Insomnia: Diagnosis and Treatment PDF

Preface

As the field of sleep medicine has matured in recent decades, it has become increasingly apparent that disruption or failure of normal sleep function, not unlike failure of other essential physiologic functions, has sweeping adverse consequences. Chronic insomnia is arguably the most common form of sleep disruption, although its significance as a serious health problem has been, and continues to be, largely overlooked. Much of this neglect seems to arise from the tacit assumption that this condition is, in effect, more a benign existential problem than a disorder deserving serious medical attention. Yet, investigations of chronic insomnia over the past 20 years underscore the importance of addressing this issue as a component of the patient's overall health care. Not only is it clear that chronic insomnia is associated with impairments in quality of life and function, comparable to those seen in disorders such as major depression and congestive heart failure, but emerging data also indicate that insomnia may be a significant risk factor for development of major psychiatric and possibly medical disorders. The availability of effective therapies that can produce clinically meaningful and durable improvement or resolution of symptoms lends further weight to the importance of identifying insomnia.

Although a small and dedicated group of sleep researchers and clinicians have made significant strides in addressing this problem, an enormous knowledge and awareness gap exists among most health care providers with respect to insomnia. Although we have made substantial efforts to address this through educational means, clearly the work has only begun. A necessary foundation of sound educational efforts is a detailed, accessible body of knowledge that addresses the pathophysiology, evaluation, and treatment of the disorder. Although many excellent books have been published on insomnia, somewhat surprisingly, there have been only limited efforts to produce a comprehensive reference text in this area. Our hope is that this volume will help to meet this need.

Insomnia is relevant to virtually all aspects of medicine. For this reason, researchers and clinicians from all fields must have access to detailed information. The subject matter of this book will certainly be of considerable interest and importance to all sleep medicine clinicians. However, its relevance and utility should extend well beyond this audience. As data increasingly underscore the important and complex interaction between insomnia and mental illness, it is incumbent upon psychiatrists, psychologists, and other mental health workers to not only identify but also actively intervene when chronic insomnia complicates psychiatric disease. Although the evidence that compels effective management of insomnia in comorbid medical and neurological disease is not yet as well developed as that for mental illness, there is, nonetheless, ample basis for internists, family practice physicians, neurologists, and other specialists to appreciate the significant role that insomnia may play in the pathogenesis and maintenance of physical illnesses.

The past 20 years have seen enormous progress in our understanding of the nature and characteristics of chronic insomnia and in our ability to accurately assess and effectively treat the problem. These advances have profoundly affected our view of chronic insomnia—most importantly, transitioning its position from that of "secondary" symptom of other disorders to a condition comorbid with other disorders. This paradigm shift is important because most chronic insomnia is, in fact, comorbid with other medical or psychiatric disease. This perspective suggests that chronic insomnia exhibits its own unique and somewhat independent pathophysiology, which is not only influenced by comorbid disorders but also, in turn, has major influence on those disorders.

This book is intended to provide the reader with a comprehensive and detailed overview of the current research and state-of-the-art practice parameters related to insomnia in three parts. The first section, Fundamentals, addresses the characteristics and consequences of chronic insomnia and, in effect, speaks about the nature of the disorder and the question of why it deserves medical attention. The Evaluation section provides the clinician with a detailed description of causes and comorbidities and offers clinicians specific guidelines and tools for evaluating the disorder in its varied and often complex presentations. Finally, the section on Management represents what we believe to be the most detailed and comprehensive description of treatment modalities for chronic insomnia that is currently available. Each of the chapters in this book is authored by recognized experts in the field whose research and writing have collectively defined this area of sleep medicine.

In the modern era, medicine has moved progressively toward a multideterminant model of causation of disease and multimodal treatment. It has become increasingly apparent that sleep is one of the critical determinants of health and well-being. It is no longer possible for researchers to effectively study disease or clinicians to effectively treat it without considering the potential role of sleep and circadian factors. We believe that this comprehensive volume will serve to stimulate interest and further inquiry in this area by scientists and clinicians from many fields, and will provide practitioners with a guide for the management of this common malady.

We welcome your thoughts, comments, and suggestions on the text to help us prepare for the Second Edition.