The Natural History of Insomnia: What We Know, Don’t Know, and Need to Know

Abstract

Over the last several decades the prevalence and incidence of insomnia has been described in great detail. These data, while essential to document the magnitude of this health problem, infrequently provide information related to the incidence of new-onset insomnia and even less frequently provide information on the incidence of spontaneous remission and relapse. Of the groundbreaking studies that document these phenomena, none have provided information about the factors that mediate/moderate the transitions between good sleep to acute insomnia and from acute insomnia to either recovery or chronic insomnia. In this review, what is known about the natural history of insomnia (in terms of prevalence, incidence, and clinical course) will be reviewed. In addition, the leading theoretical perspectives on insomnia will be reviewed (with an eye towards identifying the factors that may mediate/moderate the above noted transitions) and a research agenda provided.