ABSTRACT
The International Classification of Sleep Disorders Second Edition (ICSD-2) (1) requires both poor sleep and daytime functional compromise for the diagnosis of insomnia. Patients report numerous consequences of their insomnia, and the ICSD-2 lists the following as diagnostically sufficient examples:
Fatigue or malaise Poor attention or concentration Social or vocational dysfunction Mood disturbance Daytime sleepiness Reduced motivation or energy Increased errors or accidents Tension, headache or gastrointestinal symptoms Continuing worry about sleep
Insomnia produces numerous medical, psychological, and economic deficits in addition to changes in subjective state and performance, but only the latter two factors, specifically related to the diagnostic criteria required for a diagnosis of insomnia, will be considered in this chapter. A section reviewing subjective deficits will be followed by a section examining objective deficits.
SUBJECTIVE MOOD AND PERFORMANCE DECREMENTS ASSOCIATED WITH INSOMNIA Medications for sleep have historically been developed to produce efficacy based on decreasing sleep latency or increasing sleep time at night. Mood and performance testing have been conducted primarily to rule out hangover sedation rather than to demonstrate improvement of the daytime symptoms reported by patients. In recent years, however, researchers have realized that successful treatment for insomnia should both improve sleep parameters and reverse the daytime consequences reported by patients (2). Numerous measures have been developed to document subjective deficits in patients with insomnia. Categories that have been measured include mood, anxiety or depression, quality of life, and work-related performance. Sections reviewing significant subjective deficits will be followed by available data showing treatment response.
