Daytime symptom patterns in insomnia sufferers: is there evidence for subtyping insomnia?

Abstract

Summary The type and severity of daytime symptoms reported by insomnia sufferers may vary markedly. Whether distinctive daytime symptom profiles are related to different insomnia diagnoses has not been studied previously. Using profile analysis via multidimensional scaling, we investigated the concurrent validity of ICSD‐2 insomnia diagnoses by analysing the relationship of prototypical profiles of daytime symptoms with a subset of ICSD‐2 diagnoses, such as insomnia associated to a mental disorder, psychophisiological insomnia, paradoxical insomnia, inadequate sleep hygiene, idiopathic insomnia, obstructive sleep apnea and restless legs syndrome. In a sample of 332 individuals meeting research diagnostic criteria for insomnia (221 women, Mage = 46 years.), the profile analysis identified four prototypical patterns of daytime features. Pearson correlation coefficients indicated that the diagnoses of insomnia associated to a mental disorder and idiopathic insomnia were associated with a daytime profile characterized by mood disturbance and low sleepiness; whereas the diagnoses of psychophysiological insomnia and inadequate sleep hygiene were related to a profile marked by poor sleep hygiene, daytime tension and low fatigue. Furthermore, whereas paradoxical insomnia was consistently associated to lower daytime impairment, insomnia associated to a mental disorder appeared as the most severe daytime form of insomnia. This classification of insomnia sufferers along multiple defining dimensions provides initial validation for two basic insomnia subtypes, with a presumably distinct aetiology: insomnia characterized mainly by an ‘internal’ component, and a ‘learned’ insomnia. Research to determine which dimensions are critical for inclusion or differential weighting for defining a general typological system for insomnia sufferers is warranted.

Gender and cognitive–emotional factors as predictors of pre-sleep arousal and trait hyperarousal in insomnia

“…First, the association between negative affect and both state and trait hyperarousal is consistent with the findings on the importance of emotional valence in insomnia (30–34,36,38). Interestingly, positive affect was associated with the HAS, suggesting that elevations on both valences of affect are related to trait hyperarousal.…”

“…Recent work has attempted to classify subtypes of insomnia based on symptom constellations, including negative emotion. Psychophysiological insomnia diagnostic traits trended toward a pro le marked by negative affect (38). …”

The impact of headache and chronic musculoskeletal complaints on the risk of insomnia: longitudinal data from the Nord-Trøndelag health study

“…However, there are conflicting results regarding the association between insomnia and subjective daytime sleepiness [32]. Further, as the daytime consequences vary between different insomnia subtypes [33], and even from person to person [34], it is unlikely that one question could capture all individuals with insomnia causing daytime impairment [34]. The insomnia diagnosis in HUNT 2 is also different from the DSM-IV criteria in another aspect, as the questionnaire did not include information about the insomnia symptoms beyond one month.…”

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

“…There have been previous attempts to identify nighttime and daytime symptom cluster profiles in patients with insomnia disorder using data-driven approaches. [8][9][10][11][12][13] Similar attempts have been published characterizing the heterogeneity of obstructive sleep apnea. 14,15 However, most of these studies used cluster analysis to characterize this heterogeneity.…”