title: The daytime impact of DSM-5 insomnia disorder: comparative analysis of insomnia subtypes from the Great British Sleep Survey.
abstract: OBJECTIVE
  To profile the daytime impact of the proposed DSM-5 insomnia disorder diagnosis, with and without mental health, physical health, or other sleep disorder comorbidities; to better understand how specific daytime symptom patterns are associated with nighttime sleep in insomnia; and to compare childhood-onset and adulthood-onset insomnia disorder with respect to daytime dysfunction.
  
  
  METHODS
  Data were derived from the Great British Sleep Survey (GBSS), an open-access online population survey completed by adults who had a valid postcode and were residents of the United Kingdom. The primary variables of interest were the 6 areas that, according to the proposed DSM-5 criteria, may be impacted in the daytime by insomnia disorder: energy, concentration, relationships, ability to stay awake, mood, and ability to get through work. These variables were compared for those with versus those without insomnia disorder and across 5 insomnia subtypes (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, a combination of these 3 core symptoms, or nonrestorative sleep). Clinically comorbid insomnia presentations (insomnia disorder with poor mental health/poor physical health/additional sleep disorder symptoms) and insomnia disorder of childhood versus adult onset were also evaluated.
  
  
  RESULTS
  A total of 11,129 participants (72% female; mean age = 39 years) completed the GBSS between March 2010 and April 2011, of whom 5,083 screened as having possible insomnia disorder. Compared with those who did not have insomnia disorder, those with insomnia disorder reported greater impairment in all areas of daytime functioning (Cohen d range, 0.68-1.30). The greatest effects reflected negative impact on energy and mood. Participants with a combination of insomnia symptoms tended to be the most impaired (Cohen d range, 0.10-0.23), whereas no consistent differences emerged between the other 4 subtypes. Finally, individuals who had both insomnia disorder and poor mental health were consistently the most impaired comorbid group (Cohen d range, 0.15-0.65), and childhood-onset insomnia disorder had greater daytime impact than adult-onset insomnia disorder (P < .05 for energy; P < .01 for mood, concentration, and getting through work).
  
  
  CONCLUSIONS
  The severity of daytime impact of DSM-5 insomnia disorder varies by insomnia type. This finding has implications for the evaluation and management of insomnia in clinical practice.
authors.affiliation: University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research and Institute of Neuroscience & Psychology, College of Medical, Veterinary & Life Sciences, University of Glasgow, G51 4TF, Scotland. colin.espie@glasgow.ac.uk
authors.forename: Colin A
authors.initials: CA
authors.lastname: Espie
authors.forename: Simon D
authors.initials: SD
authors.lastname: Kyle
authors.forename: Peter
authors.initials: P
authors.lastname: Hames
authors.forename: Eva
authors.initials: E
authors.lastname: Cyhlarova
authors.forename: Michaela
authors.initials: M
authors.lastname: Benzeval
mesh_terms: D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000328:Adult; D000339:Affect; D017668:Age of Onset; D002648:Child; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D006970:Disorders of Excessive Somnolence / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D020407:Internet; D007398:Interpersonal Relations; D008297:Male; D011788:Quality of Life / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006113:United Kingdom; D014851:Wakefulness