Insomnia identity and its correlates in adolescents

Insomnia identity, defined as a conviction that one has insomnia, is a cognitive appraisal process that influences help-seeking, diagnosis, and treatment of insomnia. Previous studies in adults showed that about 50% of poor sleepers did not label themselves as having insomnia, while 10% of good sleepers endorsed insomnia identity. This analysis aimed to examine the proportions and characteristics of complaining and noncomplaining poor and good sleepers and the factors that determine self-labeling of insomnia in adolescents.

Data from a school-based study were analyzed. We defined insomnia identity as an endorsement of "insomnia" occurring 3-7 nights per week, while 3 criteria of poor sleep were examined. A total of 1447 students were included, the mean age was 14.5 years and 55.5% were females.

Using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to define poor sleep (insomnia symptoms ≥ 3 times per week), the proportions of complaining and noncomplaining poor sleepers were 2.3% and 8.8%, while complaining and noncomplaining good sleepers were 0.8% and 88.2%, respectively. The ratio between complaining and noncomplaining poor sleepers was 1 to 3.8. Complaining poor sleepers had the highest level of insomnia and daytime symptoms, while complaining good sleepers had the highest proportion of smokers and drinkers. Multivariate logistic regression showed that insomnia symptoms and sleep dissatisfaction were independent predictors of insomnia identity.

In view of the high proportion of noncomplaining poor sleepers, educational programs should address the under-appraisal of insomnia among adolescents.