Insomnia current diagnosis: an appraisal


  • Philippe Joaquim Oliveira Menezes Macêdo INDC-UFRJ
  • Gisele Schenkel de Moura Leite Neves
  • Dalva Lucia Rollemberg Poyares
  • Marleide da Mota Gomes



Insomnia, comorbid insomnia, short sleep duration.


Chronic insomnia is the most common sleep disorder in adults and its diagnosis is fundamental for adequate clinical management. The aim of this paper is to present recently published definitions of insomnia according to current international classifications, such as the
International Classification of Sleep Disorders -- Third Edition and the Diagnostic and Statistical Manual of Mental Disorders -- Fifth Edition. For the first time, these classifications are congruent related to their diagnostic criteria; both present insomnia as a distinct disorder and
divide it into acute, chronic and other. This emphasizes the necessity of a specific insomnia approach. Furthermore, it is necessary to recognize those insomniacs with physiological hyperarousal, which
may be identified by objective measures (short total sleep time, for instance). These patients may have poorer outcome, as they are at higher risk of developing cardiometabolic conditions and neurocognitive
impairment. Diagnosis is primarily made on a clinical basis (anamnesis and physical examination), while sleep diaries and questionnaires (such as Insomnia Severity Index) can help evaluate these patients. Objective measures, such as polysomnography, are not required in most cases, except when suspicion of another sleep
disorder arises.