Insomnia in particular is a highly prevalent sleep
disturbance very closely associated with fatigue. Epidemiological
studies have found that the prevalence of insomnia
lies somewhere between 10% and 48%, with an average of
about 20% in the United States and Europe [27–29]. In some
sense complementarily to the study by Leone et al., Armon et
al. have demonstrated that burnout, if left untreated, also has
the effect of disturbing sleep, and presumably thereby
contributing to new sources of fatigue, which could therefore
predispose to less successful treatment course and increased
chronicity. This would strongly suggest that burnout needs to
be addressed early, since the eventual development of sleep
disturbances may act to increase fatigue, diminish ability to
cope and thereby further exacerbate burnout in a positive
feedback type of scenario (see Fig. 1).