Many people who develop insomnia may find symptoms persist for several years, a recent study suggests. Researchers followed 3,073 middle-aged adults (mean age 48.1 years) over five years, assessing sleep at baseline and during annual checkups. At baseline, 1,717 participants (55.8%) were good sleepers; 818 people (26.6%) had subsyndromal insomnia; and 538 (17.5%) had insomnia syndrome. Among participants who were good sleepers at baseline, 13.9% developed insomnia during the study. In addition, 37.5% of individuals who reported insomnia at baseline also reported insomnia at each of the five annual follow-up assessments. "Everyone is at risk to experience situational insomnia in some stressful situations such as the pandemic, and most people resume their normal sleep patterns after the initial triggering events goes away," said lead study author Charles Morin, a professor of behavioral sleep medicine at Laval University in Quebec, Canada. "However, other people - and those who are most vulnerable to begin with - may develop poor sleep habits and unhelpful thinking patterns that may be helpful in the short term but in the long-run may perpetuate the sleep problems," Morin said by email. When people started out as good sleepers, they were 4.3 times more likely to remain good sleepers in the following year, the study found. But if they did develop insomnia, they were just as likely to report insomnia (47% probability) a year later as they were to return to good sleeper status (53% probability). Once people did have insomnia at an annual assessment, they were more likely to report insomnia a year later (odds ratio 1.60) than to improve. Even when people who reported insomnia one year had improved a year later, they were still more likely to report insomnia again at the next annual checkup than to remain in remission (OR 2.04), according to the results published in JAMA Network Open. Researchers used annual surveys to assess insomnia and sleep problems, lifestyle and work schedules, mental health, physical health, medication and substance use. Among the assessments, the Insomnia Severity Index and the Pittsburgh Sleep Quality Index were used to determine whether participants had subsyndromal insomnia or insomnia. One limitation of the study is that sleep information was self-reported, and not independently verified. It's also possible that because many people in the study had comorbidities that could impact sleep, that the results might not be generalizable to a broader population. "There may be additional factors that increase the likelihood of chronic insomnia, such as the nature of medical comorbidity, however these results support the notion that mild insomnia symptoms and insomnia syndrome are likely to be different," said Nathan Cross, a researcher at Concordia University in Montreal, Canada, who wasn't involved in the study. Even so, the results underscore the importance of clinicians taking insomnia symptoms seriously, particularly when symptoms are acute or severe, Cross said by email. "Due to the association with medical comorbidity, it is important to intervene early with evidence-based approaches aimed at treating the insomnia, rather than assume that the symptoms will improve on their own," Cross said. "While important for all individuals, this would be particularly crucial in older adults, as we are becoming aware that sleep disturbances in the elderly can at least contribute to cognitive decline." —Lisa Rapaport Source
