Study on the correlation between insomnia degree and quality of life in psychiatric outpatients in Chifeng city

Abstract

BACKGROUND

Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety. Chronic insomnia affects approximately 15% of the global population, with higher prevalence among females and the elderly. While existing research suggests a bidirectional relationship between insomnia and emotional disorders, the specific impact of insomnia severity on depression, anxiety, and quality of life remains unclear. This study investigates the correlation between insomnia severity and these factors in psychiatric outpatients, hypothesizing that greater insomnia severity is associated with higher levels of depression and anxiety, as well as poorer quality of life.

AIM

To explore the correlation between insomnia severity and depression, anxiety, and quality of life in primary chronic insomnia patients.

METHODS

From June to December 2023, 345 patients with primary insomnia in Chifeng city were recruited and divided into three groups based on Pittsburgh sleep quality index (PSQI) scores: Mild (n = 137), moderate (n = 162), and severe (n = 46). Demographic data were collected via questionnaires. Self-rating depression scale (SDS), self-rating anxiety scale (SAS), PSQI, and short form 36 (SF-36) scores were compared, and Pearson and partial correlation analyses were performed.

RESULTS

The greater the degree of insomnia, the greater the symptoms of depression and anxiety (P < 0.001). The more severe the insomnia, the lower the SF-36 score (excluding body pain), and the difference between the three groups was statistically significant (P < 0.001). Pearson correlation analysis and partial correlation analysis depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia (P < 0.001). Pearson correlation analysis and partial correlation analysis depicted the SF-36 scores were apparently positively correlated with the severity of insomnia (P < 0.05).

CONCLUSION

Depression and anxiety are independent factors influencing insomnia severity in primary chronic insomnia patients. Higher depression/anxiety levels correlate with worse insomnia, impacting quality of life.

Key Words: Insomnia severity; Life quality; Depression; Anxiety; Psychiatric outpatients; Correlation analysis

Core Tip: This study investigates the correlation between insomnia severity and depression, anxiety, and quality of life in psychiatric outpatients with primary chronic insomnia. Using the Pittsburgh sleep quality index, self-rating depression scale, and self-rating anxiety scale, we found that higher insomnia severity is associated with increased depression and anxiety symptoms and decreased quality of life (measured by short form 36). The findings highlight the importance of addressing emotional comorbidities in insomnia management to improve patients' overall well-being.

INTRODUCTION

With the progress of the society, the change of living and working environment, the competition, and the pressure of existence increase, the people with insomnia and anxiety also expand gradually. The number of insomnia patients is increasing each year, and China has accumulated a huge number of insomnia population[1]. According to statistics, the total prevalence of insomnia in China reaches 15.0%[2]. In the United States, about 25% of the population has reported suffering from insomnia, and 10% of them meet the diagnostic criteria for chronic insomnia. In contrast, the prevalence of insomnia in the natural population is about 10% to 15%, with an average annual incidence of about 5%[3,4]. Several studies have shown that there are differences in the prevalence of insomnia by gender, age, occupation, and level of somatic health[5]. In general, the prevalence of insomnia is significantly higher in females than in males, which may be due to the fact that females are physiologically more susceptible to fluctuations in the levels of endocrine hormones (estrogen and progesterone) and psychologically more susceptible to the effects of interpersonal relationships in the family and the community, which results in the high prevalence of insomnia in the female population[6]. Secondly, the prevalence of insomnia in the elderly is apparently higher than that of young and middle-aged people, which may be due to physiological changes in the sleep structure, increased nocturia, increased physical illnesses, and the use of certain insomnia-inducing medications, leading to difficulties in falling asleep and maintaining sleep, and the phenomenon of fragmentation of the sleep time is more common[7]. Due to the specificity of certain occupations, insomnia is more likely to occur in professionals who have been engaged in shift work, mental labor work, and those who have to bear greater mental stress. In addition, the body itself suffers from chronic pain diseases and neurological diseases, such as chronic cancer pain and anxiety. Depression symptoms of patients with insomnia incidence are more prone to ordinary healthy people[8]. Insomnia can be a predisposing factor leading to a variety of other physical and mental illnesses, jeopardizing the physical health of the patient, and bringing chronic, long-term, serious damage to the patient's mental health, forming a vicious circle[9]. Studies have shown that insomnia is a risk factor for suicidal behavior and thoughts, and neuropsychological tests have shown that insomnia patients have varying degrees of impairment in individual alertness, working memory, and attention concentration. Sleeping well is the key to the body's ability to maintain normal physiological functions and is crucial to maintaining the body's rhythm of life activities[10]. The long-term insomnia will not only lead to daytime function damage and decreased immunity, induce or aggravate cardiovascular and cerebrovascular diseases, but also affect the normal thinking of the brain, triggering anxiety, depression, and other emotional disorders. It brings great challenges to the development of society, family as well as individuals. Meanwhile, insomnia consumes more time and money, reduces social efficiency, and can cause huge economic losses[11,12]. The causes of insomnia are numerous and often the result of multiple factors. The results of many studies have shown that the causes of insomnia are mainly categorized into three main groups: Susceptibility factors, inducing factors, and persistent factors[13]. The susceptibility factors are the intrinsic basis for the occurrence of various sleep disorders and are related to an individual's gender, age, heredity, personality traits, and physical health conditions. The character traits are common potential factors that induce insomnia, and their basic characteristics are personality traits with the pursuit of perfection, obsessive-compulsive behavior, shyness, indecisiveness, and unstable emotional changes[14]. The inducing factors are the most direct causes of insomnia, such as sudden change of sleeping and living environment, sudden mental stimulation by adverse life events, and taking certain drugs that affect sleep (such as atropine, aminophylline and antipsychotics drugs)[15]. The persistent factors are the most common cause of chronic insomnia, which refers to the adverse factors that are difficult to be corrected within a short period of time and continue to affect sleep, including poor sleep hygiene habits, somatic disorders and neurological diseases, and drug dependence[16]. Those who suffer from cerebrovascular disease, hyperthyroidism, coronary heart disease, pulmonary heart disease, and urinary tract infection, in addition to the discomfort brought by the disease itself, which makes it impossible to fall asleep and sleep normally, the disease itself can further damage the neural structure of sleep, resulting in secondary pathologic insomnia. In short, all of the above reasons directly or indirectly lead to abnormalities in the structure and function of the central nervous system of sleep, or over-excitement of the autonomic nerves, or changes in central neurotransmitters, which ultimately lead to disturbances in the physiological rhythms of sleep and wakefulness, and thus lead to sleep disorders of varying degrees[17,18]. Therefore, our study intends to initially identify the current status and influencing factors of insomnia patients through the Pittsburgh sleep quality index (PSQI) scale and further investigate and analyze the possible risk factors. With the severity of insomnia in insomnia patients as the dependent variable and the possible risk factors affecting insomnia as the independent variables, univariate and multivariate logistic regression analyses were carried out to explore the degree of correlation between each factor and insomnia and to screen out the sensitive indicators that can predict the occurrence of insomnia in insomnia patients.

MATERIALS AND METHODS

General information about patients

A total of 360 patients with primary insomnia who met the inclusion criteria in Chifeng city from June 2023 to December 2023 were initially recruited. After distributing questionnaires and screening for completeness and consistency, 345 valid questionnaires were obtained and used for analysis. These 345 patients were divided into three groups according to their PSQI scores: Mild insomnia group (n = 137), moderate insomnia group (n = 162), and severe insomnia group (n = 46).

Diagnostic criteria

The western diagnostic standards of the 2017 edition of the Chinese Adult Insomnia Diagnosis and Treatment Guide of the Sleep Disorders Group of the Chinese Medical Association Neurology Branch were referred: (1) The presence of one of the following symptoms (parasomnia: Difficulty falling asleep, difficulty maintaining sleep, early waking, unwillingness to go to bed at the appropriate time); (2) There is a sleep-related impairment of daytime function (fatigue or general discomfort; impairment of social function; attention and memory impairment; irritable mood; abnormal daytime behavior; prone to errors and accidents in work and study, overly sensitive to sleep problems or dissatisfied with the quality of sleep in the near future; daytime sleepiness obvious; decreased energy and physical strength); (3) The related symptoms of sleep disorders and the related daytime symptoms caused by decreased sleep quality are difficult to explain simply from the lack of suitable sleep time or unsuitable sleep environment; (4) Frequency ≥ 3 times/week; (5) Duration of disease ≥ 3 months; and (6) Sleep and wake difficulties are not better explained by other types of sleep disorders.

Inclusion and exclusion criteria

Inclusion criteria: (1) Those who meet the above diagnostic criteria for insomnia; (2) 18 years ≤ age ≤ 65 years; (3) Patients who can clearly express their own thoughts and feelings, and patients without mental problems or intellectual disabilities; (4) Patients who have informed consent to the therapy and examination, voluntary participation and cooperation with this experiment; and (5) No other drugs and clinical trials are currently accepted.

Exclusion criteria: (1) Those suffering from major organic diseases or mental and psychological diseases; (2) Those who have recently planned to give birth or are breastfeeding or pregnant; and (3) Those who have participated in other studies that may affect the effect of this study.

Eliminate criteria: (1) Patients who cannot cooperate with therapy or quit by themselves during the intervention; (2) Patients who were treated with other drugs that may have had an impact on the study results; and (3) Patients with incomplete data affecting the validity of the study results.

Methods

The general information of the subjects [age, sex, body mass index (BMI), marriage, education, occupation, duration of disease, chronic disease] was collected through a structured questionnaire survey. The questionnaires were distributed to 360 eligible patients with primary insomnia who met the inclusion criteria in Chifeng city from June 2023 to December 2023. The questionnaires were administered both in person and via mail to ensure a wide reach and accessibility for participants. A total of 360 questionnaires were distributed, and 350 were returned, resulting in a recovery rate of 97.22%. After screening for completeness and consistency, 345 questionnaires were deemed valid for analysis, yielding an effective recovery rate of 95.83%. This high recovery rate and the rigorous screening process ensured the integrity and reliability of the data collected. PSQI: Contains 7 items, namely subjective sleep quality, sleep time, sleep time, sleep efficiency, sleep disorders, hypnotic drugs and daytime function. Each component is scored on a scale of 0-3, with higher scores associated with poorer sleep quality. According to PSQI score, chronic insomnia patients were divided into mild insomnia (5 ≤ PSQI ≤ 9), moderate insomnia (10 ≤ PSQI ≤ 14), and severe insomnia (15 ≤ PSQI ≤ 21). Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the degree of anxiety and depression of patients. The SAS and SDS scores were inverted scores, and the higher the scores, the more serious the anxiety and depression. SDS score ≤ 53 is classified as normal mood, score > 53 the higher the score is, the more serious depression mood, SAS ≤ 50 is classified as normal mood, score > 53 the higher the score is, the more serious anxiety mood. Medical outcomes study short form 36 (SF-36): A total of 36 items assessed patients' subjective quality of life from eight dimensions (physiological function, role physical, body pain, general health, vitality, social function, role emotional, mental health), with higher scores indicating higher quality of life. Among them, the first 4 dimensions are classified as physical health, and the last 4 dimensions are classified as mental health.

Statistical analysis

SPSS 27.0 analysis software was utilized for the analysis. Measurement data are expressed as (mean ± SD), and one-way analysis of variance (ANOVA) was employed. Count data were statistically described using percentages, and the comparison of rates between groups was conducted using the χ² test. The Pearson correlation coefficient and partial correlation coefficient were calculated to represent the relationship between the two variables. P < 0.05 indicating that the difference is statistically significant.

RESULTS

Comparison of general information

Table 1 indicated that there was no apparent difference in age, sex, BMI, marriage, education, occupation, duration of disease, chronic disease.

Table 1 Comparison of baseline data among the three groups, n (%).

Index	Degree of insomnia			F/χ2	P value
	Mild (n = 137)	Moderate (n = 162)	Severe (n = 46)
Gender (male/female)	52 /85	61 /101	15 /31	0.462	0.794
Age (years)	43.26 ± 5.38	43.59 ± 6.36	45.11 ± 5.81	1.698	0.185
BMI (kg/m2)	24. 26 ± 3. 42	25.07 ± 3. 38	24.59 ± 3.51	2.079	0.127
Education				1.040	0.595
Junior high school and below	92 (67.15)	116 (71.60)	30 (65.22)
Above junior middle school	45 (32.85)	46 (28.40)	16 (34.78)
Marital status				1.205	0.877
Spinsterhood	18 (13.14)	26 (16.05)	8 (17.39)
Married	113 (82.48)	129 (79.63)	32 (76.09)
Other (divorced or widowed)	6 (4.38)	7 (4.32)	3 (6.52)
Occupation				4.399	0.355
Brainwork	72 (52.55)	87 (53.70)	21 (45.65)
Manual labour	51 (37.23)	49 (30.25)	16 (34.78)
Unemployed or retired	14 (10.22)	26 (16.05)	9 (19.57)
Course of disease (month)	59.42 ± 5.89	60.89 ± 5.62	60.96 ± 5.10	2.851	0.059
Smoking	21 (15.33)	28 (17.28)	10 (21.74)	1.005	0.605
Drinking	15 (10.95)	21 (12.96)	7 (15.22)	0.645	0.724
Complicated chronic disease	13 (9.49)	15 (9.26)	4 (8.69)	0.026	0.987

This table compares the continuous variables (e.g., age, body mass index, disease duration) of the three groups of patients by one-way analysis of variance (ANOVA) and the categorical variables (e.g., gender, education level, and marital status) of the three groups of patients by χ² test, and the results show that there is no statistically significant difference between the groups (P > 0.05). BMI: Body mass index.

Comparison of SAS and SDS

Table 2 demonstrated the SDS and SAS scores for different levels of insomnia, indicating that the greater the degree of insomnia, the greater the symptoms of depression and anxiety (P < 0.001).

Table 2 Comparison of self-rating anxiety scale and self-rating depression scale in patients with different degree of primary insomnia.

Index		SDS score	SAS score
Degree of insomnia	Mild (n = 137)	46.80 ± 5.07	41.85 ± 5.89
	Moderate (n = 162)	52.75 ± 5.57	47.65 ± 5.57
	Severe (n = 46)	58.15 ± 5.05	53.07 ± 5.87
F		93.437	77.122
P value		< 0.001	< 0.001

This table compares the depression self-rating depression scale (SDS) and anxiety self-rating anxiety scale (SAS) scores of patients with different degrees of insomnia by one-way analysis of variance (ANOVA). The results showed a significant increase in SDS and SAS scores as the degree of insomnia increased (P < 0.001). SDS: Self-rating depression scale; SAS: Self-rating anxiety scale.

Comparison of SF-36 score

Table 3 displayed the more severe the insomnia, the lower the SF-36 score (excluding body pain), and the difference between the three groups was statistically significant (P < 0.001). Correlation analysis of insomnia degree, anxiety degree and depression degree. Pearson correlation analysis in Table 4 depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia (PSQI score), and after controlling variables (age, gender, occupational status, marital status, course of disease and combination of chronic diseases), SDS score and SAS score were still positively correlated with the severity of insomnia (P < 0.001).

Table 3 Comparison of short form 36 score in patients with different degree of primary insomnia.

Index	Degree of insomnia			F	P value
	Mild (n = 137)	Moderate (n = 162)	Severe (n = 46)
Physiological function	87.88 ± 7.91	87.32 ± 6.99	80.24 ± 11.84	16.344	< 0.001
Role physical	68.74 ± 13.67	54.46 ± 15.63	34.09 ± 12.94	104.18	< 0.001
Body pain	83.12 ± 13.38	73.40 ± 15.62	77.15 ± 11.34	17.336	< 0.001
General health	61.69 ± 10.13	47.17 ± 8.63	40.91 ± 17.88	94.574	< 0.001
Vitality	65.40 ± 11.12	59.24 ± 15.96	45.30 ± 17.60	33.391	< 0.001
Social function	69.14 ± 17.14	66.47 ± 10.10	53.98 ± 10.30	22.444	< 0.001
Role emotional	62.47 ± 14.54	52.32 ± 15.61	32.22 ± 11.76	73.917	< 0.001
Mental health	61.09 ± 10.60	58.09 ± 17.38	49.04 ± 16.28	11.264	< 0.001

This table compares the short form 36 scores of patients with different degrees of insomnia using one-way analysis of variance (ANOVA). The results showed that the scores of all dimensions except the physical pain dimension decreased significantly (P < 0.001) as the degree of insomnia increase.

Table 4 Correlation analysis between the severity of primary insomnia and depression and anxiety.

Index		SDS score	SAS score
SDS score	Pearson correlation coefficient	-	R = 0.377, P < 0.001
	Partial correlation coefficient		R = 0.112, P = 0.038
SAS score	Pearson correlation coefficient	R = 0.377, P < 0.001	-
	Partial correlation coefficient	R = 0.112, P = 0.038
PSQI score	Pearson correlation coefficient	R = 0.571, P < 0.001	R = 0.524, P < 0.001
	Partial correlation coefficient	R = 0.473, P < 0.001	R = 0.406, P < 0.001

This table assesses the relationship between insomnia severity Pittsburgh sleep quality index (PSQI score) and depression self-rating depression scale (SDS score) and anxiety self-rating anxiety scale (SAS score) by Pearson correlation analysis (Pearson correlation). The results showed that both SDS scores and SAS scores were significantly and positively correlated with PSQI scores (P < 0.001). SDS: Self-rating depression scale; SAS: Self-rating anxiety scale; PSQI: Pittsburgh sleep quality index.

Correlation analysis of insomnia degree and life quality

Pearson correlation analysis in Table 5 revealed that PSQI scores were negatively correlated with SF-36 scores (P < 0.05). And partial correlation analysis revealed that SF-36 scores (excluding body pain) were negatively correlated with PSQI scores (P < 0.05).

Table 5 Correlation analysis between the severity of primary insomnia and life quality.

Index	PSQI score
	Pearson correlation coefficient	Partial correlation coefficient
Physiological function	R = -0.236, P < 0.001	R = -0.156, P = 0.004
Role physical	R = -0.586, P < 0.001	R = -0.406, P < 0.001
Body pain	R = -0.165, P = 0.002	R = -0.041, P = 0.455
General health	R = -0.560, P < 0.001	R = -0.431, P < 0.001
Vitality	R = -0.342, P < 0.001	R = -0.164, P = 0.002
Social function	R = -0.266, P < 0.001	R = -0.105, P = 0.045
Role emotional	R = -0.478, P < 0.001	R= -0.241, P < 0.001
Mental health	R = -0.246, P < 0.001	R = -0.168, P = 0.002

This table assesses the relationship between insomnia severity Pittsburgh sleep quality index (PSQI score) and short form 36 (SF-36) quality of life scores by Pearson correlation and partial correlation analysis. The results showed that PSQI scores were significantly negatively correlated with several dimensions of the SF-36 (P < 0.001). PSQI: Pittsburgh sleep quality index.

DISCUSSION

Insomnia is a common public health problem; many adults in our country have sleep disorders of varying degrees. Insomnia seriously impairs the physical and mental health and life quality of patients and imposes a heavy burden on individuals, families, and society[19]. The cause of primary chronic insomnia is unknown, and it is related to many diseases and affected by many factors. Chronic insomnia often exists with depression, anxiety, and other comorbidities, especially closely related to depression[20]. However, the research conclusions on the relationship between chronic insomnia and anxiety and depression are mixed. Some studies showed that anxiety and depression are risk factors for chronic insomnia, while other studies indicated that anxiety and depression may be secondary symptoms of chronic insomnia. Recent studies revealed that the two are bidirectional. The focus of acute sleep therapy is to improve sleep quickly and pay more attention to the research of therapeutic drugs. Chronic insomnia has a long course of disease and has the characteristics of repeated recurrence and remission, which has a greater impact on daily life[21,22]. The focus of therapy is to help patients manage sleep, reduce recurrence, and reduce the impact on life, so it is more meaningful to clarify the influencing factors of chronic insomnia[23]. This study focuses on exploring the influencing factors of patients with primary insomnia, and observing the influence of depression and anxiety on the degree of insomnia and the influence of insomnia degree on life quality in order to provide help for the formulation of treatment strategies for patients with chronic insomnia. Our study found that the greater the degree of insomnia, the greater the symptoms of depression and anxiety (P < 0.001), indicating mood was obviously affected by sleep. This is consistent with the findings of several similar studies. For example, Riemann et al[24] showed a significant positive correlation between insomnia and depression and anxiety, which may be bi-directional, and Lauriola et al[25] showed a significant correlation between insomnia symptoms and anxiety and depression, with this correlation across gender and age groups. However, the present study further clarifies that in patients with primary insomnia, this correlation is independent of age, duration of illness, marital status, and type of occupation, which provides more specific pointers for clinical intervention. The insomnia patients due to long-term suffering from the pain of insomnia, they tend to associate and focus their emotional state, physical state, social functioning and other aspects of their performance with good or bad sleep, worrying excessively about sleep, worrying about the inability to sleep to the next day's performance, which in turn leads to a vicious cycle of insomnia, emotional depression, and more severe insomnia. Insomnia is chronic through the maintenance of depressive and anxiety symptoms, and the persistence of depressive symptoms further exacerbates insomnia[24,26,27]. Depression and anxiety are two emotional symptoms that often accompany each other, and there is a strong correlation between the two factors. In our study, this association was also found in people with insomnia[25,28]. A growing body of research suggests there may be a bidirectional relationship between depression and anxiety and chronic insomnia. Both depression and anxiety have obvious impact on the severity of insomnia, so it is of great significance to pay attention to depression and anxiety in insomnia[29]. Life quality is a multi-variable indicator closely related to health and involves a wide range of contents. It refers to the experience of individuals in different cultures and value systems on their life goals, expectations, standards and things they care about, including four aspects of individual physiology, psychology, social function and material status[30]. In our study, quality of life was compared according to the severity of insomnia, and it was found that the higher the severity of insomnia, the lower the SF-36 quality of life scores (P < 0.001), and this correlation was especially significant when the physical pain dimension was excluded (P < 0.001). This is consistent with the findings of Lucena et al[31], who noted that the impact of insomnia on quality of life is primarily in terms of psychological and social functioning rather than physical pain alone. The previous research revealed that there are many factors affecting the life quality of insomnia patients, which are closely related to sleep quality and mood, that is, poor sleep quality, poor mood, poor quality of life. Pearson correlation analysis revealed that PSQI scores were negatively correlated with SF-36 scores (P < 0.05). And partial correlation analysis revealed that SF-36 scores (excluding body pain) were negatively correlated with PSQI scores (P < 0.05). The results of our study further suggested that the worse the sleep quality, the worse the life quality. Therefore, in the therapy of insomnia, it is not only to improve the quality of sleep, but also to treat the patient's accompanying emotional disorders, in order to better improve the quality of life of patients[31]. However, due to manpower and time constraints, the number of included samples is small, our study is only a preliminary study. And it is hoped that in the future, a large sample, multi-center and more rigorous design experiment can be conducted to study the correlation between insomnia degree and anxiety, depression and life quality, so as to obtain more detailed and accurate data and provide more favorable evidence support for clinical therapy of insomnia. Although this study has achieved some results, it still has several limitations. First, the sample size was small and single-center due to manpower and time constraints, which may limit the generalizability and extrapolation of the findings. Second, this study did not involve long-term follow-up of insomnia patients and evaluation of the intervention effects, so the long-term impact of the intervention could not be fully understood. Based on these limitations, this study can only be considered as a preliminary exploration. Future studies should expand the sample size and conduct multicenter studies to verify the broad applicability of the results of this study. Meanwhile, longitudinal studies are recommended to follow the changes of insomnia patients and assess the long-term effects of different interventions. In addition, future studies need to further explore the causal relationship between insomnia and mood disorders. Although this study found that insomnia was positively associated with depression and anxiety, whether this relationship is unidirectional or bidirectional still needs to be further verified. For example, the bidirectional effects of psychological interventions or medication on insomnia and mood disorders could be assessed through randomized controlled trials or cohort studies. Ultimately, it is hoped that large-sample, multicenter, and more rigorously designed studies will be conducted in the future to explore in depth the correlation between the degree of insomnia and anxiety, depression, and quality of life, so as to provide more detailed and accurate evidence to support the clinical treatment of insomnia. The results of this study provide clear guidance for clinical practice. Individualized treatment strategies are recommended for patients with different insomnia severity and accompanying emotional states. For patients with mild insomnia, psychological intervention and lifestyle modification are recommended, such as improving sleep hygiene habits through cognitive behavioral therapy (CBT-I) and avoiding over-reliance on medication. Moderate insomnia patients can use sleeping medication appropriately on the basis of psychological intervention combined with antidepressant or anxiolytic medication to improve the mood state and break the vicious cycle of insomnia and mood disorders. Patients with severe insomnia need to adopt a comprehensive treatment program, including medication, psychotherapy, and rehabilitation training, focusing on the improvement of quality of life and social function. In clinical practice, doctors should regularly assess patients' insomnia symptoms, emotional state, and quality of life and adjust the treatment plan according to individual differences. At the same time, the importance of psychological intervention and social support should be emphasized in order to improve the treatment effect and the overall health of patients. Through this personalized, multilevel intervention strategy, patients' insomnia symptoms can be more effectively improved, accompanying mood disorders can be reduced, and their quality of life can be enhanced, thus providing more targeted and practical guidance for clinical practice.

CONCLUSION

In conclusion, anxiety and depression are independent factors affecting the severity of insomnia in patients with primary insomnia. The more severe the depression or anxiety, the more severe the insomnia. The insomnia patients not only feel poor sleep quality subjectively, but also have more depressive emotional symptoms. The severity of their insomnia may be related to life quality.