Fast Five Quiz: Sleep Disorders

Helmi L. Lutsep, MD; Zab Mosenifar, MD; Stephen Soreff, MD


August 03, 2020

Many clinicians assume that insomnia is often secondary to a psychiatric disorder. Although psychiatric disorders are the most common comorbidities associated with insomnia, they are present in less than half (40%) of all cases. A diagnosis of insomnia does increase the future risk for depression or anxiety. However, insomnia is often secondary to other disorders or conditions or caused by primary sleep disorders, such as obstructive sleep apnea, restless legs syndrome, or circadian rhythm disorders.

Common daytime effects in patients with insomnia are as follows:

  • Fatigue

  • Tiredness

  • Lack of energy

  • Irritability

  • Reduced work performance

  • Difficulty concentrating

These effects should be distinguished from EDS, which is uncommon in insomnia. If a patient is experiencing EDS (ie, Epworth Sleepiness Scale Score >10), another sleep disorder should also be considered.

According to American Academy of Sleep Medicine (AASM) guidelines, actigraphy is indicated as an approach to characterize circadian rhythm patterns or sleep disturbances in patients with insomnia, including those with depression. Actigraphy is a noninvasive technique used to assess cycles of activity and rest over several days to several weeks. An actigraph is worn like a watch on the wrist of the nondominant hand and measures activity through light and movement, allowing continuous recording for days, weeks, or longer. Although it is not indicated for routine diagnosis of sleep disorders or for assessment of severity, actigraphy may be useful as an adjunct in diagnosing insomnia, EDS, or circadian rhythm disorders.

CBT can be used to ameliorate factors that perpetuate or exacerbate chronic insomnia, such as poor sleep habits, hyperarousal, irregular sleep schedules, inadequate sleep hygiene, and misconceptions about sleep. CBT is most effective for primary insomnia, but it is also effective for comorbid insomnia as adjunctive therapy. The AASM evidence-based practice parameter found that CBT (all components), as well as individual components of stimulus-control, paradoxical intention, relaxation training, and biofeedback, were effective.

A study by Buysse and colleagues determined that brief behavioral treatment for insomnia is a simple, efficacious, and durable intervention for chronic insomnia in older adults. The treatment consisted of behavioral instructions delivered in two intervention sessions and two telephone calls.

Read more clinical information about insomnia.


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