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. 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. (shrink)

Objective: Previous research suggests a positive association between pain, depression and sleep. In this study, we investigate how sleep correlates with varying levels of pain and depression in nursing home patients with dementia.Materials and methods: Cross-sectional study with sleep-related data, derived from two multicenter studies conducted in Norway. We included NH patients with dementia according to the Mini-Mental State Examination from the COSMOS trial and the DEP.PAIN.DEM trial whose sleep was objectively measured with actigraphy. In the COSMOS trial, NH patients (...) were included if they were ≥65 years of age and with life expectancy >6 months. In the DEP.PAIN.DEM trial, patients were included if they were ≥60 years and if they had depression according to the Cornell Scale for Depression in Dementia. In both studies, pain was assessed with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale, and depression with CSDD. Sleep parameters were total sleep time, sleep efficiency, sleep onset latency, wake after sleep onset, early morning awakening, daytime total sleep time and time in bed. We registered use of sedatives, analgesics, opioids and antidepressants from patient health records and adjusted for these medications in the analyses.Results: Mean age was 86.2 years and 76.3% were female. Hierarchical regressions showed that pain was associated with higher TST and SE, less WASO and more DTS. More severe dementia was associated with more WASO and TiB. More severe depression was associated with less TST, less DTS and less TiB. Use of sedative medications was associated with less TiB.Conclusion: When sleep was measured with actigraphy, NH patients with dementia and pain slept more than patients without pain, in terms of higher total sleep time. Furthermore, their sleep efficiency was higher, indicating that the patients had more sleep within the time they spent in bed. Patients with more severe dementia spent more time awake during the time spent in bed. Furthermore, people with more severe depression slept less at daytime and had less total sleep time Controlling for concomitant medication use did not affect the obtained results. (shrink)

ObjectiveThe aim of this study was to investigate possible associations between obstructive sleep apnea and fatigue. This naturally led to considering the association between OSA and excessive sleepiness, depression, and anxiety.BackgroundOSA is a highly prevalent sleep disorder, associated with a risk of hypertension, cardiovascular events, daytime sleepiness, poor cognitive function, and sudden death during sleep. Both excessive sleepiness, fatigue, and symptoms of depression are frequently reported.Method5,464 patients referred to a university hospital for obstructive sleep apnea underwent standard respiratory polygraphy. The (...) severity of OSA was defined as either mild, moderate, or severe, using the apnea–hypopnea index. Validated questionnaires were used to assess excessive sleepiness, pathological fatigue, depression, and anxiety.ResultsNearly 70% of the patients were men, and median age was 50 years. One in three had moderate-to-severe OSA. Excessive sleepiness and pathological fatigue were present in 43 and 39%, respectively. The prevalence of possible depression and anxiety was 19 and 28%, respectively. The proportion of patients with male sex, obesity, and excessive sleepiness increased with the severity of OSA. In contrast, the proportion of patients with pathological fatigue did not increase with OSA severity, and there was a decrease in depression and anxiety with increasing OSA severity.ConclusionOur study reports that pathological fatigue, as well as anxiety and depression, did not increase with OSA severity, whereas excessive sleepiness did. Knowledge concerning conditions related to OSA severity may be indicative of pretest probability of OSA and thus change the priority for polygraphy. Furthermore, the high prevalence rates of fatigue, anxiety, and depression among these patients warrant further investigations. (shrink)

Objectives: No systematic review or meta-analysis concerning the prevalence of shift work disorder has been conducted so far. The aim was thus to review prevalence studies of SWD, to calculate an overall prevalence by a random effects meta-analysis approach and investigate correlates of SWD prevalence using a random-effects meta-regression.Methods: Systematic searches were conducted in ISI Web of Science, PsycNET, PubMed, and Google Scholar using the search terms “shift work disorder” and “shift work sleep disorder.” No restrictions in terms of time (...) frame were used. Included studies had to present original data on the prevalence of SWD in an occupational sample published in English. A total of 349 unique hits were made. In all, 29 studies were finally included from which two authors independently extracted data using predefined data fields. The meta-regression included four predictors.Results: The overall prevalence of SWD was 26.5%. Cochran Q was 1,845.4, and the I2 was 98.5%, indicating very high heterogeneity across the observed prevalence estimates. Diagnostic criteria and sample size were inversely related to SWD prevalence.Conclusions: The prevalence of SWD was high across the included studies. The between-study disparity was large and was partly explained by diagnostic criteria and sample size. In order to facilitate comparative research on SWD, there is a need for validation and standardization of assessment methodology as well as agreement in terms of sample restrictions. (shrink)