The Prevalence of Insomnia Subtypes in Relation to Demographic Characteristics, Anxiety, Depression, Alcohol Consumption and Use of Hypnotics

Abstract

The aim of the present study was to examine the prevalence of insomnia subtypes in relation to several demographic characteristics, as well as to investigate the prevalence of possible anxiety and depression, alcohol consumption and use of hypnotics within the different insomnia subtypes. Methods:The present study was based on an extensive web-based survey made publicly available in 2012. The data was downloaded in January 2019, after 113 887 people had responded to parts of, or the entire questionnaire. The 64 503 participants who met the criteria for chronic insomnia disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) comprised the study population. The present study divided insomnia into seven subtypes based on type of sleep difficulty reported; sleep onset insomnia (SOL-insomnia), sleep maintenance insomnia (WASO-insomnia), early morning awakening insomnia (EMA-insomnia) and combinations of these. Data were analyzed with chi-square tests and logistic regression analyses adjusted for sex, age, level of education and marital status.Results: More than 60% of the study population met the criteria of either SOLinsomnia or a mixed insomnia subtype consisting of SOL-, WASO-and EMA-insomnia (SOL + WASO + EMA-insomnia). The percentage distribution of insomnia subtypes within the demographic characteristics showed that participants with female sex, high age, low level of education and who were divorced, separated or a widow/widower had a higher prevalence of SOL + WASO + EMA-insomnia compared to their respective demographic counterparts. The prevalence of possible anxiety, possible depression and use of hypnotics were higher among participants with SOL + WASO + EMAinsomnia compared to the other insomnia subtypes. The combination of WASOand EMA-insomnia (WASO + EMA-insomnia) was associated with the most frequent alcohol consumption.

Number of Chronic Nighttime Insomnia Symptoms and Risk of Chronic Widespread Pain and Pain-Related Disability: The HUNT Study

“…This is in line with the view that symptoms in all phases of the sleep period (i.e., difficulty initiating sleep, trouble maintaining sleep, and early morning awakenings) are the most severe insomnia subtype, 30 influencing daily functioning such as energy and mood. 9 , 30 Our finding has important clinical implications, suggesting that reducing the severity of insomnia symptoms in people with chronic insomnia could be an important strategy towards the prevention of chronic pain and pain-related disability. However, further investigations are needed to establish whether it is the number of nighttime symptoms per se that impose an increased risk or if these associations are modified by certain combinations of nighttime symptoms.…”

“…Although speculative, it is possible that poor sleep maintenance is the most troublesome symptom when it comes to pain, 15 , 16 , 36 and that problems with initiating sleep and/or early awakening are related to other characteristics such as age, gender and comorbid conditions (eg, mental health, use of hypnotics). 9 However, further investigations are required to disentangle whether the development of chronic and disabling pain depends on the specific type and duration of the nighttime symptoms. So far, the processes linking insomnia and chronic musculoskeletal pain may be conceptualized through a framework of interconnected processes including immune responses, neurobiological changes, and altered cognitive and emotional pain processing.…”

“…However, due to the limited number of cases of CWP and pain-related disability at follow-up we could not classify participants into insomnia subtypes based on specific combinations of nighttime insomnia symptoms as suggested in a recent study. 9 Unfortunately, we had no information on objectively measured sleep duration or sleep quality, nor did we have any information about pain intensity. Moreover, we could not stratify our analyses by gender, age, or other potential effect modifiers.…”

“… 7 This heterogeneity has led to the view that insomnia is a complex disorder and that several insomnia phenotypes with different disease burden may co-exist. 8 , 9 …”

Insomnia – A Heterogenic Disorder Often Comorbid With Psychological and Somatic Disorders and Diseases: A Narrative Review With Focus on Diagnostic and Treatment Challenges

“…Insomnia subtypes may also be based on consistency (persistent, remission, relapse) ( Wu et al, 2014 ). In clinical practice, the most commonly used subdivision is related to when in the main sleep period (at sleep onset, during the sleep period, or in the morning) the insomnia symptoms occur ( Yokoyama et al, 2010 ; Bjoroy et al, 2020 ). In a recent population-based study with more than 60,000 participants, it was shown that the symptoms of anxiety and depression, and hypnotic use, were higher among participants with insomnia consisting of a combination of sleep onset, sleep maintenance, and early morning awakening problems as compared to participants with other insomnia subtypes (e.g., insomnia with pure sleep onset or sleep maintenance problems) ( Bjoroy et al, 2020 ).…”