Although the epidemiology of insomnia in the general population has received considerable
attention in the past 20 years, few studies have investigated the prevalence of insomnia
using operational definitions such as those set forth in the ICSD and DSM-IV, specifying
what proportion of respondents satisfied the criteria to reach a diagnosis of insomnia
disorder.
This is a cross-sectional study involving 25,579 individuals aged 15 years and over
representative of the general population of France, the United Kingdom, Germany, Italy,
Portugal, Spain and Finland. The participants were interviewed on sleep habits and
disorders managed by the Sleep-EVAL expert system using DSM-IV and ICSD classifications.
At the complaint level, too short sleep (20.2%), light sleep (16.6%), and global sleep
dissatisfaction (8.2%) were reported by 37% of the subjects. At the symptom level
(difficulty initiating or maintaining sleep and non-restorative sleep at least 3 nights
per week), 34.5% of the sample reported at least one of them. At the criterion level,
(symptoms+daytime consequences), 9.8% of the total sample reported having them. At
the diagnostic level, 6.6% satisfied the DSM-IV requirement for positive and differential
diagnosis. However, many respondents failed to meet diagnostic criteria for duration,
frequency and severity in the two classifications, suggesting that multidimensional
measures are needed.
A significant proportion of the population with sleep complaints do not fit into DSM-IV
and ICSD classifications. Further efforts are needed to identify diagnostic criteria
and dimensional measures that will lead to insomnia diagnoses and thus provide a more
reliable, valid and clinically relevant classification.