Management of insomnia in the neurology consultation of a multidisciplinary sleep unit

This study analyses the most common types of insomnia and comorbidities in patients referred to our sleep unit's neurology consultation, and how these patients are managed.

We conducted a retrospective, observational, descriptive study of consecutive patients diagnosed with insomnia at our hospital's sleep unit between January and December 2023, inclusive.

Of the 200 patients registered in 2023, 127 (63.5%) were diagnosed with insomnia. Of these, 64 were women (50.39%) and 63 were men (49.60%), with a mean age of 53.24 years (SD: 15.372). In our sample, the main aetiology or associated comorbidity of insomnia according to the American Academy of Sleep Medicine classification (insomnia associated with mental illness, medical illness, and other sleep disorders) was as follows: 77 patients (60.62%) with active mental disorder at the time of the consultation (anxiety, dysthymia, depression, hyperalertness/stress/rumination) and 30 patients with insomnia associated with a medical illness. The following sleep comorbidities were observed: periodic leg movements (n = 9), restless legs syndrome (n = 15), and obstructive sleep apnoea (n = 45). Of the 31 patients with insomnia associated with medical disorders, 16 also presented reactive anxiety/depression that contributed to the persistence or worsening of insomnia. Of the total 127 patients, 77 patients had insomnia associated with a mental condition, and 16 had insomnia secondary to both medical and mental conditions (73.22%).

Insomnia associated with mental conditions (depression, anxiety, dysthymia) is the most common type of insomnia. Its prevalence has increased since the COVID-19 pandemic, and now accounts for two-thirds of the patients assessed at the neurology consultations of sleep units. Idiopathic insomnia accounts for barely one-tenth of cases. Patients with chronic insomnia would benefit from initial assessment by mental health professionals, who are able to diagnose the most prevalent comorbidities and triggers, as well as other disorders that are frequently overlooked by other professionals. This approach would also improve the identification of patients eligible for cognitive-behavioral therapy, the first line of treatment for insomnia according to clinical guidelines, ultimately improving patient care and healthcare resource management.