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Epidemiology of Insomnia 17 workers tended to be frequent or habitual users of hypnotic medications more than other surveyed occupations (45). Alcohol, unfortunately, is the most commonly used hypnotic among insomniacs (roughly 15% have reported using alcohol in an attempt to self-medicate) (55,71). The underutilization of proper hypnotic medication is also seen among health care providers treating patients with insomnia. From 1987 to 1996, there was a dramatic shift in the United States toward the use of antidepressants in lieu of hypnotics for the symptomatic treatment of insomnia despite a paucity of data regarding their efficacy and the potential for serious side effects (77). Antidepressants and over-the-counter sleep aids remain the most commonly recommended and prescribed treatments for insomnia complaints (77). Statistics available from Scandinavia (Finland, Norway, and Sweden) suggest that benzodiazepines and nonbenzodiazepine hypnotics (zopiclone, zolpidem, and zaleplon), particularly zopiclone, are the hypnotics of choice in those countries (78). ECONOMIC IMPACT OF INSOMNIA Insomnia costs the US public $92.5 to $107.5 billion annually, in both direct and indirect expenses including medical expenses, ramifications of accidents, and reduced productivity due to absenteeism and decreased work efficiency (79). In France, it has a similar financial impact. According to a recent study, its direct annual cost (i.e., medical expenses including medications and health care), in 1995, was FF 10,232,992,500 ($2,067,271,100 US) (80). In the same year, Walsh and Engelhardt reported a total direct cost of $13.9 billion in the United States (81). CONCLUSION Insomnia is a prevalent complaint in the health care field. It is costly and can cause significant morbidity if not addressed appropriately. Women and the elderly tend to suffer from insomnia more than other groups of the population. Other risk factors include psychosocial stressors, psychiatric and medical problems, low income, unemployment, excessive environmental noise, not having a life partner, job-related stressors, and so on. Patients with insomnia are undertreated and hypnotics are significantly underutilized. Alcohol, unfortunately, remains the most commonly preferred method of self-treatment for insomnia. REFERENCES 1. Mahowald, M. W., Kader, G., and Schenck, C. H. (1997) Clinical categories of sleep disorders I. Continuum 3(4), 35–65. 2. Mellinger, G. D., Balter, M. B., and Uhlenhuth, E. H. (1985) Insomnia and its treatment. Prevalence and correlates. Arch. Gen. Psychiatry 42(3), 225–232. 3. Ohayon, M. (1996) Epidemiological study on insomnia in the general population. Sleep 19(3 Suppl), S7–S15. 4. Leger, D., Guilleminault, C., Dreyfus, J. P., Delahaye, C., and Paillard, M. (2000) Prevalence of insomnia in a survey of 12,778 adults in France. J. Sleep Res. 9(1), 35–42.
18 Attarian 5. Sutton, D. A., Moldofsky, H., and Badley, E. M. (2001) Insomnia and health problems in Canadians. Sleep 24(6), 665–670. 6. Simen, S., Hajak, G., Schlaf, G., et al. (1995) [Chronification of sleep disorders. Results of a representative survey in West Germany]. Nervenarzt 66(9), 686–695. 7. Ishigooka, J., Suzuki, M., Isawa, S., Muraoka, H., Murasaki, M., and Okawa, M. (1999) Epidemiological study on sleep habits and insomnia of new outpatients visiting general hospitals in Japan. Psychiatry Clin. Neurosci. 53(4), 515–522. 8. Kim, K., Uchiyama, M., Okawa, M., Liu, X., and Ogihara, R. (2000) An epidemiological study of insomnia among the Japanese general population. Sleep 23(1), 41–47. 9. Pallesen, S., Nordhus, I.H., Nielsen, G. H., et al. (2001) Prevalence of insomnia in the adult Norwegian population. Sleep 24(7), 771–779. 10. Husby, R. and Lingjaerde, O. (1990) Prevalence of reported sleeplessness in northern Norway in relation to sex, age and season. Acta Psychiatr. Scand. 81(6), 542–547. 11. Zeitlhofer, J., Rieder, A., Kopfhammer, G., et al.(1994) [Epidemiology of sleep disorders in Austria]. Wien Klin Wochenschr. 106(3), 86–88. 12. Ohayon, M. M. and Hong, S. C. (2002) Prevalence of insomnia and associated factors in South Korea. J. Psychosom. Res. 53(1), 593–600. 13. Lopez, A. T., Sanchez, E. G., and Torres, F.G. (1995) Habitos y trastornos del dormir en residentes del area metropolitana de Monterrey. Salud Mental 18, 14–22. 14. Yeo, B. K., Perera, I. S., Kok, L. P., and Tsui, W. F. (1996) Insomnia in the community. Singapore Med. J. 37(3), 282–284. 15. Hyyppa, M. and Kronholm, E. (1987) How does Finland sleep? Sleeping habits of the Finnish adult population and the rehabilitiation of sleep disturbances. Publ. Soc. Ins. Inst. ML(68), 1–110. 16. Dixon, K. N., Monroe, L. J., and Jakim, S. (1981) Insomniac children. Sleep 4(3), 313–318. 17. Archbold, K. H., Pituch, K. J., Panahi, P., and Chervin, R. D. (2002) Symptoms of sleep disturbances among children at two general pediatric clinics. J. Pediatr. 140(1), 97–102. 18. Neveus, T., Cnattinguis, S., Olsson, U., and Hetta, J. (2001) Sleep habits and sleep problems among a community sample of schoolchildren. Acta Paediatr. 90(12), 1450–1455. 19. Liu, X., Sun, Z., Uchiyama, M., Shibui, K., Kim, K., and Okawa, M. (2000) Prevalence and correlates of self-reported sleep problems among Chinese adolescents. Sleep 23(1), 27–34. 20. Ohayon, M. M., Roberts, R. E., Zulley, J., Smirne, S., and Priest, R. G. (2000) Prevalence and patterns of problematic sleep among older adolescents. J. Am. Acad. Child Adolesc. Psychiatry 39(12), 1549–1556. 21. Saarenpaa-Heikkila, O. A., Rintanaka, P. J., Laippala, P. J., and Koivikko, M. J. (1995) Sleep habits and disorders in Finnish schoolchildren. J. Sleep Res. 4(3), 173–182. 22. Tynjala, J., Kannas, L.,and Valimaa, R. (1993) How young Europeans sleep. Health Educ. Res. 8(1), 69–80. 23. Levy, D., Gray-Donald, K., Leech, J., Ziagulis, I., and Pless, I. B. (1986) Sleep patterns and problems in adolescents. J. Adolesc. Health Care 7(6), 386–389. 24. Price, V. A., Coates, T. J., Thoreson, C. E., and Grinstead, O. A. (1978) Prevalence and correlates of poor sleep among adolescents. Am. J. Dis. Child 132(6), 583–586. 25. Kirmil-Gray, K., Eagleston, J., and Gibson, E. (1984) Sleep disturbance in adolescents: sleep quality, sleep habits, beliefs about sleep, and daytime functioning. J. Youth Adolesc. 13, 375–384. 26. Rimpela, A. and Ahlstrom, S. (1983) Health habits among Finnish youth. National Board of Health 71–83. 27. Klink, M. E., Quan, S. F., Kaltenbom, W. T., and Lebowitz, M. D. (1992) Risk factors associated with complaints of insomnia in a general adult population. Influence of previous complaints of insomnia. Arch. Intern. Med. 152(8), 1634–1637. 28. Mitchell, E. S. and Woods, N. F. (1996) Symptom experiences of midlife women: observations from the Seattle Midlife Women’s Health Study. Maturitas 25(1), 1–10. 29. Owens, J. F. and Matthews, K. A. (1998) Sleep disturbance in healthy middle-aged women. Maturitas 30(1), 41–50.
Page 1 and 2: Clinical Handbook of Insomnia Edite
Page 3 and 4: C URRENT CLINICAL NEUROLOGY Daniel
Page 5 and 6: © 2004 Humana Press Inc. 999 River
Page 8: Series Editor’s Introduction The
Page 11 and 12: x Foreword nervous system hypersomn
Page 14 and 15: Contents Series Editor’s Introduc
Page 16: Contributors HRAYR P. ATTARIAN, MD
Page 19 and 20: 2 Attarian et al.
Page 21 and 22: 4 Attarian et al. until the 1970s t
Page 23 and 24: 6 Attarian et al. Table 2 Diagnosti
Page 25 and 26: 8 Attarian et al. Duration of Illne
Page 27 and 28: 10 Attarian et al. REFERENCES 1. Ma
Page 29 and 30: 12 Attarian Another study in Austri
Page 31 and 32: 14 Attarian even less well studied.
Page 33: 16 Attarian communities. A structur
Page 37 and 38: 20 Attarian 53. Kageyama, T., Kabut
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Page 41 and 42: 24 Bonnet and Arand Table 1 Reporte
Page 43 and 44: 26 Bonnet and Arand On the day spen
Page 45 and 46: 28 Bonnet and Arand SUMMARY These m
Page 47 and 48: 30 Bonnet and Arand chronic caffein
Page 49 and 50: 32 Bonnet and Arand response that a
Page 51 and 52: 34 Bonnet and Arand The Development
Page 53 and 54: 36 Bonnet and Arand ACKNOWLEDGMENT
Page 55 and 56: 38 Bonnet and Arand 45. Bonnet, M.
Page 57 and 58: 40 Attarian Table 1 Types of Insomn
Page 59 and 60: 42 Attarian 15 to 40 seconds. PLMs
Page 61 and 62: 44 Fig. 1. Example of a 1-week slee
Page 63 and 64: 46 Fig. 3. One-week printout of an
Page 65 and 66: 48 Attarian Fig. 4. Algorithm. (Use
Page 67 and 68: 50 Attarian 27. Polo-Kantola, P., E
Page 69 and 70: 52 Garcia
Page 71 and 72: 54 Garcia association is known as s
Page 73 and 74: 56 Fig. 1. A sleep log used in chil
Page 75 and 76: 58 Garcia the reality that the tend
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Page 79 and 80: 62 Garcia neurodevelopmental disabi
Page 81 and 82: 64 Garcia 35. Czeisler, C., kronaue
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68 Attarian showed similar degrees
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70 Attarian agitation and hence the
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72 Attarian Affective disorder is s
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74 Attarian and Drug Administration
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76 Fig. 2. Sleep log after treatmen
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78 Attarian 18. Bonnet, M. H. and A
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80 Attarian 65. Perlis, M., Aloia,
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82 Attarian was confirmed by resear
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84 Attarian times worrying about th
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86 Attarian insomnia or for other s
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88 Attarian
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90 Duntley tion systems found that
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92 Duntley Case 1 A 36-year-old fem
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94 Fig. 2. The objective amount of
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96 Duntley PROGNOSIS AND COMPLICATI
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98 Duntley
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100 Attarian EPIDEMIOLOGY There are
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102 Attarian CLINICAL MANIFESTATION
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104 Attarian DIAGNOSTIC WORKUP The
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106 Attarian 13. Hauri, P. J. (1998
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108 Plotkin
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110 Plotkin quality of sleep. Ultim
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112 Plotkin of the therapeutic effi
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114 Plotkin months or years. The ef
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116 Plotkin associated somatic disc
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118 Plotkin Table 1 Causes of Secon
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120 Plotkin Table 1 (continued) Lew
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122 Plotkin REFERENCES 1. Foley, D.
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124 Plotkin 48. Marchetti, F., Rome
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126 Plotkin
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128 Karaz Table 1 DSM-IV Diagnoses
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130 Karaz poor. Focusing only on th
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132 Karaz He felt hopeless that his
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134 Karaz Table 4 Diagnostic Criter
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136 Karaz complained of feeling anx
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138 Karaz other physicians avoided
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140 Karaz 17. Attarian, H. P. (2000
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142 Duntley disorders has been conf
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144 Duntley itance. A recent study
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146 Duntley The patient’s primary
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148 Duntley return to sleep. He tos
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150 Duntley Treatment of RLS should
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152 Duntley 34. Cartwright, R. (197
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154 Perlis et al.
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156 Perlis et al. Fig. 1. A schemat
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158 Perlis et al. ditioned arousal
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160 Perlis et al. subjected to empi
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162 Perlis et al. effect), (3) may
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164 Perlis et al. Cognitive Therapy
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166 Perlis et al. Table 2 Cognitive
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168 Perlis et al. Perhaps more impo
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170 Perlis et al. 28. Carskadon, M.
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172 Perlis et al.
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174 Attarian Secondary Insomnias Re
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176 Attarian 50 years of age who sl
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178 Attarian Antidepressants Becaus
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180 Attarian The use of benzodiazep
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182 Attarian to placebo. Zaleplon a
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184 Attarian 3. Wyatt, R. J., Engel
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186 Attarian residual sedation foll
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188 Index Clonidine, 183 CNS arousa
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190 Index Proton pump inhibitors, 1
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Current Clinical Neurology CLINICAL
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