Insomnia

We define insomnia as difficulty initiating sleep, difficulty in maintaining sleep, and/or early morning awakening, resulting in a sleep deficiency despite adequate opportunity for sleep and no change in the patient’s baseline “need for sleep.” Insomnia, therefore, is a symptom, reported in a patient’s history, and there is no standard objective measure of insomnia through polysomnography (PSG) or other means. The routine use of PSG alone to evaluate insomnia is not recommended, but it is important to note that a patient’s sleep report and objective data may not always agree, and the misperception of sleep quality or quantity may be an issue (Kryger, Roth, Dement. Elsevier, 2017). This chapter also endeavors to isolate sleep disruption as the primary symptom of focus, while definitions of insomnia as a disorder often describe secondary effects and impact on daytime functioning. Given the complexity of insomnia as a symptom, we discuss these secondary effects to some degree, but mainly to clarify the primary issue of sleep disturbance.