Insomnia Assessment

Sleep Disorders are Very Common in Canadians

Almost every adult has experienced short-term sleep issues. For most of these individuals this is a temporary issue related to issues with stress, changes in daily life and or work-related issues. For these people, sleep issues will commonly improve with time and don’t require any interventions.

It is estimated that approximately 40% of Canadians experience at least one symptom of insomnia (i.e. difficulty falling or staying asleep or early morning awakening) for a minimum of 3 nights per week in the previous month.1 Approximately 20% of these individuals were dissatisfied with their sleep, and over 13% met all criteria for insomnia (that is, presence of 1 insomnia symptom 3 nights or more per week for at least 1 month, accompanied by distress or daytime impairment).1

Only 13% of surveyed Canadians discussed sleep difficulties with a healthcare provider.

Insomnia Risk Factors

Insomnia occurs in individuals of all ages and races and has been observed across all cultures and countries.2 Consistent risk factors for insomnia include:2

  • Increasing age

  • Female sex

  • Comorbid (medical, psychiatric, sleep, and substance use) disorders

  • Shift work

  • Possibly unemployment and lower socioeconomic status

Insomnia is a Public Health Problem

Insomnia causes a burden to both the individual and society in general.2 Affected people with chronic insomnia have daytime impairment of cognition, mood, or performance that impacts the person and potentially family, friends, coworkers and caretakers.2 Chronic insomnia patients are more likely to use health care resources, visit physicians, be absent or late for work, make errors or have accidents at work, and have more serious road accidents.2 Increased risk for suicide, substance use relapse, and possible immune dysfunction have been reported.2

Clinical Presentation of Insomnia

The table below reviews some of the most common symptoms of insomnia. These include both sleep symptoms as well as daytime impairment.

Many patients with insomnia will present with symptoms of other comorbid conditions (e.g. chronic pain, depression)

Common Clinical Presentation of Chronic Insomnia3
Sleep Symptoms Daytime Symptoms
  • Dissatisfaction with sleep quality or duration

  • Difficulty falling asleep at bedtime

  • Waking up in the middle of the night or too early in the morning

Non-restorative or poor-quality sleep
  • Fatigue or low energy

  • Difficulties with cognitive functions (e.g. attention, concentration, and memory)

  • Mood disturbances (e.g. irritability, dysphoria)

  • Functional impairments

Sleep Assessment

The assessment of a patient with sleep disorders involves a detailed history as well as a physical and mental status evaluation.4 The table below reviews some of the key components of the history for patients with insomnia. The physical and mental status evaluation is to rule out other potential comorbid conditions associated with insomnia such as chronic pain, obstructive sleep apnea, and many mental health conditions.4

Detailed Sleep History4
Primary Insomnia Complaint
  • Characterization of Complaint(s):

    • Difficulty falling asleep

    • Awakenings

    • Poor or unrefreshing sleep

  • Onset

  • Duration

  • Frequency

  • Severity

  • Course

  • Perpetuating factors

  • Past and current treatments and responses

Pre-sleep Conditions
  • Pre-bedtime activities

  • Bedroom environment

  • Evening physical and mental status

Sleep-Wake Schedule (Average, variability)
  • Bedtime

  • Time to fall asleep

    • Factors prolonging sleep onset

    • Factors shortening sleep

  • Awakenings

    • number,characterization, duration;

    • associated symptoms

    • associated behaviours

  • Final awakening versus Time out of bed

  • Amount of sleep obtained

Daytime Activities and Function
  • Identify sleepiness versus fatigue

  • Napping

  • Work

  • Lifestyle

  • Travel

  • Daytime consequences

    • Quality of Life

    • Mood disturbance

    • Cognitive dysfunction

    • Exacerbation of comorbid conditions

References:
  1. Morin CM, LeBlanc M, Bélanger L, Ivers H, Mérette C, Savard J. Prevalence of Insomnia and its Treatment in Canada. The Canadian Journal of Psychiatry. 2011;56(9):540-548. doi:10.1177/070674371105600905

  2. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008;4(5):487-504.

  3. Morin CM, Benca R. Chronic insomnia. The Lancet. 24;379(9821):1129-1141. doi:10.1016/S0140-6736(11)60750-2

  4. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008;4(5):487-504.