National Sleep Foundation

Chapter 2: Insomnia

Risk Factors

At least five things can lead to insomnia:

  1. Learning and conditioning factors;
  2. Maladaptive thoughts about sleep and perceived lack of self-efficacy in managing insomnia (i.e., cognitive factors);
  3. Medical disorders that impair the sleep-wake cycle;
  4. Poor sleep habits and other maladaptive behaviors; and
  5. Psychological issues (e.g., stress vulnerability and hyperarousal) and psychiatric conditions.

In addition, certain types of people are at higher risk for experiencing insomnia, including:

  • Women: Women are at a higher risk for insomnia than men.1, 2 This may be due to hormones occurring during puberty,3  pregnancy4, 5, 6 the postpartum period,or during the menopausal transition and after menopause.
  • Individuals with other medical conditions: Patients with medical or mental health conditions are at increased risk of insomnia.8, 9 As noted, these include psychiatric disorders such as depression, substance abuse, or anxiety;10, 11, 12, 13, 14 and medical conditions such as cardiopulmonary disease, musculoskeletal conditions, gastrointestinal disease, endocrine conditions, chronic renal failure, and neurological disease;15, 16
  • Older individuals: The elderly have a higher risk for insomnia due to lifestyle changes associated with retirement, increased health problems, and increased use of medications.17, 18, 19 Elderly individual’s circadian rhythms also tend to shift so they both go to sleep and wake up earlier, which may interfere with their feeling well-rested. In general, older individuals have less deep sleep, more sleep fragmentation and increased napping, all of which may predispose them to insomnia.
  • Behaviors: Certain behaviors increase a person’s risk of experiencing insomnia, including having poor sleep habits and engaging in shift work.20

It is important to note that cause and effect may be circular: risk factors that induce or worsen insomnia may also be consequences of insomnia.

References

  1. Ohayan MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6:97-111.
  2. Soares CN. Insomnia in women: an overlooked epidemic? Arch Womens Ment Health. 2005;8:205-213.National Sleep Foundation (NSF). Sleep in America poll. 2005.
  3. Knutson, KL. The association between pubertal status and sleep duration and quality among a nationally representative sample of U.S. adolescents. Am J Hum Biol. 2005;17:418-424.
  4. Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol. 2000;95:14-18.
  5. Lee KA, Gay CL. Sleep in late pregnancy predicts length of labor and type of delivery. Am J Obstet Gynecol. 2004;191:2041-2046.
  6. Leger D, Scheuermaier K, Paillard M, et al. SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosom Med. 2001;63:49-55.
  7. Steiner M, Fairman M, Jansen K, Causey S. Can postpartum depression be prevented? Abstract presented at: The Marce Society, Sydney, Australia, September 2002.
  8. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA. 1989;262:1479-1484.
  9. Riemann D, Voderholzer U. Primary insomnia: a risk factor to develop depression? J Affect Disord. 2003;76:255-259.
  10. Mai, E. and Buysse, D., Insomnia: Prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep Med Clin. 2008;3(2):167-174.
  11. Knutson, KL. The association between pubertal status and sleep duration and quality among a nationally representative sample of U.S. adolescents. Am J Hum Biol. 2005;17:418-424.
  12. Hyyppa MT, Kronholm E. Quality of sleep and chronic illnesses. J Clin Epidemiol. 1989; 42:633-638.
  13. Ohayon MM. Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psychiatr Res. 1997;31:333-346.
  14. Buysse D, Reynolds C, Kupfer D, et al. Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep. 1994;17:630-637.
  15. Katz DA, McHorney CA. Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med. 1998;158:1099-1107.
  16. Sutton DA, Moldofsky H, Bradley EM. Insomnia and health problems in Canadians. Sleep 2001;24:665-670.
  17. Morgan K, Clarke D. Risk factors for late-life insomnia in a representative general practice sample. Br J Gen Pract. 1997;47:166-169.
  18. Roth T, Roehrs T. Insomnia: epidemiology, characteristics, and consequences. Clin Cornerstone. 2003;5:5-15.
  19. Schweitzer PK, Engelhardt CL, Hilliker NA, Muehlback MJ, Walsh JK. Consequences of reported poor sleep. Sleep Res. 1992;21:260
  20. Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry. 1997;154:1417-1423.