Prevalence of Insomnia and Its Treatment in Canada

By Morin, Charles M.; LeBlanc, Mélanie et al. | Canadian Journal of Psychiatry, September 2011 | Go to article overview

Prevalence of Insomnia and Its Treatment in Canada


Morin, Charles M., LeBlanc, Mélanie, Bélanger, Lynda, Ivers, Hans, Mérette, Chantal, Savard, Joseé, Canadian Journal of Psychiatry


Objectives: To estimate the prevalence of insomnia and examine its correlates (for example, demographics and physical and mental health) and treatments.

Methods: A sample of 2000 Canadians aged 18 years and older responded to a telephone survey about sleep, health, and the use of sleep-promoting products. Respondents with insomnia were identified using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and the International Classification of Diseases, Tenth Edition, criteria.

Results: Among the sample, 40.2% presented at least 1 symptom of insomnia (that is, trouble falling or staying asleep, or early morning awakening) for a minimum of 3 nights per week in the previous month, 19.8% were dissatisfied with their sleep, and 13.4% 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). Insomnia was associated with female sex, older age, and poorer self-rated physical and mental health. Thirteen per cent of respondents had consulted a health care provider for sleep difficulties once in their lifetime. Moreover, 10% had used prescribed medications for sleep in the previous year, 9.0% used natural products, 5.7% used over-the-counter products, and 4.6% used alcohol. There were differences between French- and English-speaking adults, with the former group presenting lower rates of insomnia (9.5%, compared with 14.3%) and consultation (8.7%, compared with 14.4%), but higher rates of prescribed medications (12.9%, compared with 9.3%) and the use of natural products (15.6%, compared with 7.4%).

Conclusions: Insomnia is a prevalent condition, although few people seek professional consultation for this condition. Despite regional differences in the prevalence and treatments used to manage insomnia, prescribed medications remain the most widely used therapeutic option.

Can J Psychiatry. 2011;56(9):540-548.

Clinical Implications

* The high prevalence of insomnia paired with the low consultation rate derived from this study highlight the need for more public health education about insomnia and the development of more training opportunities for health care providers to recognize and treat this problem.

* The findings also emphasize the importance of using standard algorithms based on validated diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, Tenth Edition, nosologies) to derive accurate estimates of prevalence and incidence of insomnia.

Limitations

* The absence of polysomnographic recordings may have yielded an overestimation of the prevalence of insomnia owing to other undiagnosed sleep disorders (for example, sleep apnea or restless legs syndrome).

* The lack of a more detailed clinical interview precluded the examination of the relation between insomnia and comorbid medical and psychiatric disorders.

* As for all epidemiologic surveys, the response rate was relatively low, raising questions about the generalizability of the findings to the adult population.

Key Words: epidemiology, insomnia, prevalence, sleep

Abbreviations

DSM Diagnostic and Statistical Manual of Mental Disorders

ICD International Classification of Diseases

ISI Insomnia Severity Index

Insomnia is characterized by difficulty initiating or maintaining sleep, or nonrestorative sleep, and is associated with impairments of daytime functioning.1,2 Insomnia may present as a symptom or a disorder on its own. It is the most prevalent sleep disorder and its course may be situational, recurrent, or persistent over time.3 Epidemiologic studies have documented the prevalence of insomnia in several countries around the world but estimates derived from these studies have been extremely variable, with prevalence rates ranging from 5% to 50%. …

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