Self-reported sleeplessness in 12,655 persons living in the north of Norway: The Tromsø Study

INTRODUCTION

Insomnia symptoms are frequent health problems in the general adult population, in which approximately one-third complains about insomnia symptoms, while 10-20% meet the more stringent diagnostic criteria for chronic insomnia[1]. Insomnia symptoms generally increase with age[2], and are more commonly reported by women than men[3] ^, [4]. The reasons for this gender difference are still unclear, but it is known that important biological events, often mediated by hormones and physiological changes, are associated with insomnia in women[5]. Over the last decades, the reported prevalence of insomnia symptoms has risen steadily for both men and women[6] ^, [7], and it is expected to increase even further in response to the ageing of the population[8].

During the last decades there have established certain relationships between insomnia symptoms and medical as well as psychological health: Health-related quality of life is strongly influenced by insomnia symptoms[9] and poor sleep has substantial negative economic impacts on both individuals and society[10] ^, [11]. In Germany, Hajak[12] found that severe degree of insomnia symptoms impaired individuals' perceived health even more than long-standing physical illness. Furthermore, strong associations have been reported between insomnia symptoms and poor mental health, psychological distress, anxiety, and depressive symptoms[13] ^, [14], and patients with mood disorders have increased rates of primary sleep disorders, obstructive sleep apnoea (OSA), and daytime fatigue[15]. Other common determinants that are associated with insomnia symptoms include obesity, stress, poor perceived mental health, anxiety, psychiatric disorders, and low socioeconomic status[16] ^, [17]. In a large national survey from Finland, individuals who had low household income levels, were unemployed, or were disabled retirees were most likely to report poor sleep[18].

Definitions of insomnia symptoms vary among studies[19]. For the most part, inclusion criteria are neither uniform nor relate to prevailing diagnostic systems[20] ^, [21]. This might reflect both the difficulties in measuring sleep and the subjective nature of insomnia symptoms. Consequently, comparing results among studies with such varying definitions is often complicated. Rates of insomnia symptoms, without regard to specific sleep diagnosis, also vary across studies[21]. In a recent update of the European guidelines for insomnia[1], it is stated that the diagnostic work-up for insomnia should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors and impaired daytime functioning), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated. As the present study does not provide the necessary data to diagnose insomnia according to these guidelines, we found it appropriate to use the term "self-reported sleeplessness" to describe the sleep difficulties in this study. Findings from other studies with various methodology, also not in adherence to present guidelines for diagnosing insomnia, we chose to refer to as "insomnia symptoms".

The primary aim of this large population-based cross-sectional study was to assess the prevalence of self-reported sleeplessness in a large and representative population sample in the north of Norway. A secondary aim was to analyse the possible associations between age, gender, living alone or with a spouse, level of education, employment status, income, smoking, alcohol consumption, body mass index (BMI), levels of self-reported health, and psychological distress on self-reported sleeplessness.

Publication History

Received: 27 September 2018

Accepted: 14 May 2019

Article published online:
31 October 2023

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