Clinical Review
Epidemiology of insomnia: what we know and what we still need to learn

https://doi.org/10.1053/smrv.2002.0186Get rights and content

Abstract

Epidemiologists have published more than 50 studies of insomnia based on data collected in various representative community-dwelling samples or populations. These surveys provide estimates of the prevalence of insomnia according to four definitions: insomnia symptoms, insomnia symptoms with daytime consequences, sleep dissatisfaction and insomnia diagnoses. The first definition, based on insomnia criteria as defined by the DSM-IV, recognizes that about one-third of a general population presents at least one of them. The second definition shows that, when daytime consequences of insomnia are taken into account, the prevalence is between 9% and 15%. The third definition represents 8–18% of the general population. The last definition, more precise and corresponding to a decision-making diagnosis, sets the prevalence at 6% of insomnia diagnoses according to the DSM-IV classification. These four definitions of insomnia have higher prevalence rates in women than in men. The prevalence of insomnia symptoms generally increases with age, while the rates of sleep dissatisfaction and diagnoses have little variation with age. Numerous factors can initiate or maintain insomnia. Mental disorders and organic diseases are the factors that have been the most frequently studied. The association between insomnia and major depressive episodes has been constantly reported: individuals with insomnia are more likely to have a major depressive illness. Longitudinal studies have shown that the persistence of insomnia is associated with the appearance of a new depressive episode. Future epidemiological studies should focus on the natural evolution of insomnia. Epidemiological genetic links of insomnia are yet to be studied. 2002 Harcourt Publishers Ltd

References (81)

  • S Schwartz et al.

    Insomnia and heart disease: a review of epidemiologic studies

    J Psychosom Res

    (1999)
  • DW Wetter et al.

    The relation between cigarette smoking and sleep disturbance

    Prev Med

    (1994)
  • JL Pillitteri et al.

    Over-the-counter sleep aids: widely used but rarely studied

    J Subst Abuse

    (1994)
  • MM Ohayon et al.

    Are prescribed medications effective in the treatment of insomnia complaints?

    J Psychosom Res

    (1999)
  • AF Jorm et al.

    Long-term benzodiazepine use by elderly people living in the community

    Aust N Z J Public Health

    (2000)
  • MM Ohayon et al.

    Comorbidity of mental and insomnia disorders in the general population

    Compr Psychiatry

    (1998)
  • Sleep

    (1979)
  • International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD). Rochester, MN: American Sleep Disorders Association

    (1990)
  • Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R). Washington, DC: American Psychiatric Association

    (1987)
  • Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric Association

    (1994)
  • EO Bixler et al.

    Prevalence of sleep disorders in the Los Angeles metropolitan area

    Am J Psychiatry

    (1979)
  • L Welstein et al.

    Insomnia in the San Francisco Bay area: a telephone survey. In: Guilleminault C, Lugaresi E (eds)

    Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. New York: Raven Press

    (1983)
  • MA Quera-Salva et al.

    Insomnia and use of hypnotics: study of a French population

    Sleep

    (1991)
  • ME Klink et al.

    Risk factors associated with complaints of insomnia in a general adult population. Influence of previous complaints of insomnia

    Arch Intern Med

    (1992)
  • L Mallon et al.

    Relationship between insomnia, depression, and mortality: a 12-year follow-up of older adults in the community

    Int Psychogeriatr

    (2000)
  • I Karacan et al.

    Sleep disturbance: a community survey. In: Guilleminault C, Lugaresi E (eds)

    Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. New York: Raven Press

    (1983)
  • C Janson et al.

    Prevalence of sleep disturbances among young adults in three European countries

    Sleep

    (1995)
  • S Ancoli-Israel et al.

    Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I

    Sleep

    (1999)
  • G Hoffmann

    Evaluation of severe insomnia in the general population–implications for the management of insomnia: focus on results from Belgium

    J Psychopharmacol

    (1999)
  • J Hetta et al.

    Evaluation of severe insomnia in the general population-implications for the management of insomnia: insomnia, quality of life and healthcare consumption in Sweden

    J Psychopharmacol

    (1999)
  • Y Doi et al.

    Prevalence of sleep disturbance and hypnotic medication use in relation to sociodemographic factors in the general Japanese adult population

    J Epidemiol

    (2000)
  • D Léger et al.

    Prevalence of insomnia in a survey of 12,778 adults in France

    J Sleep Res

    (2000)
  • GD Mellinger et al.

    Insomnia and its treatment: prevalence and correlates

    Arch Gen Psychiatry

    (1985)
  • T Gislason et al.

    Somatic diseases and sleep complaints: an epidemiological study of 3201 Swedish men

    Acta Med Scand

    (1987)
  • B Liljenberg et al.

    The prevalence of insomnia: the importance of operationally defined criteria

    Ann Clin Res

    (1988)
  • S Weyerer et al.

    Prevalence and treatment of insomnia in the community: results from the upper Bavarian field study

    Sleep

    (1991)
  • A Téllez-LoÁpez et al.

    Hábitos y trastornos del dormir en residentes del área metropolitana de Monterrey

    Salud Mental

    (1995)
  • DE Ford et al.

    Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?

    J Am Med Assoc

    (1989)
  • Ohayon, MM, Prevalence, diagnosis and treatment of chronic insomnia in the general population. In: Proceedings of the...
  • E Lugaresi et al.

    Good and poor sleepers: an epidemiological survey of the San Marino population. In: Guilleminault C, Lugaresi E (eds)

    Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. New York: Raven Press

    (1983)
  • Cited by (2849)

    View all citing articles on Scopus
    f1

    Correspondence should be addressed to: Maurice M. Ohayon, MD, DSc, PhD, Stanford University School of Medicine, Sleep Disorders Center, 401 Quarry Road, Suite 3301, Stanford, CA 94305, USA. Tel: 650-723-6601; Fax: 650-251-0076 or 650-725-8910;E-mail: [email protected]

    View full text