Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 392
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents 
Year : 2016  |  Volume : 5  |  Issue : 4  |  Page : 780-784  

Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities

1 Department of Family Medicine, St. Philomena's Hospital, Bengaluru, Karnataka, India
2 Department of Family Medicine, St. Martha's Hospital, Bengaluru, Karnataka, India
3 Department of Medicine, St. Philomena's Hospital, Bengaluru, Karnataka, India

Date of Web Publication28-Feb-2017

Correspondence Address:
Swapna Bhaskar
Department of Family Medicine, St. Philomena's Hospital, No. 4, Campbell Road, Neelasandra, Bengaluru  -  960  047, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4863.201153

Rights and Permissions

Introduction: Insomnia is one of the common but neglected conditions seen in family practice with long term and serious effects on health of a patient. Family physicians have the responsibility of diagnosing and adequately treating this. This study was done to find the prevalence of chronic insomnia in adult patients visiting a family medicine outpatient department (OPD) in a hospital and to assess the risk factors and co morbidities associated with it. Materials and Methods: A cross-sectional study was done in the family medicine OPD at St. Philomena's Hospital, Bengaluru. All adult patients attending the OPD from September 1 to October 30, 2015 were enrolled in the study after obtaining written consent. Athens Insomnia Scale was used to diagnose insomnia and information regarding medical co morbidities was collected. Data was analyzed for the prevalence of insomnia and its association with co morbidities. Results: Chronic insomnia was seen in 33% of the adult population sampled. Increasing age and diabetes were significantly associated with insomnia, while other socioeconomic factors and co morbidities were not significantly associated. Twenty-seven percent of patients who had insomnia did not perceive the condition, which was statistically significant. Conclusion: Insomnia is a common sleep disorder which is many times missed by a primary care physician until/unless asked for. Since there is a higher incidence with increasing age and co morbidities such as diabetes, all patients, especially middle-aged and diabetics, should be screened for insomnia by the primary care physician with a self assessed questionnaire and counseled.

Keywords: Chronic insomnia, comorbidities, prevalence, primary care

How to cite this article:
Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care 2016;5:780-4

How to cite this URL:
Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care [serial online] 2016 [cited 2021 Sep 25];5:780-4. Available from: https://www.jfmpc.com/text.asp?2016/5/4/780/201153

  Introduction Top

Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality, which occurs despite adequate opportunity for sleep, and results in some form of daytime impairment.[1] Chronic insomnia is diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,[2] and the International Classification of Sleep Disorders,[3] which have similar criteria for making the diagnosis. These criteria specify that symptoms must cause clinically significant functional distress or impairment, be present for at least 3 nights/week for at least 3 months, and not be linked to other sleep, medical, or mental disorders. Various studies worldwide have shown the prevalence of insomnia in 10%–30% of the population, some even as high as 50%–60%. It is common in older adults, females, and people with medical and mental ill health.[4],[5],[6] The consequences of insomnia are significant, such as depression, impaired work performance, work- related/motor vehicle accidents, and overall poor quality of life. It is an easy-to-diagnose condition with many self-answerable questionnaires for aid, yet goes unrecognized in a significant number of patients coming to the outpatient department with other comorbid conditions. The objective of this study was to determine the prevalence of chronic insomnia, to look for any association with socioeconomic factors and medical comorbidities, and also to assess the patient's perception of having insomnia.

  Materials and Methods Top

This cross-sectional study was conducted in the family medicine outpatient department (OPD) of a 450-bedded general hospital in Bengaluru - St. Philomena's Hospital. All adult patients attending the OPD from September 1 to October 30, 2015, were enrolled in the study after obtaining written consent. Data about age, gender, education, occupation, monthly family income in rupees, and medical comorbidities were collected using a questionnaire. Athens Insomnia Scale was given to the patient to score; illiterate patients were helped by asking the same questions in their local language. The perception of the patient was asked before answering the insomnia scale. A score of 6 or more was taken as positive for insomnia.

Collected data were alphanumerically coded and entered in an Excel sheet. The analysis was done using SPSS 19.0 software (IBM, Bangalore, India), and the Chi-square test was used for analyzing the association of risk factors. P < 0.05 was considered statistically significant for Chi-square test.

Inclusion and exclusion criteria

All adult patients attending family medicine OPD were included in the study. Patients <18 years and >60 years, patients with known psychiatric illnesses, acutely ill patients, and alcoholics were excluded from the study.

  Results Top

Two hundred and seventy-eight patients were enrolled in the study after obtaining consent – 180 were female and 98 were male.

[Table 1] shows the prevalence of insomnia with age and gender. Insomnia was found in 92 (33%) patients - 63 (68%) were female and 29 (32%) were male. Twenty-nine (32%) patients below the age of 35 had insomnia, of which 20 (69%) were female and 9 (31%) were male. Sixty-three (68%) patients were of age >35 years - of which 43 (68%) were female and 20 (32%) were male.
Table 1: Prevalence of insomnia with age and gender

Click here to view

[Table 2] shows the association of insomnia with socioeconomic variables. Insomnia was found to be significantly higher in patients >35 years of age (P = 0.015). The educational background did not significantly affect insomnia - 40% of illiterate or people with basic schooling, 19% of undergraduates, 30% of graduates, and 19% of postgraduate degree holders were found to have insomnia. Employment also had no significant correlation with insomnia - 38% unemployed, 33% unskilled laborers, 45% skilled workers, and 30% professionals were found to have insomnia although statistically insignificant. Family income was another insignificant variable - 29% of patients with monthly income <Rs. 25,000 had insomnia, 37% in the group of income between 26,000 and 50,000, 50% with income between 51,000 and 75,000, and 41% with income >Rs. 75,000 had insomnia.
Table 2: Association of socioeconomic variables with insomnia

Click here to view

[Table 3] shows the association of insomnia with medical comorbidities. Patients with diabetes had statistically significant insomnia compared to those without diabetes (P = 0.001). Fifty percent of patients with diabetes had insomnia compared to 27% without diabetes. Hypertension (37% vs. 32%), ischemic heart disease (50% vs. 33%), thyroid disorders (42% vs. 31%), respiratory disorders (35% vs. 33%), kidney diseases (67% vs. 33%), liver diseases (51% vs. 32%), and other disorders such as arthralgia/tuberculosis/seizures/gastrointestinal disorders (48% vs. 33%) were found to have statistically insignificant correlation with insomnia.
Table 3: Association of medical comorbidities with insomnia

Click here to view

[Table 4] shows the association of actual insomnia with the patient's perception. Twenty-five patients (27%) did not have the perception of insomnia although they had a score of >6 in Athens scale, which had a significant P value (P < 0.05).
Table 4: Association of patient's perception with actual insomnia

Click here to view

Review of literature

The present study was done to determine the prevalence of chronic insomnia in the adult population in a family medicine outpatient clinic. In this study, the prevalence was found to be 33% with statistically significant correlation with increasing age and diabetes. A similar study conducted in South India found a prevalence of 18.6% among healthy adults attending a tertiary hospital [7] Another Indian study identified 15.4% prevalence of insomnia; Incidence was high in persons with comorbid chronic physical illness (28.1%) compared to persons free from that (10.9%), also higher among people living in joint families than those living in a nuclear family and increasing significantly with increasing age.[8] A recent study among corporate employees in India showed a prevalence of insomnia in 13.8% of participants, of which undiagnosed population was 96.4%. The common comorbid conditions associated with insomnia were anxiety, hypertension, and depression, and alcohol consumption was observed to be significantly higher in the sufferers of insomnia.[9] Our study showed a much higher prevalence rate compared to the above three Indian studies.

A multinational study done in Latin American countries using Athens Insomnia Scale and other sleep scales in middle-aged females showed 56.6% of surveyed women suffered from either insomnia, poor sleep quality, or both.[10] The prevalence of insomnia increased with age and menopausal stage. Increasing age, the presence of chronic disease, troublesome drinking, anxiety, depression, vasomotor symptoms, and drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality. Many other international studies have also shown insomnia to be more common in women and elders.[11],[12]

Dr. Ohayan's landmark review of approximately 50 prevalence studies reported roughly 30-20-10 rule for prevalence – i.e., 30% of adults have symptoms, 15%–20% report symptoms, and <10% are likely to meet the diagnostic and statistical criteria.[13]

A meta-analysis done in the US showed that of the patients attending primary care clinics, more than 50% complained of insomnia, only if specifically asked about it, 30% visit their general practitioners (GPs) on their own initiative, and only 5% go to consultation with the main objective of receiving treatment to solve their problem.[14]

Another international survey of sleep disorders in general population found that many individuals with insomnia (47%–67%) did not seek medical attention for their sleep difficulties. Among those who sought medical help, 50%–90% received treatment. Thus, insomnia remains a largely underdiagnosed and undertreated problem.[15]

A study on Malaysian patients attending primary care clinics showed that 38.9% patients had frequent insomnia symptoms (>3 times/week), 30.7% had chronic insomnia without daytime consequences, and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity, age ≥50, anxiety symptoms, and depression symptoms were risk factors for chronic insomnia with daytime dysfunction.[16]

This study also analyzed the association of various comorbidities with insomnia and showed statistically significant correlation with patients having diabetes mellitus. In a similar study, Taylor et al.[4] demonstrated that people with chronic insomnia reported more of the following than did people without insomnia: Heart disease (21.9% vs. 9.5%), high blood pressure (43.1% vs. 18.7%), neurologic disease (7.3% vs. 1.2%), breathing problems (24.8% vs. 5.7%), urinary problems (19.7% vs. 9.5%), chronic pain (50.4% vs. 18.2%), and gastrointestinal problems (33.6% vs. 9.2%). Conversely, people with the following medical problems reported more chronic insomnia than did those without those medical problems: Heart disease (44.1% vs. 22.8%), cancer (41.4% vs. 24.6%), high blood pressure (44.0% vs. 19.3%), neurologic disease (66.7% vs. 24.3%), breathing problems (59.6% vs. 21.4%), urinary problems (41.5% vs. 23.3%), chronic pain (48.6% vs. 17.2%), and gastrointestinal problems (55.4% vs. 20.0%). When all medical problems were considered together, only patients with high blood pressure, breathing problems, urinary problems, chronic pain, and gastrointestinal problems had statistically higher levels of insomnia than those without these medical disorders.

Insomnia was also considered as a predictor for other sleep disorders such as obstructive sleep apnea in some studies.[17] A recent study done in Singapore illustrated that many patients with chronic insomnia have underlying primary sleep disorders.[18] Our study did not consider evaluating for other sleep disorders due to practical difficulties in doing sleep studies in primary care settings.

The perception of patients regarding insomnia was also significantly low in our study. A survey among adult French population in 2001–2002 regarding insomnia found that 25% of randomly selected respondents were dissatisfied with their sleep and only 13% had consulted a health-care provider, especially for insomnia.[19] In the South Indian study quoted above, only 2.2% people perceived themselves as having sleep-related problems.[7] In the study on Indian population in West Bengal, it was found that 43.2% of insomniac patients never seek medical advice for insomnia and only 15.3% actually consulted a doctor for their sleep problem.[8] In our population, no patient had actually presented with insomnia as their primary complaint, but 27% of insomniacs did not perceive their condition.

  Discussion Top

Insomnia is the most commonly encountered sleep disorder and occurs in 10%–50% of the population according to studies conducted worldwide. The pathophysiology of insomnia can actually be somewhat complex (or at least multi-factorial) because of the many inputs to the sleep-wake system in general and the additional specific behaviors and cognitions which an individual layers on top of the physiologic substrates.[20]

Studies show that insomnia negatively affects work performance, impairs decision-making, can damage relationships, increase chances of work-related/motor vehicle accidents,[21] and lead to overall decline in quality of life. Despite the prevalence of poor sleep quality and insomnia in the general population, people with sleep problems often go unnoticed in the health-care system. GPs were identified as the most frequently consulted group for sleep disorders.[19]

Insomnia can be classified as acute and chronic/primary and secondary.[22],[23],[24] When insomnia lasts for 4 weeks or more, it is classified as chronic insomnia.[2] It is further subclassified into with or without comorbidities (medical and psychiatric) and associated with another primary sleep disorder.[25] Numerous self-report instruments exist for the assessment of sleep disturbance. Among them, the most widely used are Pittsburgh Sleep Quality Index, Epworth sleepiness scale, Athens Insomnia Score, and Insomnia Severity Index.

Athens Insomnia Scale was chosen for this study because of its simple language, ease of questions and calculation, effectiveness, and reprint rights.[26],[27]

This study showed a prevalence of chronic insomnia in 33% in the sample population surveyed, with females being more affected compared to males but in statistically insignificant values. There was a significant prevalence in patients having diabetes irrespective of the duration of diabetes and drugs taken. Increasing age was also a significant contributor to insomnia in adults. There was no major correlation with education/social/economic factors and comorbid conditions such as hypertension, asthma, migraine, heart diseases, and liver or kidney diseases.

There is also poor knowledge and awareness about sleep disorders and their health-related negative consequences in our population.

  Conclusion Top

Insomnia is a common sleep disorder which is many times missed by a primary care physician until/unless asked for; the prevalence of which was as high as 33% in this study. Diabetes and increasing age were significantly associated with insomnia. Hence, all diabetic patients should be screened for insomnia by the primary care physician/diabetologist with a self-assessed questionnaire. A caring physician should assess the sleep pattern of every patient and give adequate counseling or treatment for the same.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd ed. Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine; 2005.  Back to cited text no. 1
American Psychiatric Association. Diagnostic and Statistical Manualof Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association; 2013.  Back to cited text no. 2
American Academy of Sleep Medicine. The International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL: American Academy of Sleep Medicine; 2014.  Back to cited text no. 3
Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep 2007;30:213-8.  Back to cited text no. 4
Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rössler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 2008;31:473-80.  Back to cited text no. 5
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;4:487-504.  Back to cited text no. 6
Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurol India 2012;60:68-74.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Roy SK, Bhattacharjee AK, Chakraborti C, Singh R. Prevalence of insomnia in urban population of west Bengal: A community based cross sectional study. Int J Med Public Health 2015;5:293-6.  Back to cited text no. 8
  Medknow Journal  
Yardi N, Adsule S. A cross-sectional observational study to determine the prevalence of insomnia amongst Indian corporate employees. J Assoc Physicians India 2015;63;20-5.  Back to cited text no. 9
Blümel JE, Cano A, Mezones-Holguín E, Barón G, Bencosme A, Benítez Z, et al. A multinational study of sleep disorders during female mid-life. Maturitas 2012;72:359-66.  Back to cited text no. 10
Xu M, Bélanger L, Ivers H, Guay B, Zhang J, Morin CM. Comparison of subjective and objective sleep quality in menopausal and non-menopausal women with insomnia. Sleep Med 2011;12:65-9.  Back to cited text no. 11
Rybarczyk B, Lund HG, Garroway AM, Mack L. Cognitive behavioraltherapy for insomnia in older adults: Background, evidence, and overview of treatment protocol. Clin Gerontol 2013;36:70-93.  Back to cited text no. 12
Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev 2002;6:97-111.  Back to cited text no. 13
Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002;159:5-11.  Back to cited text no. 14
Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in the general population. Curr Med Res Opin 2008;24:307-17.  Back to cited text no. 15
Zailinawati AH, Mazza D, Teng CL. Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients. Asia Pac Fam Med 2012;11:9.  Back to cited text no. 16
Glidewell RN, Roby EK, Orr WC. Is insomnia an independent predictor of obstructive sleep apnea? J Am Board Fam Med 2012;25:104-10.  Back to cited text no. 17
Wong SH, Ng BY. Review of sleep studies of patients with chronic insomnia at a sleep disorder unit. Singapore Med J 2015;56:317-23.  Back to cited text no. 18
Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med 2006;7:123-30.  Back to cited text no. 19
Pigeon WR. Diagnosis, prevalence, pathways, consequences and treatment of insomnia. Indian J Med Res 2010;131:321-32.  Back to cited text no. 20
[PUBMED]  Medknow Journal  
Kessler RC, Berglund PA, Coulouvrat C, Fitzgerald T, Hajak G, Roth T, et al. Insomnia, comorbidity, and risk of injury among insured Americans: Results from the America Insomnia Survey. Sleep 2012;35:825-34.  Back to cited text no. 21
American Psychiatric Association. Sleep Disorders: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic Criteria for Primary Insomnia. Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000. p. 597-661.  Back to cited text no. 22
American Academy of Sleep Medicine. The International Classification of Sleep Disorders, Revised. Westchester, Ill: American Academy of Sleep Medicine; 1997.  Back to cited text no. 23
World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders. World Health Organization, Geneva, Switzerland 26. TOP. Assessment to Diagnosis: Insomnia. Toward Optimized Practice (TOP) Program; 1992. Available from: http://www.topalbertadoctors.org/cpgs/?sid=18 and cpg.cats=79. [Last accessed on 2016 Sep 12].  Back to cited text no. 24
World health organization. The ICD-10 Classification of Mental and Behavioral Disorders. WHO Geneva, Switzerland; 1992.  Back to cited text no. 25
Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens insomnia scale: Validation of an instrument based on ICD-10 criteria. J Psychosom Res 2000;48:555-60.  Back to cited text no. 26
Soldatos CR, Dikeos DG, Paparrigopoulos TJ. The diagnostic validity of the Athens insomnia scale. J Psychosom Res 2003;55:263-7.  Back to cited text no. 27


  [Table 1], [Table 2], [Table 3], [Table 4]

This article has been cited by
1 Do C-tactile afferents go to sleep? A potential role for somatosensory stimulation in sleep regulation
Martine Van Puyvelde,Olivier Mairesse
Current Opinion in Behavioral Sciences. 2022; 43: 62
[Pubmed] | [DOI]
2 The effect of Pregabalin on sleep quality of patients treated with methadone maintenance therapy: A double-blind randomized clinical trial
Seyed Kaveh Hojjat,Faezeh Kaviyani,Mahnaz Amini,Hadi Akbari,Ebrahim Golmakanie,Mina Norozi Khalili
Journal of Substance Use. 2021; : 1
[Pubmed] | [DOI]
3 Primary care provider evaluation and management of insomnia
Joy Sun,Miranda V. McPhillips,Ker-Cheng Chen,Yinyin Zang,Junxin Li,Jessica Oehlke,Glenna S. Brewster,Nalaka S. Gooneratne
Journal of Clinical Sleep Medicine. 2021;
[Pubmed] | [DOI]
4 Genetic risk for subjective reports of insomnia associate only weakly with polygraphic measures of insomnia in 2,770 adults
Jonathan Foldager,Paul E. Peppard,Erika W. Hagen,Katie L. Stone,Daniel S. Evans,Gregory J. Tranah,Helge Sørensen,Poul Jennum,Emmanuel Mignot,Logan Schneider
Journal of Clinical Sleep Medicine. 2021;
[Pubmed] | [DOI]
5 Relationship between sleep duration and quality and glycated hemoglobin, body mass index, and self-reported health in Marshallese adults
Pearl A. McElfish,Jennifer A. Andersen,Holly C. Felix,Rachel S. Purvis,Brett Rowland,Aaron J. Scott,Meena Chatrathi,Christopher R. Long
Sleep Health. 2021;
[Pubmed] | [DOI]
6 Relationships of coping styles and psychological distress among patients with insomnia disorder
Yinghui Li,Xiaoyin Cong,Suzhen Chen,Yong Li
BMC Psychiatry. 2021; 21(1)
[Pubmed] | [DOI]
7 Effects of Lactobacillus plantarum PS128 on Depressive Symptoms and Sleep Quality in Self-Reported Insomniacs: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial
Yu-Ting Ho,Ying-Chieh Tsai,Terry B. J. Kuo,Cheryl C. H. Yang
Nutrients. 2021; 13(8): 2820
[Pubmed] | [DOI]
8 Comorbid Insomnia and Obstructive Sleep Apnea (COMISA): Current Concepts of Patient Management
Beatrice Ragnoli,Patrizia Pochetti,Alberto Raie,Mario Malerba
International Journal of Environmental Research and Public Health. 2021; 18(17): 9248
[Pubmed] | [DOI]
9 The Cognitive Function at Work Questionnaire (CFWQ): A new scale for measuring cognitive complaints in occupational population
Anna-Leena Heikkinen,Tuomo Hänninen,Pekka Kuikka,Ritva Akila,Aslak Savolainen,Teppo Valtonen,Adil Umer,Jyrki Lötjönen,Christer Hublin,Anne M. Remes,Teemu Paajanen
Applied Neuropsychology: Adult. 2021; : 1
[Pubmed] | [DOI]
10 Improvements in Sleep Quality and Duration Following a Meditation Retreat: an Open-Trial Pilot Study
Divya Kanchibhotla,Sheel Galada Parekh,Prateek Harsora,Shashank Kulkarni
Sleep and Vigilance. 2021;
[Pubmed] | [DOI]
11 Paradoxical Insomnia in a Frustrated Patient Treated With Hypnotics for Ten Years
Waiz Wasey,Sharefi Saleh,Kristia Abernathy,Amit Sapra,Priyanka Bhandari
Cureus. 2021;
[Pubmed] | [DOI]
12 Development and Validation of a Questionnaire to Diagnose Insomnia in Indians
Manvir Bhatia
Sleep and Vigilance. 2021;
[Pubmed] | [DOI]
13 Prevalence of Insomnia among Pancreatic Cancer Patients following Pancreaticoduodenectomy
Sabine Chalhoub,Marita Yaghi,Natasha Ard,Mariam Kanso,Jad Allam,Mohamad Khalife,Rola F. Jaafar,Walid Faraj,Giora Pillar
Sleep Disorders. 2021; 2021: 1
[Pubmed] | [DOI]
14 Association between visual impairment and sleep duration in college students: A study conducted in UAE and Lebanon
Rose Ghemrawi,Racha Kerek,Kawthar Kayed,Raghad Aldulaymi,Azza Ramadan,Mostafa Khair
Journal of American College Health. 2021; : 1
[Pubmed] | [DOI]
15 Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population
Diana Malaeb,Youssef Farchakh,Chadia Haddad,Hala Sacre,Sahar Obeid,Souheil Hallit,Pascale Salameh
Perspectives in Psychiatric Care. 2021;
[Pubmed] | [DOI]
16 Factors Associated With Healthcare Workersæ Insomnia Symptoms and Fatigue in the Fight Against COVID-19, and the Role of Organizational Support
Xia Zou,Shaokun Liu,Jie Li,Wen Chen,Jiali Ye,Yuan Yang,Fenfen Zhou,Li Ling
Frontiers in Psychiatry. 2021; 12
[Pubmed] | [DOI]
17 Cost-effectiveness of Guided Internet-Delivered Cognitive Behavioral Therapy in Comparison with Care-as-Usual for Patients with Insomnia in General Practice
Agni Baka,Tanja van der Zweerde,Jaap Lancee,Judith E. Bosmans,Annemieke van Straten
Behavioral Sleep Medicine. 2021; : 1
[Pubmed] | [DOI]
18 Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study
Daniel H Solomon,Kristine Ruppert,Laurel A Habel,Joel S Finkelstein,Pam Lian,Hadine Joffe,Howard M Kravitz
BMJ Open. 2021; 11(5): e045074
[Pubmed] | [DOI]
19 Australian Consultant Pharmacists’ Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia
Mariam M. Basheti,Minh Tran,Keith Wong,Christopher Gordon,Ronald Grunstein,Bandana Saini
Behavioral Sleep Medicine. 2021; : 1
[Pubmed] | [DOI]
20 Can improvements in sleep quality positively affect serum adiponectin-levels in patients with obstructive sleep apnea?
Solveig Magnusdottir,Robert Joseph Thomas,Hugi Hilmisson
Sleep Medicine. 2021;
[Pubmed] | [DOI]
21 Sleep-Wake Disturbances in Oncology
Kristi A. Acker,Patricia Carter
Nursing Clinics of North America. 2021; 56(2): 175
[Pubmed] | [DOI]
22 Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies
Russell Rosenberg,Leslie Citrome,Christopher L Drake
Neuropsychiatric Disease and Treatment. 2021; Volume 17: 2549
[Pubmed] | [DOI]
23 Sleep quality and COVID-19 outcomes: the evidence-based lessons in the framework of predictive, preventive and personalised (3P) medicine
Kneginja Richter,Stefanie Kellner,Thomas Hillemacher,Olga Golubnitschaja
EPMA Journal. 2021; 12(2): 221
[Pubmed] | [DOI]
24 Sleeping Well: The Gateway to Employee Wellness
Sasmita Palo,Moitrayee Das
NHRD Network Journal. 2021; 14(1): 103
[Pubmed] | [DOI]
25 Sleep disturbance, associated symptoms, and quality of life in adults living with HIV in Jakarta, Indonesia
Hening Pujasari,Judith Levy,Gabriel Culbert,Alana Steffen,David Carley,Mary Kapella
AIDS Care. 2020; : 1
[Pubmed] | [DOI]
26 Causal Links between Major Depressive Disorder and Insomnia: A Mendelian Randomisation Study
Lei Cai,Yiran Bao,Xiaoqian Fu,Hongbao Cao,Ancha Baranova,Xiangrong Zhang,Jing Sun,Fuquan Zhang
Gene. 2020; : 145271
[Pubmed] | [DOI]
27 Actigraphy versus Polysomnography to Identify Changes in the Sleep Patterns of Adults with Insomnia
Andrea dos Santos Garcia,Juliana Durães das Neves,Solange Campos Vicentini,Glycia de Almeida Nogueira,Juliana Mendes Marques,Raphael Neves Barreiros,Cristiano Bertolossi Marta,Roberto Carlos Lyra da Silva,Carlos Roberto Lyra da Silva
Revista Neurociências. 2020; 28: 1
[Pubmed] | [DOI]
28 Soporific Effect of Modified Suanzaoren Decoction and Its Effects on the Expression of CCK-8 and Orexin-A
Liang-Hui Zhan,Ying-Jie Dong,Ke Yang,Shan-Shan Lei,Bo Li,Xi Teng,Cong Zhou,Rong Luo,Qiao-Xian Yu,Hai-Ying Jin,Gui-Yuan Lv,Su-hong Chen
Evidence-Based Complementary and Alternative Medicine. 2020; 2020: 1
[Pubmed] | [DOI]
29 Prevalence of sleep disorders among university students and its impact on academic performance
Asma Ali Al Salmani,Asma Al Shidhani,Shatha Saud Al Qassabi,Shahad Ahmed Al Yaaribi,Aysha Muslem Al Musharfi
International Journal of Adolescence and Youth. 2020; 25(1): 974
[Pubmed] | [DOI]
30 High prevalence of low dairy calcium intake and association with insomnia, anxiety, depression and musculoskeletal pain in university students from Jordan
Mohammad J Alkhatatbeh,Hala N Khwaileh,Khalid K Abdul-Razzak
Public Health Nutrition. 2020; : 1
[Pubmed] | [DOI]
31 Sleep deprivation and its association with diseases- A review
Siaw-Cheok Liew,Thidar Aung
Sleep Medicine. 2020;
[Pubmed] | [DOI]
32 Effects of Sihogayonggolmoryeo-tang (Saikokaryukotsuboreito or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for insomnia disorder with prehypertension or stage 1 hypertension
Boram Lee,Yeong-Eun Jeong,Hyo-Ju Park,Young-Eun Choi,Hoseok Kim,Bo-Young Kim,Changsop Yang,In Chul Jung
Medicine. 2020; 99(29): e20980
[Pubmed] | [DOI]
33 Prevalence of Insomnia (Symptoms) in T2D and Association With Metabolic Parameters and Glycemic Control: Meta-Analysis
Anitra D M Koopman,Joline W Beulens,Tine Dijkstra,Frans Pouwer,Marijke A Bremmer,Annemieke van Straten,Femke Rutters
The Journal of Clinical Endocrinology & Metabolism. 2020; 105(3): 614
[Pubmed] | [DOI]
34 Increased microparticle levels in middle-aged and elderly patients with insomnia may be involved in the pathogenesis of arteriosclerosis
Bin Xu,Li Ma,Ning Zhang,Wei Guo,Li-Ming Luo,Chen Wang,Yue Jiang,Li-Ge Liu
International Angiology. 2020; 39(3)
[Pubmed] | [DOI]
35 Role of Ascaridole and p-Cymene in the Sleep-Promoting Effects of Dysphania ambrosioides Essential Oil via the GABAergic System in a ddY Mouse Inhalation Model
Godfried Dougnon,Michiho Ito
Journal of Natural Products. 2020;
[Pubmed] | [DOI]
36 Factors related to difficulty sleeping in adults and older people registered with the Family Health Strategy
Ana Maria Farias Ribeiro,Luiza Alves da Silva,Fernando Carli de Oliveira,Tatiana Carvalho Reis Martins,Bruna Moretti Luchesi
Geriatrics, Gerontology and Aging. 2020; 14(4): 236
[Pubmed] | [DOI]
37 Insomnia and cognitive performance: A systematic review and meta-analysis
Sophie Wardle-Pinkston,Danica C. Slavish,Daniel J. Taylor
Sleep Medicine Reviews. 2019;
[Pubmed] | [DOI]
38 A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model
Casey D. Wright,Alaina G. Tiani,Amber L. Billingsley,Shari A. Steinman,Kevin T. Larkin,Daniel W. McNeil
Frontiers in Psychology. 2019; 10
[Pubmed] | [DOI]
39 Off-label uses of drugs for depression
Sigrid S. Skånland,Artur Cieslar-Pobuda
European Journal of Pharmacology. 2019; : 172732
[Pubmed] | [DOI]
40 Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes
Judith R Davidson,Ciara Dickson,Han Han
British Journal of General Practice. 2019; 69(686): e657
[Pubmed] | [DOI]
41 Sleep-Related Attentional Bias to Word Stimuli in Patients with Insomnia Disorder
Soohyun Kim,Seong min Oh,Jeong Eun Jeon,Ha Young Lee,Inkyung Park,Juhyun Park,Mi hyun Lee,Yu Jin Lee
Chronobiology in Medicine. 2019; 1(2): 69
[Pubmed] | [DOI]
42 Sleep-related symptoms of midlife women with and without type 2 diabetes mellitus
Eun-Ok Im,You Lee Yang,Jianghong Liu,Wonshik Chee
Menopause. 2019; 26(10): 1178
[Pubmed] | [DOI]
43 The Frequency of Sleep Medication Use and the Risk of Subjective Cognitive Decline (SCD) or SCD With Functional Difficulties in Elderly Individuals Without Dementia
Joo Eun Lee,Yeong Jun Ju,Ki Hong Chun,Soon Young Lee,Anne Newman
The Journals of Gerontology: Series A. 2019;
[Pubmed] | [DOI]
44 Insomnia and cardiovascular autonomic control
Daniela Grimaldi,Michael R. Goldstein,Jason R. Carter
Autonomic Neuroscience. 2019; 220: 102551
[Pubmed] | [DOI]
45 Lifestyle Choices and Brain Health
Jacobo Mintzer,Keaveny Anne Donovan,Arianne Zokas Kindy,Sarah Lenz Lock,Lindsay R. Chura,Nicholas Barracca
Frontiers in Medicine. 2019; 6
[Pubmed] | [DOI]
46 Sedative and hypnotic effects of Vaccinium bracteatum Thunb. through the regulation of serotonegic and GABAA-ergic systems: Involvement of 5-HT1A receptor agonistic activity
Dool-Ri Oh,Yujin Kim,Ara Jo,Eun Jin Choi,Kyo-Nyeo Oh,Jaeyong Kim,Huwon Kang,Young Ran Kim,Chul yung Choi
Biomedicine & Pharmacotherapy. 2019; 109: 2218
[Pubmed] | [DOI]
47 Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach
Mayyada Wazaify,Eman Elayeh,Razan Tubeileh,Eman A. Hammad,Carl Richard Schneider
PLOS ONE. 2019; 14(12): e0226076
[Pubmed] | [DOI]
48 Insomnia among primary care adult population in Aseer region of Saudi Arabia: gastroesophageal reflux disease and body mass index correlates
Nabil Joseph Awadalla,Hassan Mohammed Al-Musa
Biological Rhythm Research. 2019; : 1
[Pubmed] | [DOI]
49 Insomnia symptoms in primary care: A prospective study focusing on prevalence of undiagnosed co-morbid sleep disordered breathing
Hugi Hilmisson,Erla Sveinsdottir,Neale Lange,Solveig Magnusdottir
European Journal of Internal Medicine. 2019;
[Pubmed] | [DOI]
50 Auricular Plaster Therapy for Comorbid Insomnia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Huimin Zhao,Dan Li,Ying Yang,Yueting Liu,Jie Li,Jing Mao
Evidence-Based Complementary and Alternative Medicine. 2019; 2019: 1
[Pubmed] | [DOI]
51 New organisation for follow-up and assessment of treatment efficacy in sleep apnoea
Monique Suarez-Giron,Maria R. Bonsignore,Josep M. Montserrat
European Respiratory Review. 2019; 28(153): 190059
[Pubmed] | [DOI]
52 Factors related to insomnia among end-stage renal disease patients on hemodialysis in Jakarta, Indonesia
Indri Lufiyani,Anggri Noorana Zahra,Sri Yona
Enfermería Clínica. 2019;
[Pubmed] | [DOI]
53 Distinct effects of orexin receptor antagonist and GABAA agonist on sleep and physical/cognitive functions after forced awakening
Jaehoon Seol,Yuya Fujii,Insung Park,Yoko Suzuki,Fusae Kawana,Katsuhiko Yajima,Shoji Fukusumi,Tomohiro Okura,Makoto Satoh,Kumpei Tokuyama,Toshio Kokubo,Masashi Yanagisawa
Proceedings of the National Academy of Sciences. 2019; : 201907354
[Pubmed] | [DOI]
54 Sedative and hypnotic effects of compound Anshen essential oil inhalation for insomnia
Yu Zhong,Qin Zheng,Pengyi Hu,Xiaoying Huang,Ming Yang,Guilin Ren,Qing Du,Jun Luo,Kenan Zhang,Jing Li,Haixia Wu,Yuanyuan Guo,Shanshan Liu
BMC Complementary and Alternative Medicine. 2019; 19(1)
[Pubmed] | [DOI]
55 The Association between Vitamin D Deficiency and Sleep Disorders: A Systematic Review and Meta-Analysis
Qi Gao,Tingyan Kou,Bin Zhuang,Yangyang Ren,Xue Dong,Qiuzhen Wang
Nutrients. 2018; 10(10): 1395
[Pubmed] | [DOI]
56 Sleep disorders: Serious threats among kidney transplant recipients
Sandesh Parajuli,Rachna Tiwari,Dana F. Clark,Didier A. Mandelbrot,Arjang Djamali,Kenneth Casey
Transplantation Reviews. 2018;
[Pubmed] | [DOI]
57 Characteristics of the “young-old” and “old-old” community-dwelling suicidal Ideators: A longitudinal 6-month follow-up study
C. Hyung Keun Park,Jae Won Lee,Sang Yeol Lee,Se-Hoon Shim,Shin Gyeom Kim,Jeewon Lee,Min-Hyuk Kim,Jong-Woo Paik,Seong-Jin Cho,Jungjoon Moon,Dong-Wook Jeon,Seokho Kim,Jae-Hyun Park,Sungeun You,Hong Jin Jeon,Yong Min Ahn
Comprehensive Psychiatry. 2018;
[Pubmed] | [DOI]
58 The influence of sleep disorders on the quality of life in patients with chronic low back pain
Izabella Uchmanowicz,Aleksandra Koltuniuk,Aneta Stepien,Bartosz Uchmanowicz,Joanna Rosinczuk
Scandinavian Journal of Caring Sciences. 2018;
[Pubmed] | [DOI]
59 Sleep and Orofacial Pain
Gary D. Klasser,Galit Almoznino,Giulio Fortuna
Dental Clinics of North America. 2018;
[Pubmed] | [DOI]
60 Prevalence and risk factors of type 2 diabetes in insomnia sufferers: A study on 1311 individuals referred for sleep examinations
Matthieu Hein,Jean-Pol Lanquart,Gwénolé Loas,Philippe Hubain,Paul Linkowski
Sleep Medicine. 2018;
[Pubmed] | [DOI]
61 Effect of Acupuncture Cooperated with Low-frequency Repetitive Transcranial Magnetic Stimulation on Chronic Insomnia: A Randomized Clinical Trial
Yang-pu Zhang,Wei-jing Liao,Wen-guang Xia
Current Medical Science. 2018; 38(3): 491
[Pubmed] | [DOI]
62 Shared Dysregulation of Homeostatic Brain-Body Pathways in Depression and Type 2 Diabetes
Claire J. Hoogendoorn,Juan F. Roy,Jeffrey S. Gonzalez
Current Diabetes Reports. 2017; 17(10)
[Pubmed] | [DOI]
63 Insomnia in primary care—a study from India
T S Jaisoorya,Ajit Bhalchandra Dahale,Kumar G Sunil,L Manoj,GR Gokul,K Thennarassu
Sleep Health. 2017;
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
   Materials and Me...
   Article Tables

 Article Access Statistics
    PDF Downloaded1559    
    Comments [Add]    
    Cited by others 63    

Recommend this journal