![]() But adolescents have difficulty with delayed sleep phase disturbances, which tend to delay the circadian rhythms. We used to discard it as being an unimportant problem in children. Karl Doghramji, MD: In children, it’s more common than we used to think. Thorpy, MD: What about age-related factors, Karl? How often do we see insomnia in children? We know that insomnia is a little more common in older adults, but how common is it in the childhood age range? What’s also interesting is that we have some studies suggesting that the management of these insomnia complaints may impart some benefit in terms of psychiatric disease. And fomenting insomnia seems to foment underlying psychiatric disease. This is particularly apparent in depression and psychiatric disease, where we see that the problems with insomnia often predict the onset of depressive disorders. There seems to be a bidirectional relationship between the comorbidities of insomnia and insomnia itself. One final thing I’d like to mention is the comorbidities of insomnia. The recognition of insomnia as a problem worthy of clinical consideration unfortunately isn’t common in medical settings. Guess how many patients had a diagnosis of insomnia on the chart? Zero. Of 100 inpatients, 80 had significant insomnia, which put them at a diagnostic categorization of insomnia disorder. We conducted a chart study of inpatients at my institution. What’s interesting about these prevalent data in medical settings is that the recognition of insomnia is extraordinarily low from both patients and physicians. ![]() Around 80% of psychiatric patients have insomnia, depending on whether it’s inpatient or outpatient. In physicians’ offices, psychiatric settings, 30% or 25% of primary care patients had insomnia. The prevalence of insomnia seems to increase in certain settings-for example, medical settings. It occurs in 5% to 10% of the population at any time, so it’s a very common problem. We also know that an insomnia disorder, as Erinn described, occurs for 3 months or longer, causing distress, functioning issues, and so on. Some international studies have estimated it’s the second most common complaint, with the first being upper-airway symptoms. Karl Doghramji, MD: Insomnia is 1 of the most prevalent complaints known to man. What is a general prevalence of insomnia? How common is this? Karl, I’ll bet there are certain groups where insomnia is more common. We’ve talked about the causes of insomnia. Thorpy, MD: We’ve talked about the symptoms of insomnia. Pain, chronic pain, cancer-sleep is something that affects nearly every aspect of our physiology, so it’s not surprising that when our physiology breaks down, when we have disease processes, that’s going to impact our sleep and cause insomnia problems. Then we have neurological and medical illnesses, multiple sclerosis, Parkinson disease. Let’s move on to psychiatric illness, which has such a tight association with insomnia, particularly depression and anxiety, bipolar disorder, and schizophrenia. These can have an insomnia component that may or may not get better when you treat the primary problem. As sleep physicians, we’ve got to think about obstructive sleep apnea, restless leg syndrome, and circadian rhythm sleep disorders, like the wake-sleep phase syndrome. A lot of things out there can be problematic. The sleep of a bed partner or other people in the home can also disturb an individual’s sleep. When we look at psychosocial factors and environmental factors-ambient lighting, temperature, noises-the sleep environment might not be conducive to sleep. In many ways, we live in a toxic environment for sleep. In today’s day and age, it can be a challenge for people to clear the mind and allow sleep to happen. Sleep is something that happens given the right circumstances, it’s not something that you do. Nathaniel Fletcher Watson, MD: Thanks, Michael. How do everyday lifestyle events, the psychosocial aspects, contribute to insomnia? Nate, perhaps you could tell us a little about how disturbed sleep patterns contribute to medical psychiatric disorders, which contribute to insomnia. Thorpy, MD: There are many causes for insomnia.
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