title: Phenotypes of sleeplessness: stressing the need for psychodiagnostics in the assessment of insomnia.
abstract: Insomnia is a too general term for various subtypes that might have different etiologies and therefore require different types of treatment. In this explorative study we used cluster analysis to distinguish different phenotypes in 218 patients with insomnia, taking into account several factors including sleep variables and characteristics related to personality and psychiatric comorbidity. Three clusters emerged from the analysis. The 'moderate insomnia with low psychopathology'-cluster was characterized by relatively normal personality traits, as well as normal levels of anxiety and depressive symptoms in the presence of moderate insomnia severity. The 'severe insomnia with moderate psychopathology'-cluster showed relatively high scores on the Insomnia Severity Index and scores on the sleep log that were indicative for severe insomnia. Anxiety and depressive symptoms were slightly above the cut-off and they were characterized by below average self-sufficiency and less goal-directed behavior. The 'early onset insomnia with high psychopathology'-cluster showed a much younger age and earlier insomnia onset than the other two groups. Anxiety and depressive symptoms were well above the cut-off score and the group consisted of a higher percentage of subjects with comorbid psychiatric disorders. This cluster showed a 'typical psychiatric' personality profile. Our findings stress the need for psychodiagnostic procedures next to a sleep-related diagnostic approach, especially in the younger insomnia patients. Specific treatment suggestions are given based on the three phenotypes.
authors.affiliation: a Sleep Medicine Centre 'Kempenhaeghe' , Heeze , The Netherlands.
authors.forename: Merijn
authors.initials: M
authors.lastname: van de Laar
authors.affiliation: b Philips Group Innovation - Research , Eindhoven , The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Leufkens
authors.affiliation: b Philips Group Innovation - Research , Eindhoven , The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Bakker
authors.affiliation: a Sleep Medicine Centre 'Kempenhaeghe' , Heeze , The Netherlands.|c Faculty of Medicine and Health Sciences, Department of Internal Medicine , University of Ghent , Ghent , Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Pevernagie
authors.affiliation: a Sleep Medicine Centre 'Kempenhaeghe' , Heeze , The Netherlands.|d Department of industrial design , Eindhoven University of Technology , Eindhoven , The Netherlands.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Overeem
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D002605:Character; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011599:Psychopathology; D012307:Risk Factors; D012649:Self Concept; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Cluster analysis; cognitive behavioural treatment; coping; fatigue; personality