Treatment of insomnia – A preventive strategy for cardiovascular and mental disorders

Insomnia is defined as a difficulty initiating or maintaining sleep with daytime impairments like increased fatigue, decreased attention, and increased mood irritability for at least three nights a week for a period of 3 months. DSM 5 has established a new overarching category of insomnia disorder, thus replacing the old primary vs. secondary dichotomy.Insomnia has been traditionally viewed as a symptom or consequence of somatic or mental disorders. The last decade has seen a paradigm shift, focusing more on the question whether insomnia as an independent diagnostic entity may be predictive for other disorders/diseases, especially in the cardiovascular and mental area. There is now strong evidence that insomnia is a risk factor for cardiovascular disorders on the one hand and for mental disorders, especially depression, on the other hand. These data raise the question, whether early and adequate treatment of insomnia may be preventive for the somatic or mental sequelae of the disorder. The first-line treatment for insomnia is cognitive behavioral treatment (CBT-I) which comprises techniques like education about sleep, behavioral recommendations, relaxation training and cognitive restructuring. These techniques are usually delivered as a treatment package in one to eight sessions. CBT-I has been shown to be very effective for the treatment of insomnia. There is now also growing evidence that this type of treatment is effective in comorbid insomnia, i.e. insomnia coupled with mental or somatic disorders. First tentative data indicate that insomnia treatment may be effective as prevention for mental and somatic disorders.