title: Insomnia disorder.
abstract: Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.
authors.affiliation: Université Laval, École de psychologie, 2325 rue des Bibliothèques, Québec City, Québec G1V 0A6, Canada.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Morin
authors.affiliation: Henry Ford Hospital Sleep Disorders and Research Center, Detroit, Michigan, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Drake
authors.affiliation: Department of Psychology, University of California, Berkeley, Berkeley, California, USA.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Harvey
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krystal
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.affiliation: Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Riemann
authors.affiliation: Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Spiegelhalder
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D003863:Depression / Q000523:psychology; D006801:Humans; D010146:Pain / Q000523:psychology; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology* / Q000628:therapy; D013315:Stress, Psychological / Q000523:psychology