Department of Psychology, Brooklyn College and the Graduate Center of the City University of New York, New York 11210, USA.
J Affect Disord. 2012 May;138(3):192-212. doi: 10.1016/j.jad.2011.05.014. Epub 2011 Jun 8.
Chronic insomnia, a public health crisis affecting 10-15% of the U.S. population and costing billions of dollars annually, typically presents with one or more comorbid psychiatric or organic conditions. Historical classification of chronic insomnia as "secondary" to a presenting comorbid condition has resulted in under-recognition and under-treatment of both the insomnia and comorbid condition(s). Though critical in any model of comorbid disease management, chronic insomnia receives little, if any, public policy attention.
We conducted a systematic review of recent empirical studies, review papers, books, government documents, press releases, advertisements, and articles pertaining to the classification, epidemiology, treatment, and physiology of sleep, insomnia, and comorbid conditions. Data were located primarily through MEDLINE, PsycINFO, SCOPUS, and PUBMED databases.
Our goal was to provide an overview of the systems for classifying insomnia and available epidemiological data, and to review theoretical models regarding the etiology and maintaining factors of chronic insomnia along with research on the complex, bidirectional associations between chronic insomnia and various affective (and other) conditions.
After thorough review of the literature, we propose several public policy measures as an initial step in managing chronic insomnia in the United States. These include introducing a nation-wide multi-modal educational and awareness campaign titled "Sleep America;" increasing the availability and demand for behavioral sleep medicine - the initially preferred treatment approach; and increasing the use of monitoring and enforcement activities by regulatory authorities to curtail false and misleading claims by sponsors of supplements or treatments for insomnia. Through the adoption of such measures, we hope to galvanize a national interest in healthy sleep and the evidence-based treatment of chronic insomnia.
慢性失眠是一种公共健康危机，影响了美国 10-15%的人口，每年造成数十亿美元的损失，通常表现为一种或多种合并的精神或器质性疾病。慢性失眠的历史分类为“继发于现有合并症”，导致对失眠和合并症的识别和治疗不足。尽管在任何合并疾病管理模型中都至关重要，但慢性失眠几乎没有得到公共政策的关注。
我们对最近的实证研究、综述文章、书籍、政府文件、新闻稿、广告和与睡眠、失眠和合并症的分类、流行病学、治疗和生理学相关的文章进行了系统回顾。数据主要通过 MEDLINE、PsycINFO、SCOPUS 和 PUBMED 数据库检索。
我们的目标是提供一个关于失眠分类和现有流行病学数据的概述，并回顾关于慢性失眠的病因学和维持因素的理论模型，以及关于慢性失眠与各种情感（和其他）状况之间复杂、双向关联的研究。
在对文献进行彻底审查后，我们提出了几项公共政策措施，作为在美国管理慢性失眠的初始步骤。这些措施包括发起一项名为“睡眠美国”的全国性多模式教育和宣传活动；增加行为睡眠医学的可用性和需求，这是最初首选的治疗方法；并增加监管机构监测和执法活动，以遏制睡眠障碍补充剂或治疗赞助商的虚假和误导性声明。通过采取这些措施，我们希望激发人们对健康睡眠和慢性失眠的循证治疗的兴趣。
