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A Practical Guide to Insomnia Assessment

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Primary Care Sleep Medicine

Abstract

In this chapter we discuss our approach to insomnia assessment. This involves using both the two-process model of sleep regulation to help understand sleep patterns commonly seen in insomniacs and the 3-P model of insomnia to appreciate the evolution of difficulty sleeping over time. The importance of individual differences in sleep need is also discussed. This chapter is not meant to be a comprehensive listing of all conditions that can effect sleep or a list of all the resources available to assess sleep, but instead focuses on issues most frequently seen when treating patients with trouble sleeping (medication effects, obstructive sleep apnea, aging, mental illness, and a few other common medical disorders are described). We hope that this work will provide insight into both novice and experienced clinicians alike.

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References

  1. Spielman AJ, Yang CM, Glovinsky PB. Assessment techniques for insomnia. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2011.

    Google Scholar 

  2. Spielman AJ, Glovinsky P. The varied nature of insomnia. In: Hauri PJ, editor. Case studies in insomnia. New York, NY: Plenum Press; 1991.

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  4. Spielman AJ. Assessment of insomnia. Clin Psychol. 1986;6:11–25.

    Google Scholar 

  5. Drake C, Richardson G, Roehrs T, Scofield H, Roth T. Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep. 2004;27(2):285–91.

    PubMed  Google Scholar 

  6. Fernandez-Mendoza J, Vela-Bueno A, Vgontzas AN, Ramos-Platon MJ, Olavarrieta-Bernardino S, Bixler EO, et al. Cognitive-emotional hyperarousal as a premorbid characteristic of individuals vulnerable to insomnia. Psychosom Med. 2010;72(4):397–403.

    Article  PubMed  Google Scholar 

  7. 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 

  8. Morin CM, Rodrigue S, Ivers H. Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med. 2003;65(2):259–67.

    Article  PubMed  Google Scholar 

  9. Carney CE, Edinger JD, Morin CM, Manber R, Rybarczyk B, Stepanski EJ, et al. Examining maladaptive beliefs about sleep across insomnia patient groups. J Psychosom Res. 2010;68(1):57–65.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Carney CE, Edinger JD, Manber R, Garson C, Segal ZV. Beliefs about sleep in disorders characterized by sleep and mood disturbance. J Psychosom Res. 2007;62(2):179–88.

    Article  PubMed  Google Scholar 

  11. Ursin R, Bjorvatn B, Holsten F. Sleep duration, subjective sleep need, and sleep habits of 40- to 45-year-olds in the Hordaland Health Study. Sleep. 2005;28(10):1260–9.

    PubMed  Google Scholar 

  12. Randall DK. Rethinking sleep. The New York Times. 2012 September 22, 2012; Sect. Opinion.

    Google Scholar 

  13. Borbely AA. A two process model of sleep regulation. Hum Neurobiol. 1982;1(3):195–204.

    CAS  PubMed  Google Scholar 

  14. Strecker RE, Morairty S, Thakkar MM, Porkka-Heiskanen T, Basheer R, Dauphin LJ, et al. Adenosinergic modulation of basal forebrain and preoptic/anterior hypothalamic neuronal activity in the control of behavioral state. Behav Brain Res. 2000;115(2):183–204.

    Article  CAS  PubMed  Google Scholar 

  15. Achermann P, Borbely AA. Simulation of daytime vigilance by the additive interaction of a homeostatic and a circadian process. Biol Cybern. 1994;71(2):115–21.

    Article  CAS  PubMed  Google Scholar 

  16. Pigeon WR, Perlis ML. Sleep homeostasis in primary insomnia. Sleep Med Rev. 2006;10(4):247–54.

    Article  PubMed  Google Scholar 

  17. Feinberg I, Maloney T, March JD. Precise conservation of NREM period 1 (NREMP1) delta across naps and nocturnal sleep: implications for REM latency and NREM/REM alternation. Sleep. 1992;15(5):400–3.

    CAS  PubMed  Google Scholar 

  18. Werth E, Dijk DJ, Achermann P, Borbely AA. Dynamics of the sleep EEG after an early evening nap: experimental data and simulations. Am J Physiol. 1996;271(3 Pt 2):R501–10.

    CAS  PubMed  Google Scholar 

  19. Bjorvatn B, Pallesen S. A practical approach to circadian rhythm sleep disorders. Sleep Med Rev. 2009;13(1):47–60.

    Article  PubMed  Google Scholar 

  20. Lavie P. Insomnia and sleep-disordered breathing. Sleep Med. 2007;8 Suppl 4:S21–5.

    Article  PubMed  Google Scholar 

  21. Lichstein KL, Justin Thomas S, Woosley JA, Geyer JD. Co-occurring insomnia and obstructive sleep apnea. Sleep Med. 2013;14(9):824–9.

    Article  PubMed  Google Scholar 

  22. Ioachimescu OC, Collop NA. Sleep-disordered breathing. Neurol Clin. 2012;30(4):1095–136.

    Article  PubMed  Google Scholar 

  23. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4(2):101–19.

    Article  PubMed  Google Scholar 

  24. Sun ER, Chen CA, Ho G, Earley CJ, Allen RP. Iron and the restless legs syndrome. Sleep. 1998;21(4):371–7.

    CAS  PubMed  Google Scholar 

  25. Wilt TJ, MacDonald R, Ouellette J, Khawaja IS, Rutks I, Butler M, et al. Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis. JAMA Intern Med. 2013;173(7):496–505.

    Article  CAS  PubMed  Google Scholar 

  26. Hornyak M, Scholz H, Kohnen R, Bengel J, Kassubek J, Trenkwalder C. What treatment works best for restless legs syndrome? Meta-analyses of dopaminergic and non-dopaminergic medications. Sleep Med Rev. 2013;18(2):153–64.

    Article  PubMed  Google Scholar 

  27. Salin-Pascual RJ, Galicia-Polo L, Drucker-Colin R. Sleep changes after 4 consecutive days of venlafaxine administration in normal volunteers. J Clin Psychiatry. 1997;58(8):348–50.

    Article  CAS  PubMed  Google Scholar 

  28. Yang C, White DP, Winkelman JW. Antidepressants and periodic leg movements of sleep. Biol Psychiatry. 2005;58(6):510–4.

    Article  CAS  PubMed  Google Scholar 

  29. Page 2nd RL, Ruscin JM, Bainbridge JL, Brieke AA. Restless legs syndrome induced by escitalopram: case report and review of the literature. Pharmacotherapy. 2008;28(2):271–80.

    Article  CAS  PubMed  Google Scholar 

  30. Rottach KG, Schaner BM, Kirch MH, Zivotofsky AZ, Teufel LM, Gallwitz T, et al. Restless legs syndrome as side effect of second generation antidepressants. J Psychiatr Res. 2008;43(1):70–5.

    Article  PubMed  Google Scholar 

  31. 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 

  32. Wilson S, Argyropoulos S. Antidepressants and sleep: a qualitative review of the literature. Drugs. 2005;65(7):927–47.

    Article  CAS  PubMed  Google Scholar 

  33. Katz DA, McHorney CA. Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med. 1998;158(10):1099–107.

    Article  CAS  PubMed  Google Scholar 

  34. Taylor DJ, Lichstein KL, Durrence HH, Reidel BW, Bush AJ. Epidemiology of insomnia, depression, and anxiety. Sleep. 2005;28(11):1457–64.

    PubMed  Google Scholar 

  35. Mendlewicz J. Sleep disturbances: core symptoms of major depressive disorder rather than associated or comorbid disorders. World J Biol Psychiatry. 2009;10(4):269–75.

    Article  PubMed  Google Scholar 

  36. Tariq SH, Pulisetty S. Pharmacotherapy for insomnia. Clin Geriatr Med. 2008;24(1):93–105. vii.

    Article  PubMed  Google Scholar 

  37. Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res. 2006;40(8):700–8.

    Article  PubMed  Google Scholar 

  38. Viola AU, Brandenberger G, Toussaint M, Bouhours P, Paul Macher J, Luthringer R. Ritanserin, a serotonin-2 receptor antagonist, improves ultradian sleep rhythmicity in young poor sleepers. Clin Neurophysiol. 2002;113(3):429–34.

    Article  CAS  PubMed  Google Scholar 

  39. American Psychiatric Association. Diagnostic and statistical manual of mental health disorders (DSM-IV). Washington, DC: American Psychiatric Press; 1994.

    Google Scholar 

  40. Benca RM, Obermeyer WH, Thisted RA, Gillin JC. Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry. 1992;49(8):651–68. discussion 69–70.

    Article  CAS  PubMed  Google Scholar 

  41. Ohayon MM, Roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003;37(1):9–15.

    Article  PubMed  Google Scholar 

  42. Luthringer R, Toussaint M, Schaltenbrand N, Bailey P, Danjou PH, Hackett D, et al. A double-blind, placebo-controlled evaluation of the effects of orally administered venlafaxine on sleep in inpatients with major depression. Psychopharmacol Bull. 1996;32(4):637–46.

    CAS  PubMed  Google Scholar 

  43. Jindal RD, Friedman ES, Berman SR, Fasiczka AL, Howland RH, Thase ME. Effects of sertraline on sleep architecture in patients with depression. J Clin Psychopharmacol. 2003;23(6):540–8.

    Article  CAS  PubMed  Google Scholar 

  44. Hicks JA, Argyropoulos SV, Rich AS, Nash JR, Bell CJ, Edwards C, et al. Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression. Br J Psychiatry. 2002;180:528–35.

    Article  CAS  PubMed  Google Scholar 

  45. van Bemmel AL, van den Hoofdakker RH, Beersma DG, Bouhuys AL. Changes in sleep polygraphic variables and clinical state in depressed patients during treatment with citalopram. Psychopharmacology (Berl). 1993;113(2):225–30.

    Article  Google Scholar 

  46. Asplund R. Nocturia in relation to sleep, somatic diseases and medical treatment in the elderly. BJU Int. 2003;91(3):302–3.

    Article  CAS  PubMed  Google Scholar 

  47. Schuh-Hofer S, Wodarski R, Pfau DB, Caspani O, Magerl W, Kennedy JD, et al. One night of total sleep deprivation promotes a state of generalized hyperalgesia: a surrogate pain model to study the relationship of insomnia and pain. Pain. 2013;154(9):1613–21.

    Article  PubMed  Google Scholar 

  48. Kundermann B, Spernal J, Huber MT, Krieg JC, Lautenbacher S. Sleep deprivation affects thermal pain thresholds but not somatosensory thresholds in healthy volunteers. Psychosom Med. 2004;66(6):932–7.

    Article  PubMed  Google Scholar 

  49. Onen SH, Alloui A, Gross A, Eschallier A, Dubray C. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 2001;10(1):35–42.

    Article  CAS  PubMed  Google Scholar 

  50. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.

    CAS  PubMed  Google Scholar 

  51. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255–73.

    PubMed  Google Scholar 

  52. Foley DJ, Monjan A, Simonsick EM, Wallace RB, Blazer DG. Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years. Sleep. 1999;22 Suppl 2:S366–72.

    PubMed  Google Scholar 

  53. Neikrug AB, Ancoli-Israel S. Sleep disorders in the older adult - a mini-review. Gerontology. 2010;56(2):181–9.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Gibson EM, Williams 3rd WP, Kriegsfeld LJ. Aging in the circadian system: considerations for health, disease prevention and longevity. Exp Gerontol. 2009;44(1–2):51–6.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Weitzman ED, Moline ML, Czeisler CA, Zimmerman JC. Chronobiology of aging: temperature, sleep-wake rhythms and entrainment. Neurobiol Aging. 1982;3(4):299–309.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Matthew R. Ebben Ph.D. .

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Ebben, M.R., Spielman, A.J. (2014). A Practical Guide to Insomnia Assessment. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_6

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  • DOI: https://doi.org/10.1007/978-1-4939-1185-1_6

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