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CLINICAL SYNTHESIS   |    
Recent Advances in the Understanding of Insomnia
Karl Doghramji, M.D.
FOCUS 2014;12:3-8. doi:10.1176/appi.focus.12.1.3
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Author Information and CME Disclosure

Karl Doghramji, M.D., Professor of Psychiatry, Neurology, and Medicine; Medical Director, Jefferson Sleep Disorders Center; Program Director, Fellowship in Sleep Medicine, Thomas Jefferson University

Dr. Doghramji reports the following disclosures: Consultant: UCB, Jazz, Teva, Vanda; Stock: Merck.

Address correspondence to Karl Doghramji, M.D., Thomas Jefferson University, 211 South Ninth St., Suite 500, Philadelphia, PA 19107; e-mail: Karl.Doghramji@jefferson.edu

Abstract

Whereas once thought to be a benign malady, recent advances in sleep research confirm that insomnia is a common condition with a host of associated risks and consequences. Our view of insomnia is also shifting from a symptomatic complaint, to a distinct disorder with a host of psychological, neurophysiological, and genetic correlates. Recently completed longitudinal studies have also altered our view of the relationship between co-occurring insomnia and medical/psychiatric disorders, from a model of unidirectional causality to one of autonomous disorders interacting in a bidirectional fashion. These conceptual changes have served as the foundations of substantive changes in the diagnostic guidelines for insomnia in DSM−5.

Abstract Teaser
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Topics

insomnia ; sleep
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Anchor for Jump
Table 1. DSM–5 Criteria for Insomnia Disordera
Table Footer Note

Note: Acute and short-term insomnia (i.e., symptoms lasting less than 3 months but otherwise meeting all criteria with regard to frequency, intensity, distress, and/or impairment) should be coded as another specified insomnia disorder.

Table Footer Note

a Reprinted from American Psychiatric Association ( 1). Used with permission.

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References Container
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CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Changes in the diagnostic formulation of insomnia in DSM-5 include which of the following:

See Doghramji: Table 1. DSM-5 Criteria for Insomnia Disorder p 6
2.
The risk of insomnia is greatest in which of the following populations:

See Doghramji: Prevalence, p 3
3.
A 75-year old woman requests a psychiatric consultation for frequently interrupted sleep; she falls asleep readily but awakens about six times per night, getting only about 6 hours of sleep between her bedtime of 11 p.m. and rising at 8 a.m. She is apparently in good health but is fatigued and very worried about getting inadequate sleep. A sleep laboratory study revealed no sleep disorder requiring medical management. Which of the following is the first best treatment choice?

See Byrne: Behavioral Strategies of CBT-I, Sleep Restriction Treatment p 35
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