive behavioral therapy for insomnia and acute insomnia: considerations and controversies. Sleep Med Clin. 2019; 14:267–274.
35). Lack L, Scott H, Lovato N. Intensive sleep retraining treatment of insomnia. Sleep Med Clin. 2019; 14:245–252.
Article
36). Rash JA, Kavanagh VAJ, Garland SN. A metaanalysis of mindfulness-based therapies for insomnia and sleep disturbance: moving towards processes of change. Sleep Med Clin. 2019; 14:209–233.
37). Melo DLM, Carvalho LBC, Prado LBF, Prado GF. Biofeedback therapies for chronic insomnia: a systematic review. Appl Psychophysiol Biofeedback. 2019; 44:259–269.
Article
38). Schabus M, Griessenberger H, Gnjezda MT, Heib DPJ, Wislowska M, Hoedlmoser K. Better than sham? A double-blind placebo-controlled neurofeedback study in primary insomnia. Brain. 2017; 140:1041–1052.
Article
39). Huang Z, Li Y, Bianchi MT, Zhan S, Jiang F, Li N, et al. Repetitive transcranial magnetic stimulation of the right parietal cortex for comorbid generalized anxiety disorder and insomnia: a randomized, double-blind, sham-controlled pilot study. Brain Stimul. 2018; 11:1103–1109.
Article
40). Jiang CG, Zhang T, Yue FG, Yi ML, Gao D. Efficacy of repetitive transcranial magnetic stimulation in the treatment of patients with chronic primary insomnia. Cell Biochem Biophys. 2013; 67:169–173.
Article
41). Wilt TJ, MacDonald R, Brasure M, Olson CM, Carlyle M, Fuchs E, et al. Pharmacologic treatment of insomnia disorder: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med. 2016; 165:103–112.
Article
42). Gerlach LB, Wiechers IR, Maust DT. Prescription benzodiazepine use among older adults: a critical review. Harv Rev Psychiatry. 2018; 26:264–273.
Article
43). Wong CK, Marshall NS, Grunstein RR, Ho SS, Fois RA, Hibbs DE, et al. Spontaneous adverse event reports associated with zolpidem in the United States 2003-2012. J Clin Sleep Med. 2017; 13:223–234.
Article
44). Lee J, Jung SJ, Choi JW, Shin A, Lee YJ. Use of sedative-hypnotics and the risk of Alzheimer's dementia: a retrospective cohort study. PLoS One. 2018; 13:e0204413.
Article
45). Pillai V, Roth T, Roehrs T, Moss K, Peterson EL, Drake CL. Effectiveness of benzodiazepine receptor agonists in the treatment of insomnia: an examination of response and remission rates. Sleep. 2017; 40.
Article
46). By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015; 63:2227–2246.
47). Hintze JP, Edinger JD. Hypnotic discontinuation in chronic insomnia. Sleep Med Clin. 2018; 13:263–270.
Article
48). Beaulieu-Bonneau S, Ivers H, Guay B, Morin CM. Longterm maintenance of therapeutic gains associated with cognitive-behavioral therapy for insomnia delivered alone or combined with zolpidem. Sleep. 2017; 40:zsx002.
Article
49). Winkler A, Rief W. Effect of placebo conditions on polysomnographic parameters in primary insomnia: a metaanalysis. Sleep. 2015; 38:925–931.
Article
50). Takaesu Y, Utsumi T, Okajima I, Shimura A, Kotorii N, Kuriyama K, et al. Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: a systematic review and metaanalysis. Sleep Med Rev. 2019; 48:101214.
Article
51). Auld F, Maschauer EL, Morrison I, Skene DJ, Riha RL. Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Med Rev. 2017; 34:10–22.
Article
52). Wade A, Downie S. Prolonged-release melatonin for the treatment of insomnia in patients over 55 years. Expert Opin Investig Drugs. 2008; 17:1567–1572.
Article
53). Riha RL. The use and misuse of exogenous melatonin in the treatment of sleep disorders. Curr Opin Pulm Med. 2018; 24:543–548.
Article
54). Sys J, Van Cleynenbreugel S, Deschodt M, Van der Linden L, Tourn-oy J. Efficacy and safety of non-benzodiazepine and non-Z-drug hypnotic medication for insomnia in older people: a systematic literature review. Eur J Clin Pharmacol. 2019.
Article
55). Frase L, Nissen C, Riemann D, Spiegelhalder K. Making sleep easier: pharmacological interventions for insomnia. Expert Opin Phar-macother. 2018; 19:1465–1473.
Article
56). Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, et al. Antidepressants for insomnia in adults. Cochrane Database Syst Rev. 2018; 5:CD010753.
Article
57). Karsten J, Hagenauw LA, Kamphuis J, Lancel M. Low doses of mirtazapine or quetiapine for transient insomnia: a randomised, double-blind, cross-over, placebo-controlled trial. J Psychopharmacol. 2017; 31:327–337.
Article
58). Ruwe F, IJzerman-Boon P, Roth T, Zammit G, Ivgy-May N. A phase 2 randomized dose-finding study with esmirtazapine in patients with primary insomnia. J Clin Psychopharmacol. 2016; 36:457–464.
Article
59). Srinivasan V, Brzezinski A, Pandi-Perumal SR, Spence DW, Cardinali DP, Brown GM. Melatonin agonists in primary insomnia and depression-associated insomnia: are they superior to sedative-hypnotics? Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35:913–923.
Article
60). Yi XY, Ni SF, Ghadami MR, Meng HQ, Chen MY, Kuang L, et al. Trazodone for the treatment of insomnia: a metaanalysis of randomized placebo-controlled trials. Sleep Med. 2018; 45:25–32.
Article
61). Merenstein D, Diener-West M, Halbower AC, Krist A, Rubin HR. The trial of infant response to diphenhydramine: the TIRED study–a randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med. 2006; 160:707–712.
62). Hoyer D, Allen A, Jacobson LH. Hypnotics with novel modes of action. Br J Clin Pharmacol. 2019.
Article
63). Raglan GB, Swanson LM, Arnedt JT. Cognitive behavioral therapy for insomnia in patients with medical and psychiatric comorbidities. Sleep Med Clin. 2019; 14:167–175.
Article
64). Gebara MA, Siripong N, DiNapoli EA, Maree RD, Germain A, Reynolds CF, et al. Effect of insomnia treatments on depression: a systematic review and metaanalysis. Depress Anxiety. 2018; 35:717–731.
Article
65). Asarnow LD, Manber R. Cognitive behavioral therapy for insomnia in depression. Sleep Med Clin. 2019; 14:177–184.
Article
66). Blom K, Jernelöv S, Rück C, Lindefors N, Kaldo V. Three-year followup comparing cognitive behavioral therapy for depression to cognitive behavioral therapy for insomnia, for patients with both diagnoses. Sleep. 2017; 40:zsx108.
Article
67). Fava M, McCall WV, Krystal A, Wessel T, Rubens R, Caron J, et al. Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiatry. 2006; 59:1052–1060.
Article
68). Colvonen PJ, Straus LD, Stepnowsky C, McCarthy MJ, Goldstein LA, Norman SB. Recent advancements in treating sleep disorders in co-occurring PTSD. Curr Psychiatry Rep. 2018; 20:48.
Article
69). Akinnusi M, El Solh AA. Drug treatment strategies for insomnia in patients with posttraumatic stress disorder. Expert Opin Pharmaco-ther. 2019; 20:691–699.
Article
70). Kaplan KA, Harvey AG. Behavioral treatment of insomnia in bipolar disorder. Am J Psychiatry. 2013; 170:716–720.
Article
71). Glidewell RN, McPherson Botts E, Orr WC. Insomnia and anxiety: diagnostic and management implications of complex interactions. Sleep Med Clin. 2015; 10:93–99.
72). Uhde TW, Cortese BM, Vedeniapin A. Anxiety and sleep problems: emerging concepts and theoretical treatment implications. Curr Psychiatry Rep. 2009; 11:269–276.
Article
73). Al-Jawder SE, Bahammam AS. Comorbid insomnia in sleep-related breathing disorders: an under-recognized association. Sleep Breath. 2012; 16:295–304.
Article
74). Sweetman A, Lack L, Catcheside PG, Antic NA, Smith S, Chai-Coetzer CL, et al. Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial. Sleep. 2019; 42:zsz178.
Article
75). Gupta R, Zalai D, Spence DW, BaHammam AS, Ramasubramanian C, Monti JM, et al. When insomnia is not just insomnia: the deeper correlates of disturbed sleep with reference to DSM-5. Asian J Psychiatr. 2014; 12:23–30.
Article
76). Miller MA, Mehta N, Clark-Bilodeau C, Bourjeily G. Sleep pharmacotherapy for common sleep disorders in pregnancy and lactation. Chest. 2020; 157:184–197.
Article
Full Text Links
  • JKNA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr