Epidemiology of Sleep: Age, Gender, and Ethnicity

By Kenneth L. Lichstein; H. Heith Durrence et al. | Go to book overview

5
An Archive of Insomnia

There are no widely accepted quantitative criteria for defining insomnia, in part explaining why prevalence for insomnia vary wildly (see chap. 2). Neither the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10, World Health Organization, 1992), nor the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IX American Psychiatric Association, 1994), nor the International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD, American Sleep Disorders Association, 1990) provides adequate quantitative criteria for assigning the insomnia diagnosis (reviewed in Lichstein, Durrence, Taylor, Bush, & Riedel, 2003).

We recently derived empirically based quantitative criteria for insomnia (Lichstein et al., 2003), providing a reasoned alternative to the extant typical epidemiological practice of determining insomnia presence solely by asking individuals, do you have insomnia? We combined two approaches to establish diagnostic criteria. First, we reviewed two decades of psychology clinical trials for insomnia to determine modal practice with regard to frequency, severity, and duration criteria for insomnia. This procedure identified widely accepted frequency and duration criteria, but failed to resolve ambiguity in selecting severity criteria. Second, we applied sensitivity-specificity analyses to four common severity criteria to identify the most valid criterion. We concluded that severity of sleep onset latency (SOL) or wake time after sleep onset (WASO) of (a) ≥31 min (b) occurring ≥3 nights a week (c) for ≥6 months are the most defensible quantitative criteria for insomnia.

Poor sleep is critical to diagnosing insomnia, but it is not sufficient. We also considered evidence of daytime impairment requisite to conferring this diagnosis. This standard derives from the ICSD, which requires a re-

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Epidemiology of Sleep: Age, Gender, and Ethnicity
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Preface ix
  • 1 - Goals and Distinctive Characteristics of This Survey 1
  • 2 - A Review of Epidemiological Studies of Insomnia and Sleep 9
  • 3 - Methods of This Survey 42
  • 4 - An Archive of Normal Sleep 73
  • Appendix 113
  • 5 - An Archive of Insomnia 152
  • 6 - An Archive of the Sleep of African Americans 177
  • 7 - Summary of Main Findings 202
  • Appendix A - Alphabetical Listing of Abbreviations and Acronyms 217
  • References 219
  • Author Index 229
  • Subject Index 235
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