Insomnia with Short Sleep Duration: Nosological, Diagnostic, and Treatment Implications

Overview

Journal Sleep Med Clin

Publisher Elsevier

Specialty Psychiatry

Date 2013 Sep 28

PMID 24072989

Citations 31

Authors

Alexandros N Vgontzas

Julio Fernandez-Mendoza

Affiliations

Soon will be listed here.

Abstract

The diagnosis of insomnia is based solely on subjective complaints. This has contributed to the low reliability and validity of the current nosology of insomnia as well as to its lack of firm association with clinically relevant outcomes such as cardiometabolic and neurocognitive morbidity. We review evidence that insomnia with objective short sleep duration is associated with physiological hyperarousal, higher risk for hypertension, diabetes, neurocognitive impairment, and mortality as well as with a persistent course. It also appears that objective short sleep duration in poor sleepers is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of physiological hyperarousal or medical complications. Thus, short sleep duration in insomnia may be a reliable marker of the biological severity and medical impact of the disorder. We propose that (a) objective measures of sleep be included in the diagnosis of insomnia and its subtypes, (b) objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment and diagnosis of insomnia in a clinician's office setting, and (c) insomnia with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.

Citing Articles

2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association.

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Daytime autonomic nervous system functions differ among adults with and without insomnia symptoms.

McCall W, Looney S, Zulfiqar M, Ketcham E, Jones M, Mixson C J Clin Sleep Med. 2023; 19(11):1885-1893.

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Animal models of human insomnia.

Fernandez F, Perlis M J Sleep Res. 2023; 32(6):e13845.

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Association of insomnia and short sleep duration, alone or with comorbid obstructive sleep apnea, and the risk of chronic kidney disease.

Beaudin A, Raneri J, Ahmed S, Hirsch Allen A, Nocon A, Gomes T Sleep. 2022; 45(7).

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The relationship between the HDRS insomnia items and polysomnographic (PSG) measures in individuals with treatment-resistant depression.

Hejazi N, Farmer C, Oppenheimer M, Falodun T, Park L, Duncan Jr W J Psychiatr Res. 2022; 148:27-33.

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