Diagnostic criteria.
It is a condition of unsatisfactory sleep quality mainly due to insomnia, and other symptoms are secondary to insomnia, including difficulty in falling asleep, poor sleep, easy waking, excessive dreaming, early waking, difficulty in falling back asleep after waking, discomfort after waking, fatigue, or daytime sleepiness. Insomnia can cause anxiety, depression, or fear in patients, and lead to decreased efficiency in mental activities and impede social functioning.
Symptom criteria.
1. having insomnia as almost the only symptom, including difficulty in falling asleep, poor sleep, excessive dreaming, early waking, or difficulty in falling back asleep after waking, discomfort after waking, fatigue, or daytime sleepiness, etc.
2. Having the dominant concept of insomnia and extreme concern about the result of insomnia.
Severe criteria: dissatisfaction with the quantity and quality of sleep causes significant distress or impaired social functioning.
Course criteria: occurring at least 3 times a week and for at least 1 month.
Exclusion criteria: exclude secondary insomnia caused by symptoms of somatic diseases or psychiatric disorders.
Note: If insomnia is a component of some somatic disease or mental disorder symptom, it is not diagnosed as insomnia separately.
International Classification of Diseases.
Non-organic insomnia
Insomnia is a condition in which the quality and/or quantity of sleep is unsatisfactory for a significant period of time. In diagnosing insomnia, the length of sleep generally considered normal should not be used as a criterion for deviation, because some people (so-called short sleepers) need only a short period of sleep and do not consider themselves to be insomniacs. On the contrary, some people suffer from poor sleep quality, but their sleep duration is subjectively and/or objectively considered to be in the normal range.
Among insomniacs, difficulty falling asleep is the most common complaint, followed by difficulty maintaining sleep and early awakening. However, these conditions usually coexist in the patient’s complaints. Typically, insomnia occurs at times of increased stress in life and is seen in women, older adults, and people with psychological dysfunction and poor socioeconomic status. If a person has recurrent insomnia, he becomes increasingly fearful of insomnia and overly concerned about its consequences. This creates a vicious cycle that perpetuates the person’s problem.
At bedtime, people with insomnia describe themselves as feeling tense, anxious, worried or depressed, with thoughts racing. They often think too much about how to get enough sleep, personal problems, health conditions, and even death. They often try to deal with their nervousness by using eye medication or drinking alcohol. In the early morning, they often complain of feeling mentally and physically exhausted; during the day, they are characterized by feeling depressed, worried, nervous, irritable and overly preoccupied with themselves.
Diagnostic points.
In order to confirm the diagnosis, the following clinical features are necessary.
1. complaints of either difficulty falling asleep, difficulty maintaining sleep, or poor sleep quality.
2. The sleep disorder occurs at least three times a week and lasts for more than one month.
3. day and night preoccupation with insomnia and excessive concern about the consequences of insomnia.
4. The unsatisfactory quantity or quality of sleep causes significant distress or affects social and occupational functioning.
Whenever qualitative or qualitative dissatisfaction of sleep is the only complaint of the patient, it should be coded here. The presence of other psychiatric symptoms such as depression, anxiety, or obsessions does not negate the diagnosis of insomnia if insomnia is the underlying symptom or if the chronicity and severity of the insomnia is such that the patient views it as the underlying symptom. Other coexisting disorders should also be coded when symptoms are significant and persistent and appropriate treatment is necessary. It should be noted that most insomniacs are usually overly concerned with their sleep disorder and deny the presence of an emotional problem. Therefore, a careful clinical evaluation must be performed before the psychological basis for the complaint of insomnia can be ruled out.
Insomnia is a common symptom in other psychiatric disorders, such as affective, neurotic, organic and eating disorders, psychoactive substance-induced psychosis. Schizophrenia and other sleep disorders such as dream demons. Insomnia can also be accompanied by somatic disorders, lying down; with pain, discomfort or when taking certain medications. If insomnia is only one of multiple symptoms of a particular mental disorder or somatic condition, i.e. it does not predominate in the clinical phase, then the diagnosis should be limited to the main mental or somatic disorder. In addition, other sleep disorders such as nightmares, sleep-wake rhythm disorders, sleep apnea and nocturnal myoclonus can establish the diagnosis only if they result in a quantitative or qualitative decrease in sleep.