CoChat
Sign Up
Cited by 148Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population

Open access
Seow, Lee Seng Esmond, Verma, Swapna Kamal, Mok, Yee Ming, Kumar, Sunita, Chang, Sherilyn, Satghare, Pratika, Hombali, Aditi, Vaingankar, Janhavi +2 more·2018·Journal of Clinical Sleep Medicine
DOI 10.5664/jcsm.6942PMC PMC5786843
Open this paper in CoChat — free accountOpen PDF

Abstract

Study Objectives: With the introduction of insomnia disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), greater emphasis has been placed on the diagnosis and treatment of sleep disorder even in the presence of a coexisting mental disorder. The current study seeks to explore the clinical picture of insomnia in the context of psychiatric disorders commonly associated with sleep complaints by assessing the prevalence and correlates of DSM-5 insomnia disorder, and examining the extent to which insomnia symptoms have been addressed in this population. Methods: Four hundred treatment-seeking outpatients suffering from depressive, bipolar affective, anxiety, and schizophrenia spectrum disorders were recruited. DSM-5 insomnia was established using the modified Brief Insomnia Questionnaire. Differences in sociodemographic factors, clinical status, impairment outcomes, and mental health services utilization were compared. Information on patients’ help-seeking experiences for insomnia-related symptoms was collected to determine the treatment received and treatment effectiveness. Results: Almost one-third of our sample (31.8%) had DSM-5 insomnia disorder. Those with insomnia disorder had significantly higher impairment outcomes than their counterparts but no group difference was observed for mental health services utilization. Findings based on past treatment contact for sleep problems suggest that diagnosis and treatment of insomnia is lacking in this population. Conclusions: With the new calling from DSM-5, clinicians treating psychiatric patients should view insomnia less as a symptom of their mental illnesses and treat clinical insomnia as a primary disorder. Patients should also be educated on the importance of reporting and treating their sleep complaints. Nonmedical (cognitive and behavioral) interventions for insomnia need to be further explored given their proven clinical effectiveness.

Integrity signals

Registry

Crossref · 10.5664/jcsm.6942

Cites

54 of 54 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

3 of 23 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Because clinical manifestations are similar, sleep disorders may often be mistakenly attributed to the patient's primary psychiatric condition.

    “Because the clinical manifestations are similar, sleep disorders may often be mistakenly attributed to the patient's primary psychiatric condition.46”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [46] Stores G. Misdiagnosing sleep disorders as primary psychiatric conditions. Adv Psychiatr Treat. 2003;9(1):69–77. source
  • Findingown data

    DSM-5 insomnia disorder was more prevalent among those who had a low physical activity level.

    “It was more prevalent among the younger age group (21 to 39 years), the unemployed, those who had low physical activity level, those who had a secondary psychiatric diagnosis, and those who were on sleep medications.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the current study, those with current DSM-5 insomnia disorder had significantly worse well-being than those without.

    “In the current study, those with current DSM-5 insomnia disorder were found to have significantly higher impairment outcomes in terms of functioning, well-being, and daytime fatigue than those without.”
    Quote in the paperSubstantial claim
  • Findingown data

    Those with DSM-5 insomnia disorder had significantly higher impairment outcomes in areas of functioning, well-being, and daytime fatigue compared to those without insomnia disorder.

    “Those with insomnia disorder had significantly higher impairment outcomes than their counterparts”
    • Also stated in: § Impairment Outcomes and Mental Health Services Utilization in the Past Year · plain
      “Table 3 shows that those with insomnia disorder had significantly higher impairment outcomes in areas of functioning, well-being, and daytime fatigue compared to those without.”
    Quote in the paperSubstantial claim
  • Findingown data

    A total of 91.0% of patients (n = 182) were prescribed psychotropic medications or sleeping pills to aid them in their sleep.

    “A total of 91.0% of patients (n = 182) were prescribed psychotropic medications or sleeping pills to aid them in their sleep, of which 74.2% (n = 135) found the drug treatment to be helpful but to varying extent.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients' self-reported past help-seeking experiences and treatment effectiveness accurately reflect the diagnosis and treatment they received for insomnia-related sleep problems.
  • Classified as probably not a substantial claim. 7
  • May combine two claims. 11

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The use of psychological and behavioral therapies such as cognitive behavioral therapy or combined treatment with drug intervention to treat chronic insomnia has been strongly advocated in medical practice.

    “The use of psychological and behavioral therapies such as cognitive behavioral therapy or combined treatment with drug intervention to treat chronic insomnia has been strongly advocated in medical practice.1,47”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [1] Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med. 2008;4(5):487–504. source

      The Psychological and Behavioral Therapies section recommends behavioral interventions, including CBT-I, as initial treatment for chronic insomnia. The guideline permits combining them with medication, particularly when initial treatment has been ineffective, but the Combined Therapy for Insomnia section says the evidence is mixed and shows no clear advantage over CBT alone. Thus, describing combined treatment as strongly advocated overstates the guideline. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [47] Siebern AT, Suh S, Nowakowski S. Non-pharmacological treatment of insomnia. Neurotherapeutics. 2012;9(4):717–727. source

      The “Cognitive Behavioral Therapy for Insomnia: Evidence of Effectiveness” section (page unavailable) says NIH and sleep-medicine practice parameters recommend CBTI as a standard treatment. It discusses trials of CBTI combined with medication, but does not say combined treatment is strongly advocated; it reports that CBTI alone maintained improvements better at follow-up. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The prevalence of DSM-5 insomnia was highest among those with depressive disorder (45.0%), followed by anxiety disorder (33.0%), schizophrenia spectrum disorder (25.0%), and bipolar disorder (23.8%).

    “The prevalence of DSM-5 insomnia was highest among those with depressive disorder (45.0%), followed by anxiety disorder (33.0%), schizophrenia spectrum disorder (25.0%), and bipolar disorder (23.8%).”
    • Also stated in: § DSM-5 Insomnia Disorder · plain
      “Our findings revealed decreasing DSM-5 insomnia disorder prevalence across major depressive disorder (45.0%), followed by anxiety disorders (33.0%), schizophrenia spectrum disorder (25.0%), and bipolar affective disorder (23.8%).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Hong Kong-modified Brief Insomnia Questionnaire validly identifies DSM-5 insomnia disorder in this Singapore psychiatric outpatient sample.

  • May combine two claims.

    Findingown data

    Common concerns about drug treatment were daytime drowsiness (n = 23), nonsustained effectiveness (n = 21), and drug dependence (n = 18).

    “Common concerns were, however, daytime drowsiness (n = 23), nonsustained effectiveness (n = 21), and drug dependence (n = 18).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients' self-reported past help-seeking experiences and treatment effectiveness accurately reflect the diagnosis and treatment they received for insomnia-related sleep problems.

  • May combine two claims.

    Findingown data

    There were significant differences for both difficulty initiating and maintaining sleep across the four psychiatric disorders (P < .001).

    “In terms of the nature of sleep difficulties, chi-square analyses revealed only significant differences (P < .001)for both difficulty initiating and maintaining sleep across the four psychiatric disorders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Those with insomnia disorder had higher mental health services utilization than those without, despite being nonsignificant.

    “Despite being nonsignificant, those with insomnia disorder had higher mental health services utilization than those without.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the current study, mental health services utilization in the past year among those with DSM-5 insomnia disorder was higher but not significantly higher than among those without.

    “Yet, the mental health services utilization in the past year among them was higher but not significantly higher, compared to their counterparts.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The DSM-5 change in sleep-wake diagnostic criteria advocates for the treatment of insomnia itself in addition to the medical or psychiatric disorder.

    “This significant change in the sleep-wake diagnostic criteria in recognition of the comorbid nature of insomnia also advocates for the treatment of insomnia itself in addition to the medical or psychiatric disorder.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Reynolds CF, O'Hara R DSM-5 Sleep-wake disorders classification: overview for use in clinical practice. Am J Psychiatry. 2013;170(10):1099–1101. source

  • May combine two claims.

    Interpretationown data

    Diagnosis and treatment of insomnia is lacking in this psychiatric population.

    “Findings based on past treatment contact for sleep problems suggest that diagnosis and treatment of insomnia is lacking in this population.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Patients' self-reported past help-seeking experiences and treatment effectiveness accurately reflect the diagnosis and treatment they received for insomnia-related sleep problems.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Nord-Trøndelag Health Study established an adjusted DSM-5 insomnia prevalence of 7.9% among a general adult population in Norway.

    “The Nord-Trøndelag Health Study has established an adjusted DSM-5 insomnia prevalence of 7.9% among a general adult population in Norway, 33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Uhlig BL, Sand T, Odegard SS, Hagen K. Prevalence and associated factors of DSM-V insomnia in Norway: the Nord-Trondelag Health Study (HUNT 3). Sleep Med. 2014;15(6):708–713. source

  • May combine two claims.

    Interpretationcitation

    Both the Norway and Hong Kong prevalences were lower than the reported prevalence of 31.8% in this psychiatric outpatient sample.

    “both of which were lower than our reported prevalence of 31.8% in a psychiatric outpatient sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The weighted prevalence of DSM-5 insomnia in the Hong Kong population was 10.8%.

    “whereas the weighted prevalence in Hong Kong population was found to be 10.8%, 34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Chung KF, Yeung WF, Ho FY, Yung KP, Yu YM, Kwok CW. Cross-cultural and comparative epidemiology of insomnia: the Diagnostic and statistical manual (DSM), International classification of diseases (ICD) and International classification of sleep disorders (ICSD). Sleep Med. 2015;16(4):477–482. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Studies in community-based and nonpsychiatric clinical samples have found a high proportion of 40% to 60% of individuals with insomnia to suffer from mainly depression or anxiety disorder.

    “Studies in community-based and nonpsychiatric clinical samples have also found a high proportion of 40% to 60% of individuals with insomnia to suffer from mainly depression or anxiety disorder, among other mental”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The low rate of diagnosis for insomnia may be due to clinicians attributing patients' sleep problems to their psychiatric or other medical disorders and possible recall bias.

    “This low rate of diagnosis for insomnia may be due to clinicians' attribution of the patients' sleep problems to be secondary to their psychiatric or other medical disorders and possible recall bias.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Ogbolu et al. found ICD-10 nonorganic insomnia to be more prevalent among those with major depression (n = 15, 33.3%), followed by bipolar affective disorder (n = 6, 24.0%), anxiety and other neurotic disorders (n = 3, 18.8%), and schizophrenia (n = 7, 10.6%) using diagnostic groups of smaller sample size.

    “Ogbolu et al., 32 however, found International Classification of Diseases, Tenth Revision nonorganic insomnia to be more prevalent among those with major depression (n = 15, 33.3%), followed by bipolar affective disorder (n = 6, 24.0%), anxiety and other neurotic disorders (n = 3, 18.8%), and schizophrenia (n = 7, 10.6%) using diagnostic groups of smaller sample size.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Ogbolu RE, Aina OF, Famuyiwa OO, Erinfolami AR. A study of insomnia among psychiatric out-patients in Lagos Nigeria. J Sleep Disord Ther. 2013;2012. source

  • May combine two claims.

    Study design and conductreasoning

    The study did not assess sleep disorders other than insomnia, which may have influenced variables such as daytime sleepiness and functioning.

    “We did not assess these sleep disorders other than insomnia, which may have influenced some of the variables studied, such as daytime sleepiness and functioning.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The current study was conducted in a single clinical setting within Singapore and adopted a convenient sampling strategy that recruited only patients with specific mental diagnoses, limiting the generalizability of findings to a larger population of psychiatric patients.

    “The current study was conducted in a single clinical setting within Singapore and has adopted a convenient sampling strategy that recruited only patients with specific mental diagnoses, thus limiting the generalizability of our findings to a larger population of psychiatric patients.”
    Quote in the paperNot a substantial claim
16 of 16

  • The paper relies on this without support.

    Patients' self-reported past help-seeking experiences and treatment effectiveness accurately reflect the diagnosis and treatment they received for insomnia-related sleep problems.

    “A semistructured questionnaire was used to collect information on patients' past help-seeking experience for any lifetime insomnia-related sleep problems with a health care professional.”
    “Only 12.5% of patients (n = 25) recalled being informed of their insomnia diagnosis by their doctors and only 12.0% of patients (n = 24) recounted being educated on sleep hygiene or receiving any form of psychotherapy for their sleep problems.”

  • The paper relies on this without support.

    The Hong Kong-modified Brief Insomnia Questionnaire validly identifies DSM-5 insomnia disorder in this Singapore psychiatric outpatient sample.

    “The current study adopted the Hong Kong-modified BIQ and a diagnosis of DSM-5 insomnia disorder was given if all the following criteria were met:”
    “Additional items were later added and validated in the Hong Kong population to generate insomnia diagnosis according to the DSM-5.24”

  • The paper relies on this without support.

    Treating insomnia as a disorder itself helps alleviate concurrent psychiatric symptoms.

    “which has been shown to help alleviate concurrent psychiatric symptoms.”

  • The paper relies on this without support.

    Nonmedical (cognitive and behavioral) interventions for insomnia have proven clinical effectiveness.

    “Nonmedical (cognitive and behavioral) interventions for insomnia need to be further explored among psychiatric patients given their proven clinical effectiveness.”

  • The paper relies on this without support.

    Other sleep disorders such as obstructive sleep apnea may be responsible for poor sleep.

    “As other sleep disorders such as obstructive sleep apnea may also be responsible for poor sleep, referral to a sleep specialist for further evaluation should be considered.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Bech P. Measuring The Dimensions of Psychological Well-Being by the WHO-5. QoL Newsletter. 2004;32:15–16.

Cited by

Sorted by citations

Related

Authors
Seow, L. S. E., Verma, S. K., Mok, Y. M., Kumar, S., Chang, S., Satghare, P., Hombali, A., Vaingankar, J., Chong, S. A., & Subramaniam, M.
Affiliations
  • Institute of Mental Health (SG)
  • Loyola University Chicago (US)
ORCID
Venue
Journal of Clinical Sleep Medicine
Publisher
Springer Science and Business Media LLC
Published
2018-02-15
Volume
14
Issue
2
Pages
237-244
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
DOI
10.5664/jcsm.6942
PMC
PMC5786843
OpenAlex
W2787326024
Cited by
148
References
54
Citations by year
2026: 16 · 2025: 36 · 2024: 26 · 2023: 24 · 2022: 17 · 2021: 10 · 2020: 11 · 2019: 4 · 2018: 4
FWCI
9.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
World Health Organization
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords
insomnia, DSM-5, mental illness, insomnia prevalence, functional disability, mental health service utilization, insomnia treatment, cognitive behavioral therapy for insomnia, depression, bipolar disorder, anxiety disorders, schizophrenia spectrum disorders
MeSH terms
Adult, Aged, Anxiety Disorders, Mental Disorders, Bipolar Disorder, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Acceptance of Health Care, Surveys and Questionnaires, Schizophrenia, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review