All Insomnia Isn’t the Same

SR: How did you determine each participant’s type of insomnia?

Bolstad: We used the first three questions of the Insomnia Severity Index to assess the degree participants experienced each type of insomnia. This scale is widely used in sleep research and practice, and it has been validated for use with older adults.

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SR: What surprised you?

Bolstad: The biggest surprise to me was the size of the effects we found. We found medium to large effects for the relations between onset insomnia and anxiety symptoms as well as maintenance insomnia and depressive symptoms.

SR: Thoughts on whether sleep-onset insomnia is a gateway to sleep maintenance insomnia?

Bolstad: The present study was unable to test this question, though it is interesting. We conducted a follow-up analysis using a longitudinal data set, and we found a significant pathway from onset insomnia to maintenance insomnia one year later in older adults. Vivek Pillai, PhD, and colleagues (2015) also suggested that sleep onset insomnia may lead to more chronic insomnia.¹

SR: What are the clinical implications of your research?

Bolstad: Basic clinical implications of this research include the need for thorough and precise assessment of insomnia and affective disorder symptoms in older adults. For example, if an older adult patient reports symptoms of anxiety or depression, the practitioner would be wise to also assess for onset and maintenance insomnia, or vice versa.

SR: What further research should be done?

Bolstad: Our findings support the need for further clinical intervention research on older adults to determine whether assessment and intervention on specific types of insomnia result in better mental health outcomes. Further, longitudinal research exploring the causality of the relations we found would help to advance the field.

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The Study:

Bolstada CJ, Nadorffa MR. What types of insomnia relate to anxiety and depressive symptoms in late life? Heliyon. 2020 Nov 2;6(11):e05315.

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Reference:

1. Pillai V, Roth T, Drake CL. The nature of stable insomnia phenotypes. Sleep. 2015;38(1):127–38.

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