Treating the health, quality of life, and functional impairments in insomnia.

STUDY OBJECTIVES: Impairments in health, function, and quality of life (QOL) are a central feature of insomnia, yet insomnia treatment is targeted solely to improving problems falling and staying asleep. It is not even known if the nonsleep deficits improve with current treatment. We hypothesized that therapy that improves sleep also improves these nonsleep difficulties and carried out this review to test that hypothesis.

METHODS: A literature search identified the health, function, and QOL deficits of insomnia patients. A second search determined the effect of insomnia treatments on those problems, capturing randomized controlled treatment trials in insomnia patients that included relevant measures.

RESULTS: Insomnia patients report a variety of symptoms, including daytime sleepiness, fatigue, cognitive impairment, symptoms of depression, anxiety, health decrements, and impairment in social and occupational function. However, the reported deficits are generally not paralleled by objective evidence of impairment. Nineteen treatment studies reported measures related to these deficits. At least one treatment (eszopiclone [5 studies], zopiclone [2 studies], progressive muscle relaxation [2], zolpidem [2], multi-component cognitive-behavioral therapy [1], doxepin [1], valerian/hops [1], and stimulus control [1]) led to a significant improvement compared with placebo in at least one of these measures in 14/20 studies.

CONCLUSIONS: Treatment can improve the perceived health, function, and QOL of insomnia patients. This potential improvement signals the need to shift the attention of research and clinical practice to include aspects other than sleep difficulties and move towards defining successful therapy as not only improving sleep but also eliminating deficits in health, function, and QOL.