At any given time, over forty percent of us report difficulty getting to sleep or staying asleep during attempted sleep periods. Despite the huge numbers that these percentages imply, individuals with clinical insomnia form a much smaller subset of those reporting insomnia. So what about all of those highly frustrated individuals reporting insomnia that do not meet the criteria of a clinical insomnia subclass? It turns out that if they were put through a systematic process, many would show indications of other common sleep disorders in tandem with maladaptive beliefs and behaviors associated with sleep. Some would, indeed, present with clinical insomnia.
The process of addressing insomnia complaints requires first ruling out other common sleep disorders with overlapping symptoms. This includes obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movement disorder (PLMD) and many other possible disorders. If any of these disorders are suspected they must be addressed as a priority even while continuing the investigative process of identifying OTHER contributions to insomnia, such as medication use, hyperarousal, circadian mistiming, or maladaptive behaviors. In practice— all of the components that contribute to insomnia, including other medical conditions, should be addressed.
