Abstract
Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. In this study the value of using the patient's own reasons for sleep disturbance are explored. Using secondary data analysis of a nationally representative psychiatric survey the patterning of the various reasons respondents provided for self-reported sleep problems were examined. Over two thirds (69.3%) of respondents could identify a specific reason for their sleep problem with worry (37.9%) and illness (20.1%) representing the most commonly reported reasons. And while women reported more sleep problems for almost every reason compared with men, the patterning of reasons by age showed marked variability. Sleep problem symptoms such as difficulty getting to sleep or waking early also showed variability by different reasons as did the association with major correlates such as worry, depression, anxiety and poor health. While prevalence surveys of ‘insomnia’ or ‘poor sleep’ often assume the identification of an underlying homogeneous construct there may be grounds for recognising the existence of different sleep problem types particularly in the context of the patient's perceived reason for the problem.
Highlights
In recent years a large number of studies have documented the extensive prevalence of sleep disturbances in the adult population with upwards of 30% considered to be affected [1]
The exact status of sleep disturbance or insomnia within medicine is unclear as it can be treated as a symptom or as a disease [13]
DSM-IV separates ‘primary’ insomnia – which might be considered an illness in its own right – from ‘secondary’ insomnia in which the sleep problems are both consequence/symptoms of an underlying disease, such as mental illness, a general medical condition or medication
Summary
In recent years a large number of studies have documented the extensive prevalence of sleep disturbances in the adult population with upwards of 30% considered to be affected [1] In this burgeoning field there have been debates about how best to define and measure sleep problems but their wide extent has not seemed in doubt. The second method for teasing out sub-types is to search for different underlying causes of the symptom – as when haemoptysis (coughing up blood) was found to be caused by both tuberculosis and lung cancer This approach has been widely deployed by research which has identified a range of biopsychosocial and socioeconomic factors that may help understand differences in sleep problems [4,5,6,7,8,9,10,11]; such studies have attempted to develop causal pathways linking external events and experiences with sleep disturbance. A third approach to understanding the patterning of sleep problems in the population is to classify according to respondents reported own explanation of the problem
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