Prognosis and Complications

Abstract

Chronic insomnia is a persistent disorder with periods of remissions and relapses. Persistence rates vary between 40 and 75 % over 1-20 years and are higher in women and older adults. Initial insomnia severity can predict the longitudinal course of this disorder and subjects with severe symptoms are three times more likely to have persistent insomnia with relapses. When left untreated, it is associated with negative psychiatric and medical outcomes, although the bidirectional relation between insomnia and these disorders is difficult to understand. Insomnia is associated with a two- to fourfold increased risk of developing depression, and this risk can be seen even up to 30 years later. Persistent insomnia can be associated with negative treatment outcomes during depression therapy, and is a risk factor for increased episodes of depression relapse and suicidal behavior. Insomnia is also associated with neurocognitive impairment, but its role as a risk factor for dementia is less clear. Insomnia is a risk factor for obesity, diabetes, hypertension, cardiac disease, and stroke, particularly when associated with short sleep duration. Insomnia is also a major public health issue and is associated with absenteeism, reduced work productivity, and increased disability, accidents, and health care costs. The indirect costs of untreated insomnia clearly outweigh the potential direct costs of treating it. Therefore, insomnia should be recognized and managed early in its course. (PsycINFO Database Record (c) 2016 APA, all rights reserved)