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VOLUME 35, ISSUE 12

PROSPECTIVE ASSESSMENT OF NOCTURNAL AWAKENINGS IN TREATMENT-SEEKING INSOMNIA PATIENTS
Prospective Assessment of Nocturnal Awakenings in a Case Series of Treatment-Seeking Chronic Insomnia Patients: A Pilot Study of Subjective and Objective Causes

http://dx.doi.org/10.5665/sleep.2244

Barry Krakow, MD1,2,3; Edward Romero, BS4; Victor A. Ulibarri, BA1,2; Shara Kikta2

1Sleep and Human Health Institute, Albuquerque, New Mexico; 2Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico; 3University of New Mexico Health Sciences Center, Departments of Emergency Medicine and Psychiatry, Albuquerque, New Mexico; 4University of New Mexico School of Medicine, Albuquerque, New Mexico



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Background:

The cause of nocturnal awakenings in patients with chronic insomnia is rarely researched. This study prospectively assessed the etiology of nocturnal awakenings (subjectively and objectively) among patients with insomnia at a private, community-based sleep medical center.

Methods:

Twenty adult patients with chronic insomnia enrolled between April 2008 and February 2010 met diagnostic criteria for an insomnia disorder, never previously visited a sleep specialist or underwent sleep testing, and reported no classic sleep disordered breathing symptoms. Patients completed validated scales for insomnia, sleepiness, impairment, anxiety, depression, and quality of life, a qualitative interview to assess subjective reasons for awakenings, and a diagnostic sleep study to objectively assess awakenings and their precipitants.

Results:

Subjective and objective data showed clinically meaningful insomnia, primarily sleep maintenance insomnia. The most common self-reported reasons for awakenings were: uncertain cause (50%), nightmares (45%), nocturia (35%), bedroom distractions (20%), or pain (15%). No patient identified breathing symptoms as a cause. Objectively, 531 awakenings were observed in the total sample, and 478 (90%) were preceded by sleep breathing events (apnea, hypopnea, or respiratory effort-related event). Fifty-three awakenings were caused by other factors (independent leg jerks [7], spontaneous [14], and sleep that was laboratory-induced [32]). Thirty awakenings ≥ 5 min—a duration sufficient to predispose toward an insomnia episode—were each preceded by a breathing event.

Conclusions:

Among patients with insomnia with no classic sleep breathing symptoms and therefore low probability of a sleep breathing disorder, most of their awakenings were precipitated by a medical condition (sleep disordered breathing), which contrasted sharply with their perceptions about their awakenings.

Citation:

Krakow B; Romero E; Ulibarri VA; Kikta S. Prospective assessment of nocturnal awakenings in a case series of treatment-seeking chronic insomnia patients: a pilot study of subjective and objective causes. SLEEP 2012;35(12):1685-1692.

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