An international survey of insomnia: under-recognition and under-treatment of a polysymptomatic condition

Background: Due to its high prevalence, considerable impact on well-being, and high medical and societal costs, insomnia represents an important healthcare challenge. Despite this, the prevalence of this condition is underrecognized and many sufferers do not receive adequate treatment. Objective: This international survey investigated the prevalence and characteristics of insomnia in the general population in France, Italy, Japan and the USA to better understand why insomnia is under-recognized and under-treated. Research design and methods: Type, frequency, natural history of night- and day-time symptoms, and attitudes of people regarding the nature and treatment of insomnia was quantitatively assessed from a representative sample of the general population aged > 18 years in each of the four countries. A survey of an extensive series of standardized 10-15-min interviews was conducted over the telephone by professional interviewers. Results: Insomnia was reported by 37.2% of respondents in France and Italy, 6.6% in Japan, and 27.1% in the USA. The mean number of symptoms reported per patient was two, with sleep maintenance insomnia the most predominant symptom (73%), followed by difficulty falling asleep (61%), and poor sleep quality (48%). Daytime fatigue and impaired concentration and attention were the most commonly reported next-day symptoms as a result of poor sleep. The majority of individuals with sleep problems reported being 'somewhat' or 'very' bothered by their symptoms, and reported that their sleep problems impacted on their daily quality of life either 'somewhat' or 'a lot'. Among individuals with a history of insomnia, the rate of reporting insomnia symptoms to physicians was generally low and of those who did consult a physician, few were prescribed any medication. Conclusions: The results of this study suggest that in Europe, Japan and the USA, the burden of insomnia on sufferers is considerable. Many respondents took no action to alleviate their insomnia symptoms despite the poor sleep impacting on their daily quality of life either 'somewhat' or 'a lot'.