Insomnia: risk factors, sex- and age-specific features, and therapeutic approaches

Abstract

Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. Insomnia is often divided into subtypes based on the prevailing symptom. Insomnia is a risk factor for developing other somatic and mental disorders such as cerebrovascular diseases, hypertension, diabetes mellitus, depression, and causes increased healthcare costs. Given the bidirectional association of insomnia with the development of other somatic and mental diseases, the term “comorbid insomnia” may be used. The etiology and pathophysiology of insomnia involve genetic, environmental, behavioural, and physiological factors. The goals of insomnia treatment are to improve quantitative and qualitative aspects of sleep, to reduce the distress and anxiety associated with poor sleep, and to improve daytime function. Efficacious treatments for insomnia include behavioural, cognitive, and pharmacological interventions. Simple behavioural interventions may be provided in primary care facilities, but lack of training in these techniques limits their use. Among pharmacological interventions, the most evidence exists for benzodiazepine receptor agonist drugs, although on-going concerns focus on their safety as compared to modest efficacy. Different “natural” and OTC drugs are used as sleeping medications, for instance melatonin-based drugs. Behavioural treatments should be used whenever possible, and drugs should be limited to the lowest necessary dose and shortest necessary duration.