Skip to main content

Diagnosis of Insomnia Disorder

  • Chapter
  • First Online:
Essentials of Sleep Medicine

Part of the book series: Respiratory Medicine ((RM))

  • 1109 Accesses

Abstract

As one of the most prevalent and costly sleep disorders, it is imperative that practitioners are able to accurately and efficiently assess for insomnia disorder in the clinic in addition to providing informed and up-to-date treatment options. Due to the impaired daytime functioning associated with insomnia disorder, quality of life can be negatively impacted and the risk of developing a comorbid mood disorder such as depression is elevated. This chapter will review appropriate methods of assessment and diagnosis of insomnia disorder to inform best practices in treatment. By properly diagnosing and treating insomnia disorder, practitioners can not only enhance the sleep health of patients but also improve overall quality of life and mental health.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. DSMTF, editor. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric A, American Psychiatric Association. Arlington: American Psychiatric Association; 2013.

    Google Scholar 

  2. Medicine AAoS. International classification of sleep disorders—third edition (ICSD-3) online version. Westchester: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  3. Roth T, Coulouvrat C, Hajak G, Lakoma MD, Sampson NA, Shahly V, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, second edition criteria: results from the America insomnia survey. Biol Psychiatry. 2011;69(6):592–600.

    Article  PubMed  Google Scholar 

  4. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.

    Article  PubMed  Google Scholar 

  5. Morin CM, Belanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009;169(5):447–53.

    Article  PubMed  Google Scholar 

  6. Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini GF. Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol. 2014;21(1):57–64.

    Article  PubMed  Google Scholar 

  7. Fernandez-Mendoza J, He F, Vgontzas AN, Liao D, Bixler EO. Interplay of objective sleep duration and cardiovascular and cerebrovascular diseases on cause-specific mortality. J Am Heart Assoc. 2019;8(20):e013043.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cheng P, Pillai V, Mengel H, Roth T, Drake CL. Sleep maintenance difficulties in insomnia are associated with increased incidence of hypertension. Sleep Health. 2015;1(1):50–4.

    Article  PubMed  Google Scholar 

  9. Jarrin DC, Alvaro PK, Bouchard MA, Jarrin SD, Drake CL, Morin CM. Insomnia and hypertension: a systematic review. Sleep Med Rev. 2018;41:3–38.

    Article  PubMed  Google Scholar 

  10. Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO. Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder. Sleep Med Rev. 2013;17(4):241–54.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lin CL, Chien WC, Chung CH, Wu FL. Risk of type 2 diabetes in patients with insomnia: a population-based historical cohort study. Diabetes Metab Res Rev. 2018;34(1)

    Google Scholar 

  12. Sexton CE, Storsve AB, Walhovd KB, Johansen-Berg H, Fjell AM. Poor sleep quality is associated with increased cortical atrophy in community-dwelling adults. Neurology. 2014;83(11):967–73.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hung CM, Li YC, Chen HJ, Lu K, Liang CL, Liliang PC, et al. Risk of dementia in patients with primary insomnia: a nationwide population-based case-control study. BMC Psychiatry. 2018;18(1):38.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1–3):10–9.

    Article  PubMed  Google Scholar 

  15. Cheng P, Kalmbach DA, Tallent G, Joseph CL, Espie CA, Drake CL. Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep. 2019;42(10)

    Google Scholar 

  16. Bishop TM, Crean HF, Hoff RA, Pigeon WR. Suicidal ideation among recently returned veterans and its relationship to insomnia and depression. Psychiatry Res. 2019;276:250–61.

    Article  PubMed  Google Scholar 

  17. Russell K, Rasmussen S, Hunter SC. Insomnia and nightmares as markers of risk for suicidal ideation in young people: investigating the role of defeat and entrapment. J Clin Sleep Med. 2018;14(5):775–84.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kucharczyk ER, Morgan K, Hall AP. The occupational impact of sleep quality and insomnia symptoms. Sleep Med Rev. 2012;16(6):547–59.

    Article  PubMed  Google Scholar 

  19. Brossoit RM, Crain TL, Leslie JJ, Hammer LB, Truxillo DM, Bodner TE. The effects of sleep on workplace cognitive failure and safety. J Occup Health Psychol. 2019;24(4):411–22.

    Article  PubMed  Google Scholar 

  20. Asche CV, Joish VN, Camacho F, Drake CL. The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder. Curr Med Res Opin. 2010;26(8):1843–53.

    Article  PubMed  Google Scholar 

  21. Klemas N. Clinical Economics. Insomnia Med Econ. 2015;92(6):24–5, 30

    PubMed  Google Scholar 

  22. Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015;147(4):1179–92.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev. 2010;14(1):9–15.

    Article  PubMed  Google Scholar 

  24. Winkelman JW, Buxton OM, Jensen JE, Benson KL, O'Connor SP, Wang W, et al. Reduced brain GABA in primary insomnia: preliminary data from 4T proton magnetic resonance spectroscopy (1H-MRS). Sleep. 2008;31(11):1499–506.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Saito YC, Maejima T, Nishitani M, Hasegawa E, Yanagawa Y, Mieda M, et al. Monoamines inhibit GABAergic neurons in ventrolateral preoptic area that make direct synaptic connections to hypothalamic arousal neurons. J Neurosci. 2018;38(28):6366–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Mazzocchi G, Malendowicz LK, Gottardo L, Aragona F, Nussdorfer GG. Orexin a stimulates cortisol secretion from human adrenocortical cells through activation of the adenylate cyclase-dependent signaling cascade. J Clin Endocrinol Metabol. 2001;86(2):778–82.

    Article  CAS  Google Scholar 

  27. Borbely AA, Daan S, Wirz-Justice A, Deboer T. The two-process model of sleep regulation: a reappraisal. J Sleep Res. 2016;25(2):131–43.

    Article  PubMed  Google Scholar 

  28. Achermann P, Borbély AA. Chapter 37 - Sleep homeostasis and models of sleep regulation. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 5th ed. Philadelphia: W.B. Saunders; 2011. p. 431–44.

    Chapter  Google Scholar 

  29. Drake CL, Friedman NP, Wright KP Jr, Roth T. Sleep reactivity and insomnia: genetic and environmental influences. Sleep. 2011;34(9):1179–88.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. 1987;10(4):541–53.

    Article  CAS  PubMed  Google Scholar 

  31. Perlis M, Shaw PJ, Cano G, Espie CA. Chapter 78 – Models of insomnia. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 5th ed. Philadelphia: W.B. Saunders; 2011. p. 850–65.

    Chapter  Google Scholar 

  32. Drake CL, Pillai V, Roth T. Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia. Sleep. 2014;37(8):1295–304.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710-e.

    Article  Google Scholar 

  34. Kalmbach DA, Buysse DJ, Cheng P, Roth T, Yang A, Drake CL. Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder. Sleep Med. 2020;71:151–60.

    Article  PubMed  Google Scholar 

  35. Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry. 2004;161(11):2126–8.

    Article  PubMed  Google Scholar 

  36. Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700.

    Article  PubMed  Google Scholar 

  37. Seow LSE, Verma SK, Mok YM, Kumar S, Chang S, Satghare P, et al. Evaluating DSM-5 insomnia disorder and the treatment of sleep problems in a psychiatric population. J Clin Sleep Med JCSM. 2018;14(2):237–44.

    Article  PubMed  Google Scholar 

  38. Vgontzas AN, Bixler EO, Lin HM, Prolo P, Mastorakos G, Vela-Bueno A, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab. 2001;86(8):3787–94.

    Article  CAS  PubMed  Google Scholar 

  39. Edinger JD, Ulmer CS, Means MK. Sensitivity and specificity of polysomnographic criteria for defining insomnia. J Clin Sleep Med. 2013;9(5):481–91.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Pillai V, Roth T, Drake CL. Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission. Sleep Med. 2016;26:62–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Taylor DJ, Wilkerson AK, Pruiksma KE, Williams JM, Ruggero CJ, Hale W, et al. Reliability of the structured clinical interview for DSM-5 sleep disorders module. J Clin Sleep Med. 2018;14(3):459–64.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–33.

    Article  PubMed  Google Scholar 

  43. Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract. 2012;13:40.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Klink ME, Quan SF, Kaltenborn WT, Lebowitz MD. Risk factors associated with complaints of insomnia in a general adult population. Influence of previous complaints of insomnia. Arch Intern Med. 1992;152(8):1634–7.

    Article  CAS  PubMed  Google Scholar 

  46. Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, et al. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep Med. 2020;65:62–73.

    Article  PubMed  Google Scholar 

  47. Kalmbach DA, Cheng P, Arnedt JT, Cuamatzi-Castelan A, Atkinson RL, Fellman-Couture C, et al. Improving daytime functioning, work performance, and quality of life in postmenopausal women with insomnia: comparing cognitive behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. J Clin Sleep Med. 2019;15(7):999–1010.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Drake CL, Kalmbach DA, Arnedt JT, Cheng P, Tonnu CV, Cuamatzi-Castelan A, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019;42(2)

    Google Scholar 

  49. Kalmbach DA, Cheng P, O'Brien LM, Swanson LM, Sangha R, Sen S, et al. A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Med. 2020;72:82–92.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med. 2016;18:7–18.

    Article  PubMed  Google Scholar 

  52. Beaulieu-Bonneau S, LeBlanc M, Merette C, Dauvilliers Y, Morin CM. Family history of insomnia in a population-based sample. Sleep. 2007;30(12):1739–45.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Hodges CJ, Ogeil RP, Lubman DI. The effects of acute alcohol withdrawal on sleep. Hum Psychopharmacol. 2018;33(3):e2657.

    Article  PubMed  Google Scholar 

  54. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019;18(3):337–52.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002;40(8):869–93.

    Article  CAS  PubMed  Google Scholar 

  56. Harvey AG, Tang NK, Browning L. Cognitive approaches to insomnia. Clin Psychol Rev. 2005;25(5):593–611.

    Article  PubMed  Google Scholar 

  57. Drake CL, Vargas I, Roth T, Friedman NP. Quantitative measures of nocturnal insomnia symptoms predict greater deficits across multiple daytime impairment domains. Behav Sleep Med. 2015;13(1):73–87.

    Article  PubMed  Google Scholar 

  58. Zammit GK. Subjective ratings of the characteristics and sequelae of good and poor sleep in normals. J Clin Psychol. 1988;44(2):123–30.

    Article  CAS  PubMed  Google Scholar 

  59. Carey TJ, Moul DE, Pilkonis P, Germain A, Buysse DJ. Focusing on the experience of insomnia. Behav Sleep Med. 2005;3(2):73–86.

    Article  PubMed  Google Scholar 

  60. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

    Article  CAS  PubMed  Google Scholar 

  61. Lerdal A. Fatigue severity scale. In: Michalos AC, editor. Encyclopedia of quality of life and well-being research. Dordrecht: Springer Netherlands; 2014. p. 2218–21.

    Chapter  Google Scholar 

  62. Treur JL, Gibson M, Taylor AE, Rogers PJ, Munafo MR. Investigating genetic correlations and causal effects between caffeine consumption and sleep behaviours. J Sleep Res. 2018;27(5):e12695.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Thakkar MM, Sharma R, Sahota P. Alcohol disrupts sleep homeostasis. Alcohol. 2015;49(4):299–310.

    Article  CAS  PubMed  Google Scholar 

  64. Wichniak A, Wierzbicka A, Jernajczyk W. Sleep and antidepressant treatment. Curr Pharm Des. 2012;18(36):5802–17.

    Article  CAS  PubMed  Google Scholar 

  65. Stoschitzky K, Sakotnik A, Lercher P, Zweiker R, Maier R, Liebmann P, et al. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol. 1999;55(2):111–5.

    Article  CAS  PubMed  Google Scholar 

  66. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307.

    Article  PubMed  Google Scholar 

  67. Lineberger MD, Carney CE, Edinger JD, Means MK. Defining insomnia: quantitative criteria for insomnia severity and frequency. Sleep. 2006;29(4):479–85.

    Article  PubMed  Google Scholar 

  68. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

    Article  CAS  PubMed  Google Scholar 

  69. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601–8.

    Article  PubMed  PubMed Central  Google Scholar 

  70. National Sleep Foundation. Sleep Diary 2020 [Available from: https://www.sleepfoundation.org/sites/default/files/inline-files/SleepDiaryv6.pdf.

  71. de Zambotti M, Cellini N, Goldstone A, Colrain IM, Baker FC. Wearable sleep technology in clinical and research settings. Med Sci Sports Exerc. 2019;51(7):1538–57.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Atkin T, Comai S, Gobbi G. Drugs for insomnia beyond benzodiazepines: pharmacology, clinical applications, and discovery. Pharmacol Rev. 2018;70(2):197–245.

    Article  CAS  PubMed  Google Scholar 

  73. Silva GE, Vana KD, Goodwin JL, Sherrill DL, Quan SF. Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth sleepiness scales. J Clin Sleep Med. 2011;7(5):467–72.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Vana KD, Silva GE, Goldberg R. Predictive abilities of the STOP-Bang and Epworth sleepiness Scale in identifying sleep clinic patients at high risk for obstructive sleep apnea. Res Nurs Health. 2013;36(1):84–94.

    Article  PubMed  Google Scholar 

  75. Castelnovo A, Ferri R, Punjabi NM, Castronovo V, Garbazza C, Zucconi M, et al. The paradox of paradoxical insomnia: a theoretical review towards a unifying evidence-based definition. Sleep Med Rev. 2019;44:70–82.

    Article  PubMed  Google Scholar 

  76. World Health O. ICD-10 : international statistical classification of diseases and related health problems: tenth revision. 2nd ed. Geneva: World Health Organization; 2004.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher Drake .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Atkinson, R., Drake, C. (2022). Diagnosis of Insomnia Disorder. In: Badr, M.S., Martin, J.L. (eds) Essentials of Sleep Medicine. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-93739-3_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-93739-3_12

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-93738-6

  • Online ISBN: 978-3-030-93739-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics