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Insomnia – Condition or Symptom of Comorbidity

Insomnia Comorbidities
Insomnia is a symptom that arises from multiple environmental, medical, psychological and mental health disorders.1 A high rate of comorbidities exists between chronic insomnia and medical and psychiatric disorders.2 It is estimated that 10-15% of patients who have chronic insomnia are of primary origin.1 Insomnia that is comorbid with psychiatric disorders, medical disorders, circadian rhythm disorders, or substances or medications accounts for nearly 85-90% of chronic insomnia.1
Comorbid Psychiatric Conditions
Many patients with psychiatric disorders experience chronic insomnia.3 Individuals with insomnia are more than five times as likely to present anxiety or depression.2 Insomnia frequently occurs in people with anxiety, mood, impulse-control and substance use disorders.2 The table below reviews some key information on comorbid psychiatric conditions.
Insomnia is a risk factor for new onset psychiatric disorders, most notably depression, anxiety and substance use disorders.2
Common Comorbid Psychiatric Conditions with Insomnia1-4 | |
---|---|
Mood Disorders |
|
Anxiety Disorders |
|
Schizophrenia |
|
Dementia |
|
Comorbid Physical Disorders
There are a number of medical conditions that are commonly associated with insomnia. The most common comorbid conditions involved chronic pain, gastrointestinal problems, breathing difficulties, heart disease, urinary problems and neurological disorders.4
The table below reviews some of the most common medical comorbidities with insomnia.
Common Medical Comorbid Conditions with Insomnia4–64-6 | |
---|---|
Chronic Pain |
|
Obstructive sleep apnea |
|
Restless leg syndrome |
|
Gastroesophageal reflux disorder (GERD) |
|
Respiratory conditions |
|
Other conditions |
|
Medications can Commonly Worsen Insomnia
It is not only psychiatric and medical conditions associated with insomnia, but also the medications used to manage them. Several common medications such as antidepressants and opioids used for chronic pain are associated with worsening sleep disturbances.3 The table below reviews some of the most common medications associated with insomnia.
Common Medications Associated with Insomnia3 | |
---|---|
Category | Examples |
Antidepressants |
|
Stimulants |
|
Decongestants |
|
Cardiovascular |
|
Bronchodilators |
|
Alcohol |
|
The ideal treatment for the management of insomnia would be to address the patient’s underlying insomnia.
References:
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Reddy MS, Chakrabarty A. “Comorbid” Insomnia. Indian J Psychol Med. 2011;33(1):1-4. doi:10.4103/0253-7176.85388
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Morin CM, Benca R. Chronic insomnia. The Lancet. 24;379(9821):1129-1141. doi:10.1016/S0140-6736(11)60750-2
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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.
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Roth T. Comorbid insomnia: current directions and future challenges. Am J Manag Care. 2009;15 Suppl:S6-13.
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Jank R, Gallee A, Boeckle M, Fiegl S, Pieh C. Chronic Pain and Sleep Disorders in Primary Care. Pain Res Treat. 2017;2017. doi:10.1155/2017/9081802
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Tang NKY. Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Rev Pain. 2008;2(1):2-7. doi:10.1177/204946370800200102