Psychosocial and psychosomatic aspects of insomnia

Abstract

As shown in this review, insomnia is very common and often constitutes a chronic health problem excused by diverse medical, psychiatric and psychosocial conditions as well as substance abuse. Approximately 10% of the general population and 20% of primary care attendees suffer from severe insomnia. Clinical hallmarks of sleeplessness are the patients' complaints about insufficient and non-restorative sleep, severe daytime consequences without any tendency to fall asleep and presence of symptoms on three days per week for more than one month. Insomniacs tend to suffer from psycho-physiologic hyperarousal that prevents physical and mental relaxation. They are more susceptible to stress and seem to have a high sympathetic drive. Insomnia therefore has been compared to chronic caffeine intoxication. It must he pointed out that insomnia is probably more a qualitative rather than a quantitative disorder of sleep. Neither doctors nor patients routinely talk about disturbed sleep during consultations which might he one reason why insomnia very often goes undiagnosed. Consequently, physicians should routinely inquire afoul their patients' sleep and sleeping habits and take, if appropriate, a full sleep history on the basis of which further investigational and therapeutic steps can be planned: well-established tools of proved efficacy are available to treat both primary and secondary insomnia. Acute or transient insomnia lasting less than four weeks can he treated with hypnotics. Chronic insomnia is the domain of nonpharmacological psychotherapy, which can be conducted in a single or group setting.