Abstract
Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea (COMISA). In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases.
Highlights
This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder
Insomnia symptoms may be present in all the different sleep disorders, as highlighted above
Sometimes it is difficult to disentangle whether the patient suffers from insomnia disorder or whether the symptoms are an indication of another sleep disorder
Summary
This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. In order to guide clinicians in the identification of specific disorders or diseases, the American Academy of Sleep Medicine has developed the International Classification of Sleep Disorders (ICSD), a diagnostic system used within sleep medicine all around the world. Patients may present symptoms characteristic of several sleep disorders when seeking help for their problem, that is, most sleep disorders usually cause disturbances both during the night (e.g., poor and/or interrupted sleep) and during the day (e.g., fatigue, sleepiness, cognitive deficits, mood disturbances). Even though patients with different sleep disorders may present symptoms or complaints which resemble each other, the treatment-ofchoice differs substantially between the different diagnostic categories, as detailed below. A thorough diagnostic assessment is a necessity in order to be able to best help patients with sleep problems
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