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Insomnia Disorder
Brittany Webber
What is Insomnia?
S Most prevalent of the sleep disorders
S Insomnia is a condition in which you have trouble falling or staying
asleep. Some people with insomnia may fall asleep easily but
wake up too soon. Other people may have the opposite problem,
or they have trouble with both falling asleep and staying asleep.
The end result is poor-quality sleep that doesnt leave you feeling
refreshed when you wake up.
S It is an important public health problem that requires accurate
diagnosis and effective treatment

Symptoms
S Insomnia commonly interferes with personal relationships, job
performance, and daily functioning, and is associated with the
following symptoms:
S Difficulty falling or staying asleep
S Nonrestorative sleepindividuals feel that sleep is not refreshing or
of poor quality
S Daytime fatigue and/or sleepiness
S Difficulty concentrating and remembering
S Changes in moodirritability, anxiety, depression
S Reduced motivation and energy

Risk Factors
S Anyone can have an occasional sleepless night, but the
following factors may increase the chance for developing
insomnia:
S Gender female
S Age older than 60 years
S Mental and medical disorders
S Stress
S Night shift at work/Rotating shifts
S Traveling/Time Zones
Diagnosis
*Blood or urine tests
*Sleep loga record
of your actual sleep
habits and sleep
patterns over 7 to 14
days
*Sleep study
(polysomnography)
an overnight test
to diagnose
DSM 5 Criteria
S A. A predominant complaint of dissatisfaction with sleep quantity or quality,
associated with one (or more) of the following symptoms:
S 1. Difficulty initiating sleep (In children, this may manifest as difficulty initiating
sleep without caregiver intervention)
S 2. Difficulty maintaining sleep, characterized by frequent awakenings or
problems returning to sleep after awakenings (In children, this may manifest as
difficulty returning to sleep without caregiver intervention)
S 3. Early-morning awakening with inability to return to sleep
S B. The sleep disturbance causes clinically significant distress or impairment in
social, occupational, educational, academic, behavioral, or other important
areas of functioning
S C. The sleep difficulty occurs at least 3 nights per week
S D. The sleep difficulty is present for at least 3 months
DSM 5 Criteria Continued
S E. The sleep difficulty occurs despite adequate opportunity for
sleep
S F. The insomnia is not better explained by and does not occur
exclusively during the course of another sleep-wake disorder
(narcolepsy, a breathing-related sleep disorder, a circadian
rhythm sleep-wake disorder, a parasomnia)
S G. The insomnia is not attributable to the physiological effects
of a substance
S H. Coexisting disorders and medical conditions do not
adequately explain the predominant complaint of insomnia
The Vicious Cycle of Insomnia
Assessments
S Polysomnography (sleep study) records your brain
waves, the oxygen level in your blood, heart rate and
breathing, as well as eye and leg movements
S Insomnia Screening Questionnaires
S Insomnia Severity Index
S Fatigue Severity Scale
S Sleep logs
Algorithm for the Evaluation of
Chronic Insomnia
Ethical Considerations
S Increased risk for suicide and depression
S Therapists should be alert to the possible individual and
societal risks (such as self-medication)
S Ethical Boundaries
S Ethical Principles: Beneficience, Nonmalficience
Treatment
S Cognitive Behavioral Therapy
S Stimulus control, sleep restriction, sleep hygiene, relaxation
training, cognitive therapy
S Biofeedback
S Patient is taught to respond to auditory/visual cues by
engaging in relaxation exercises or guided imagery
S Mindfulness meditation
S http://www.youtube.com/watch?v=cRCODpFfTG4
Cultural Considerations
S Sleep differences/patterns within cultures
S Susto a cultural-bound syndrome, witnessing a
traumatic event, primarily among Latin-American cultures
may involve insomnia
S Reasons for therapy may vary depending on
culture/religion
Resources
S Sleep Disorders Center JFK Medical Center
S Atlantis, FL (561) 965-7300
S Sleep Disorders Center Good Samaritan Medical
Center
S West Palm Beach, FL (561) 650-6023
S Sleep & Fatigue Treatment Center
S Delray Beach, FL (561) 450-8328


References
S Adult Insomnia: Assessment to Diagnosis (2007) Retrieved from
http://www.centreforsleep.com/assets/images/pdf/insomnia_assessment_guideline07.pdf
S American Psychiatric Association (2013). Diagnostic and statistical manual of mental
disorders (5
th
ed). Arlington, VA. American Psychiatric Association.
S American Sleep Association (2007) Retrieved from
http://www.sleepassociation.org/index.php?p=aboutinsomnia
S Helpguide.org Retrieved from http://www.helpguide.org/life/insomnia_treatment.htm
S Journal of Clinical Sleep Medicine (2008) Retrieved from
http://www.aasmnet.org/Resources/clinicalguidelines/040515.pdf
S The Journal of the American Medical Association (2013) Retrieved from
http://jama.jamanetwork.com.southuniversity.libproxy.edmc.edu//article.aspx?articleid=165
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