PRIMARY INSOMNIA (PI) IS A PREVALENT AND SERI- OUS HEALTH CONCERN CHARACTERIZED BY COM- PLAINTS OF CHRONIC NOCTURNAL SLEEP disturbance

599 PRIMARY INSOMNIA (PI) IS A PREVALENT AND SERIOUS HEALTH CONCERN CHARACTERIZED BY COMPLAINTS OF CHRONIC NOCTURNAL SLEEP disturbance and associated daytime impairment occurring in the absence of any contributory medical or psychiatric condition. Current evidence suggests that 1% to 2%1,2 of the general population and approximately 20%3,4 of patients encountered in clinical settings suffer for this form of sleep difficulty. Since PI persists in the absence of medical/psychiatric causes, there is, perhaps, a temptation to minimize the seriousness of this condition. However, epidemiologic studies show PI substantially increases health care utilization/costs and absenteeism from work among affected individuals.3,5,6 Also, numerous studies have shown that PI dramatically increases risks for depressive illness even after other significant predictors are statistically controlled.7-9 In addition, PI contributes to reduced productivity, work-related accidents, increased alcohol consumption, serious falls among the elderly, and a general sense of being in poor health.10-14 Anecdotal observations suggest that PI sufferers are well aware of their day-to-day impairment. Indeed, clinical observations suggest such patients commonly view themselves as sleepy, fatigued, cognitively impaired, and generally not as “mentally sharp” as they recall themselves to be prior to the onset of their sleep difficulties. Despite such common reports, laboratory-based studies conducted with PI sufferers have shown that the daytime deficits of such individuals are rather elusive and difficult to document phenomena. In fact, in a recent summary prepared for the 2005 NIH State-of-the-Science Conference on the Manifestations and Management of Chronic Insomnia in Adults, Bonnet15 noted that studies of daytime psychomotor deficits among PI sufferers have produced significant findings at no better than chance levels. Given such mixed findings, some researchers have attributed PI sufferers’ diurnal complaints to such traits as their dysfunctional beliefs about the impact of insomnia on functioning16 or excessive self-focus17 rather than to any “real” or measurable daytime impairment. Rapid publication