"...Not just a minor thing, it is something major, which stops you from functioning daily": quality of life and daytime functioning in insomnia.

According to diagnostic manuals, insomnia is a 24-hr disorder, impairing important aspects of daytime functioning. There is, however, little published work describing the impact of insomnia on important areas of functioning or, indeed, the experience of living with chronically disturbed sleep on a daily basis. This study recruited 11 volunteers with persistent insomnia to take part in 1 of 3 focus-group discussions, exploring the typical daytime consequences of poor sleep and impact on quality of life (QoL). A sub-sample (n = 8) were also asked to keep an audio-diary for 7 days--appraising sleep quality and subsequent daytime functioning. Interpretative phenomenological analysis (IPA) of transcripts produced 3 superordinate themes: "just struggle through," "isolated, feeling like an outsider," and "insomnia as an obstruction to the desired self." Participants described daily difficulties with cognitive, emotional, and physical functioning; this had the cumulative effect of reducing work performance and social participation, as well as limiting life aspirations. Participants also described feeling isolated because of their disorder; this was precipitated by a lack of understanding from others and experiences with health care providers. Important novel data were generated on the proximal and distal impact of insomnia, indicating that chronically disturbed sleep can seriously limit overall QoL.