Persistent insomnia symptom risk high

Jan 13 2014

By Lucy Piper, Senior medwireNews Reporter

Insomnia symptoms are often persistent, report researchers who found that targeting sleep-interfering behaviors may be one method of prevention.

The team estimates that only one-third of individuals with insomnia will experience spontaneous remission of their symptoms over a 4-year period.

Engaging in sleep-interfering behaviors was one of the primary risk factors associated with persistence, note the researchers.

“This finding raises the intriguing possibility that behavioral treatments that directly target sleep interfering behaviors, such as those taught in the course of cognitive behavioral therapy for insomnia (CBT-I), might be an effective preventative intervention,” says the team, led by Rachel Manber (Stanford University, Palo Alto, California, USA) and Chol Shin (Korea University Ansan Hospital).

“The public health impact of such an intervention could be high, given that persistent insomnia symptoms was associated with higher depression scores and lower physical or mental health QoL [quality of life].”

The researchers assessed insomnia symptoms in 1247 individuals, aged an average of 54 years, using a 4-point Likert scale on which they rated difficulty initiating sleep, difficulty maintaining sleep, and experience of early morning awakenings and not feeling refreshed in the morning.

Of these individuals, 316 (25.3%) were classified as having insomnia symptoms at baseline due to experiencing at least one of the four symptoms (defined as score ≥3) more than three to four times a week.

Persistent insomnia was the most common course for patients with insomnia at baseline, with 35.4% continuing to experience symptoms at a further two time points measured 2 years apart.

Patients at highest risk for persistent insomnia symptoms were those who had poor baseline sleep quality on the Pittsburgh Sleep Quality Index (≥9 points), frequently endorsed engaging in sleep-interfering behaviors on the Sleep Behavior Scale (≥18 points), and reported low mental health QoL on the mental composite summary of the 12-item Short-Form health survey (<54 points).

Thirty-one (64.6%) of the patients with persistent insomnia met all three of these risk factors, while just 5.2% met none of them.

“This finding highlights the importance of addressing multiple risk factors in preventing transient sleep disturbance from turning into persistent insomnia,” Manber and Shin write in Sleep Medicine.

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