Acute vs chronic

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Diagnosing insomnia: acute vs chronic

According to the ICD‑11, insomnia disorders are defined as:1

  • Difficulty initiating or maintaining sleep, resulting in general sleep dissatisfaction and daytime impairment
Historically, insomnia was considered to be trouble sleeping as a result of underlying conditions or lifestyle‑related behaviour.2
Recent evidence suggests that insomnia is a medical condition with underlying neurobiological dysregulation, known as hyperarousal.3
In the UK, approximately 35.0%‑38.6% of adults are affected by some sort of regular sleep disturbance and 6.8%-14.8% are predicted to have chronic insomnia.4

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Chronic insomnia is defined in the WHO ICD‑11 as:1
  • difficulty falling or staying asleep, early awakening or non‑restorative sleep which results in impaired daytime functioning or wellbeing
  • daytime symptoms which may include fatigue, low mood or irritability, malaise and cognitive impairment
  • experienced several times a week for at least 3 months
Patients with sleep‑related symptoms and no daytime impairment are not considered to have chronic insomnia1
Short-term or acute insomnia is defined in the WHO ICD‑11 as:1
  • difficulty initiating or maintaining sleep resulting in sleep dissatisfaction and some form of daytime impairment
  • less than 3 months duration

Other key diagnostic systems for insomnia include:5-7

  • International Classification of Sleep Disorders: Diagnostic and Coding Manual 3rd edition text revision (ICSD‑3‑TR)
  • Diagnostic and Statistical Manual of Mental Disorders 5th edition text revision (DSM-5-TR)
All three vary in their respective definitions of insomnia,6,7 which may explain the variation in prevalence estimates.

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Differentiating chronic insomnia from other sleep‑related disorders

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COPD: chronic obstructive pulmonary disorder; DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders 5th edition text revision; ICD-11: International Classification of Diseases 11th Revision; ICSD-3 TR: International Classification of Sleep Disorders text revision, Diagnostic and Coding Manual 3rd edition; NICE: National Institute for Health and Care Excellence; PTSD: post-traumatic stress disorder; WHO: World Health Organization

QUVIVIQ™ is indicated for the treatment of adult patients with insomnia characterised by symptoms present for at least 3 months and considerable impact on daytime functioning.24

This information is intended for UK healthcare professionals.

▼This medicine is subject to additional monitoring.

Adverse events must be reported. Healthcare professionals are asked to report any suspected adverse reactions via www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in Google Play or Apple App Store. Adverse events should also be reported to ds.safety.uk@idorsia.com

References

  1. World Health Organization (WHO). International statistical classification of diseases and related health problems (ICD) 11th revision. Available at: icd.who.int. Accessed August 2025
  2. Sharpley A L, Attenburrow M E, Cowen P J. Assessment and treatment of insomnia (including a case control study of patients with primary insomnia). Int J Psychiatry Clin Pract 1997;1(2):107-117
  3. Riemann D, Baglioni C et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017;26(6):675-700
  4. Hafner M, Romanelli R J et al. The societal and economic burden of insomnia in adults: an international study. RAND Corporation, 2023
  5. Judd B G, Sateia M J. Classification of sleep disorders, 2022. Available at: uptodate.com. Accessed August 2025
  6. Mai E, Buysse D J. Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep Med Clin 2008;3(2):167-174
  7. Morin C M, Benca R. Chronic insomnia. Lancet 2012;379(9821):1129-1141
  8. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia, June 2024. Available at: cks.nice.org.uk. Accessed August 2025
  9. Sleep Foundation. Parasomnias. Available at sleepfoundation.org. Accessed August 2025
  10. Ohayon M M. The parasomnias and other sleep-related movement disorders (Editors Thorpy M J, Plazzi G). Chapter 2 – Epidemiology of parasomnias. Cambridge University Press 2010:7-12
  11. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Obstructive sleep apnoea syndrome. Scenario: management of sleep apnoea, November 2021. Available at: cks.nice.org.uk. Accessed August 2025
  12. Parliamentary Office of Science and Technology (POST). 2018. POSTbrief 29: sleep and long-term health. Available from researchbriefings.files.parliament.uk. Accessed August 2025
  13. Sleep Foundation. Circadian rhythm disorders. Available at sleepfoundation.org. Accessed August 2025
  14. Lee E K. Circadian rhythm sleep-wake disorders (Editor Auger R R). Introduction to circadian rhythm disorders. Springer, 2020:29-43
  15. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Restless legs syndrome, August 2024. Available at: cks.nice.org.uk. Accessed August 2025
  16. NHS. Narcolepsy, December 2022. Available at: nhs.uk. Accessed August 2025
  17. Narcolepsy UK. About narcolepsy. Available from narcolepsy.org.uk. Accessed August 2025
  18. Perlis M, Shaw P et al. Models of Insomnia. In M H Kryger, T Roth, W C Dement, eds, Principles and practice of sleep medicine, 5th edition, 2010, 850-865
  19. Morin C M, Drake C L et al. Insomnia disorder. Nat Rev Dis Primers 2015;1:15026
  20. Wilson S, Anderson K et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. J Psychopharmacol 2019;33(8):923-947
  21. Riemann D, Espie C A et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023;32(6):e14035
  22. The Epworth Sleepiness Scale. Available at: nasemso.org. Accessed August 2025
  23. Morin C M, Belleville G et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011;34(5):601-608
  24. QUVIVIQ™ Idorsia Pharmaceuticals Ltd, Summary of Product Characteristics

© NICE 2023 Daridorexant for treating long-term insomnia. Available from www.nice.org.uk/guidance/ta922. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/ publication.

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UK-DA-00653 | Date of preparation: September 2025

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