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Predisposition in the Evolution of Insomnia: Evidence, Potential Mechanisms, and Future Directions

  • Christopher L. Drake
    Correspondence
    Corresponding author. Sleep Disorders and Research Center, Henry Ford Hospital CFP3, 2799 West Grand Boulevard, Detroit, MI 48202.
    Affiliations
    Sleep Disorders and Research Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA

    Department of Psychiatry and Behavioral Neurosciences, Wayne State College of Medicine, 2751 E. Jefferson, Detroit, MI 48207, USA
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  • Thomas Roth
    Affiliations
    Sleep Disorders and Research Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA

    Department of Psychiatry and Behavioral Neurosciences, Wayne State College of Medicine, 2751 E. Jefferson, Detroit, MI 48207, USA
    Search for articles by this author
      The prevalence of chronic insomnia has been estimated to be between 10% and 15% [
      • Ford D.E.
      • Kamerow D.B.
      Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?.
      ,
      • Ohayon M.M.
      Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders.
      ]. Studies that have assessed insomnia incidence have found rates of 3% to 5% per year [
      • Breslau N.
      • Roth T.
      • Rosenthal L.
      • et al.
      Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.
      ,
      • Morgan K.
      Daytime activity and risk factors for late-life insomnia.
      ,
      • Foley D.J.
      • Monjan A.
      • Simonsick E.M.
      • et al.
      Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years.
      ,
      • Quan S.F.
      • Katz R.
      • Olson J.
      • et al.
      Factors associated with incidence and persistence of symptoms of disturbed sleep in an elderly cohort: the Cardiovascular Health Study.
      ]. The morbidity associated with this disorder is now well established. Insomnia has been shown to be a significant risk factor for the development of major depression in several prospective studies [
      • Ford D.E.
      • Kamerow D.B.
      Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?.
      ,
      • Breslau N.
      • Roth T.
      • Rosenthal L.
      • et al.
      Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.
      ,
      • Chang P.P.
      • Ford D.E.
      • Mead L.A.
      • et al.
      Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study.
      ,
      • Perlis M.L.
      • Giles D.E.
      • Buysse D.J.
      • et al.
      Self-reported sleep disturbance as a prodromal symptom in recurrent depression.
      ], and there are now data suggesting that treatment of insomnia significantly augments antidepressant therapy [
      • Fava M.
      • McCall W.V.
      • Krystal A.
      • et al.
      Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder.
      ]. Industrial accidents [
      • Leger D.
      • Guilleminault C.
      • Bader G.
      • et al.
      Medical and socio-professional impact of insomnia.
      ], absenteeism [
      • Godet-Cayre V.
      • Pelletier-Fleury N.
      • Le Vaillant M.
      • et al.
      Insomnia and absenteeism at work. Who pays the cost?.
      ], and falls in the elderly (independent of medication use) [
      • Avidan A.Y.
      • Fries B.E.
      • James M.L.
      • et al.
      Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes.
      ] also have been linked to insomnia. Finally, quality of life is significantly lower in insomniacs and is comparable to that of patients who have other chronic medical conditions [
      • Katz D.A.
      • McHorney C.A.
      The relationship between insomnia and health-related quality of life in patients with chronic illness.
      ,
      • Simon G.E.
      • VonKorff M.
      Prevalence, burden, and treatment of insomnia in primary care.
      ]. The high level of morbidity associated with insomnia contributes to its direct cost to society, which has been estimated in the United States population as more than 13 billion dollars per year [
      • Walsh J.K.
      • Engelhardt C.L.
      The direct economic costs of insomnia in the United States for 1995.
      ].
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