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Insomnia Cures"Following the powerpoint presentation, recent research publications relating to insomnia cures are available free "
Treatment options for insomnia.
Treatment options for insomnia. Am Fam Physician. 2007 Aug 15;76(4):517-26 Authors: Ramakrishnan K, Scheid DC The frequency of sleep disruption and the degree to which insomnia significantly affects daytime function determine the need for evaluation and treatment. Physicians may initiate treatment of insomnia at an initial visit; for patients with a clear acute stressor such as grief, no further evaluation may be indicated. However, if insomnia is severe or long-lasting, a thorough evaluation to uncover coexisting medical, neurologic, or psychiatric illness is warranted. Treatment should begin with nonpharmacologic therapy, addressing sleep hygiene issues and exercise. There is good evidence supporting the effectiveness of cognitive behavior therapy. Exercise improves sleep as effectively as benzodiazepines in some studies and, given its other health benefits, is recommended for patients with insomnia. Hypnotics generally should be prescribed for short periods only, with the frequency and duration of use customized to each patient's circumstances. Routine use of over-the-counter drugs containing antihistamines should be discouraged. Alcohol has the potential for abuse and should not be used as a sleep aid. Opiates are valuable in pain-associated insomnia. Benzodiazepines are most useful for short-term treatment; however, long-term use may lead to adverse effects and withdrawal phenomena. The better safety profile of the newer-generation nonbenzodiazepines (i.e., zolpidem, zaleplon, eszopidone, and ramelteon) makes them better first-line choices for long-term treatment of chronic insomnia. PMID: Insomnia cures 17853625 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Nightly treatment of primary insomnia with eszopiclone for six months: effect on sleep, quality of life, and work limitations. Sleep. 2007 Aug 1;30(8):959-68 Authors: Walsh JK, Krystal AD, Amato DA, Rubens R, Caron J, Wessel TC, Schaefer K, Roach J, Wallenstein G, Roth T STUDY OBJECTIVES: To evaluate 6 months' eszopiclone treatment upon patient-reported sleep, fatigue and sleepiness, insomnia severity, quality of life, and work limitations. DESIGN: Randomized, double blind, controlled clinical trial. SETTING: 54 research sites in the U.S. PATIENTS: 830 primary insomnia patients who reported mean nightly total sleep time (TST) < or = 6.5 hours/night and/or mean nightly sleep latency (SL) >30 min. INTERVENTION: Eszopiclone 3 mg or matching placebo. MEASUREMENTS: Patient-reported sleep measures, Insomnia Severity Index, Medical Outcomes Study Short-Form Health Survey (SF-36), Work Limitations Questionnaire, and other assessments measured during baseline, treatment Months 1-6, and 2 weeks following discontinuation of treatment. RESULTS: Patient-reported sleep and daytime function were improved more with eszopiclone than with placebo at all months (P <0.001). Eszopiclone reduced Insomnia Severity Index scores to below clinically meaningful levels for 50% of patients (vs 19% with placebo; P <0.05) at Month 6. SF-36 domains of Physical Functioning, Vitality, and Social Functioning were improved with eszopiclone vs placebo for the Month 1-6 average (P < 0.05). Similarly, improvements were observed for all domains of the Work Limitations Questionnaire with eszopiclone vs placebo for the Month 1-6 average (P <0.05). CONCLUSIONS: This is the first placebo-controlled investigation to demonstrate that long-term nightly pharmacologic treatment of primary insomnia with any hypnotic enhanced quality of life, reduced work limitations, and reduced global insomnia severity, in addition to improving patient-reported sleep variables.
PMID: Insomnia cures 17702264 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Long-term nightly treatment with indiplon in adults with primary insomnia: results of a double-blind, placebo-controlled, 3-month study. Sleep. 2007 Jun 1;30(6):743-52 Authors: Scharf MB, Black J, Hull S, Landin R, Farber R OBJECTIVES: To evaluate the efficacy and safety of indiplon in primary insomnia. DESIGN: Randomized, double-blind, placebo-controlled, 3-month study. SETTING: Multi-center outpatient setting. PATIENTS: N=702 (61% female; mean age 46 years) who met DSM-IV criteria for primary insomnia of at least 3 months' duration. Interventions: Indiplon 10 mg (n=236), indiplon 20 mg (n=233), or placebo (n=233). MEASUREMENTS: Subjective assessment of each of the following: latency to sleep onset (sLSO), total sleep time (sTST), number of awakenings after sleep onset (sNAASO), wake time after sleep onset (sWASO), sleep quality, Insomnia Severity Index (ISI), and global improvement. RESULTS: Treatment with indiplon resulted in significant improvement relative to placebo at all time points for the primary endpoint, sLSO. Mean sLSO at Month 1 for each treatment group was: 10 mg (34.0 +/- 1.3 mins), 20 mg (33.0 +/- 1.3 mins), and placebo (48.7 +/- 1.9 mins; P <0.0001 for both comparisons); efficacy was sustained through Month 3. Both doses of indiplon resulted in significant improvement in sleep maintenance and duration endpoints, sTST and sWASO, as well as sleep quality, ISI, and global improvement at all assessment time points. CONCLUSIONS: In patients with chronic insomnia, long-term nightly treatment with 10 mg and 20 mg doses of indiplon resulted in significant and sustained efficacy in sleep onset, maintenance, and duration, and significant associated improvement in both daytime functioning and quality of life.
PMID: Insomnia cures 17580596 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Insomnia: zolpidem extended-release for the treatment of sleep induction and sleep maintenance symptoms. MedGenMed. 2007;9(1):11 Authors: Doghramji PP Insomnia impairs daytime functioning or causes clinically significant daytime distress. The consequences of insomnia, if left untreated, may contribute to the risks of developing additional serious conditions, such as psychiatric illness, cardiovascular disease, or metabolic issues. Furthermore, some comorbidities associated with insomnia may be bidirectional in their causality because psychiatric and other medical problems can increase the risk for insomnia. Regardless of the serious consequences of inadequately treated insomnia, clinicians often do not inquire into their patients' sleep habits, and patients, in turn, are not forthcoming with details of their sleep difficulties. The continuing education of physicians and patients with regard to insomnia and currently available therapies for the treatment of insomnia is, therefore, essential. Insomnia may present as either a difficulty falling asleep, difficulty maintaining sleep, or waking too early without being able to return to sleep. Furthermore, these symptoms often change over time in an unpredictable manner. Therefore, when considering a sleep medication, one with efficacy for the treatment of multiple insomnia symptoms is recommended. A modified-release formulation of zolpidem, zolpidem extended-release, has been approved for the treatment of insomnia characterized by both difficulty in falling asleep and maintaining sleep. Here, we review studies supporting the use of zolpidem extended-release in the treatment of sleep-onset and sleep maintenance difficulties.
PMID: Insomnia cures 17435620 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Self-management of fatal familial insomnia. Part 2: case report. MedGenMed. 2006;8(3):66 Authors: Schenkein J, Montagna P CONTEXT: Fatal familial insomnia (FFI) is a genetically transmitted neurodegenerative prion disease that incurs great suffering and has neither a treatment nor cure. The clinical literature is devoid of management plans (other than palliative). Part 1 of this article reviews the sparse literature about FFI, including case descriptions. Part 2 describes the efforts of one patient (with the rapid-course Met-Met subtype) who contended with his devastating symptoms and improved the quality of his life. DESIGN: Interventions were based on the premise that some symptoms may be secondary to insomnia and not a direct result of the disease itself. Strategies (derived by trial and error) were devised to induce sleep and increase alertness. Interventions included vitamin supplementation, narcoleptics, anesthesia, stimulants, sensory deprivation, exercise, light entrainment, growth hormone, and electroconvulsive therapy (ECT). RESULTS: The patient exceeded the average survival time by nearly 1 year, and during this time (when most patients are totally incapacitated), he was able to write a book and to successfully drive hundreds of miles. CONCLUSION: Methods to induce sleep may extend and enhance life during the disease course, although they do not prevent death. It is hoped that some of his methods will inspire further clinical studies.
PMID: Insomnia cures 17406189 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Self management of fatal familial insomnia. Part 1: what is FFI? MedGenMed. 2006;8(3):65 Authors: Schenkein J, Montagna P CONTEXT: Fatal familial insomnia (FFI) is a genetically transmitted neurodegenerative prion disease that incurs great suffering and has neither a treatment nor a cure. The clinical literature is devoid of management plans (other than palliative). Part 1 of this article reviews the sparse literature about FFI, including case descriptions. Part 2 of this paper describes the efforts of 1 patient (with the rapid-course Met-Met subtype) to contend with his devastating symptoms and improve the quality of his life. DESIGN: Interventions were based on the premise that some symptoms may be secondary to insomnia and not a direct result of the disease itself. Strategies (derived by trial and error) were devised to induce sleep and increase alertness. Interventions included vitamin supplementation, narcoleptics, anesthesia, stimulants, sensory deprivation, exercise, light entrainment, growth hormone, and electroconvulsive therapy. RESULTS: The patient exceeded the average survival time by nearly 1 year, and during this time (when most patients are totally incapacitated), he was able to write a book and to successfully drive hundreds of miles. CONCLUSION: Methods to induce sleep may extend and enhance life during the disease, although they do not prevent death. It is hoped that some of his methods might inspire further clinical studies.
PMID: Insomnia cures 17406188 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults. NIH Consens State Sci Statements. 2005 Jun 13-15;22(2):1-30 Authors: OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of currently available data on manifestations and management of chronic insomnia in adults. PARTICIPANTS: A non-DHHS, non-advocate 12-member panel representing the fields of psychology, psychiatry, neuroscience, anesthesiology, sleep disorders, geriatric medicine, epidemiology, health services research, nursing, and community medicine. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience. EVIDENCE: Presentations by experts and a systematic review of the medical literature prepared by the University of Alberta Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience. CONFERENCE PROCESS: Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. This statement and all past statements from the NIH Consensus Development Program are available at the same web address of http://www.consensus.nih.gov. CONCLUSIONS: Chronic insomnia is a major public health problem affecting millions of individuals, along with their families and communities. Little is known about the mechanisms, causes, clinical course, comorbidities, and consequences of chronic insomnia. Evidence supports the efficacy of cognitive-behavioral therapy and benzodiazepine receptor agonists in the treatment of this disorder, at least in the short term. Very little evidence supports the efficacy of other treatments, despite their widespread use. Moreover, even for those treatments that have been systematically evaluated, the panel is concerned about the mismatch between the potential lifelong nature of this illness and the longest clinical trials, which have lasted 1 year or less. A substantial public and private research effort is warranted, including developing research tools and conducting longitudinal studies of randomized clinical trials. Finally, there is a major need for educational programs directed at physicians, health care providers, and the public.
PMID: Insomnia cures 17308547 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Hypnosis for treatment of insomnia in school-age children: a retrospective chart review. BMC Pediatr. 2006;6:23 Authors: Anbar RD, Slothower MP BACKGROUND: The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. METHODS: A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7-17). When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. RESULTS: Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. CONCLUSION: Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children.
PMID: Insomnia cures 16914044 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Recent developments in the classification, evaluation, and treatment of insomnia. Chest. 2006 Jul;130(1):276-86 Authors: Summers MO, Crisostomo MI, Stepanski EJ Sleep/wake complaints, and specifically insomnia, are some of the more common problems encountered in the outpatient setting. Despite its prevalence, few clinicians are experts at diagnosing and treating this entity. Additionally, diagnosis and treatment of insomnia is a time-intensive process (often the initial interview takes at least 1 h, depending on the complexity of the insomnia). With a conservative estimate of the annual cost of insomnia between dollar 92.5 and dollar 107.5 billion dollars, it is becoming clear that insomnia has significant medical and public health implications. A problem that has hampered insomnia research is the lack of a standard definition of insomnia for use in research, as well as guidelines for assessment. In recent years, there have been important advances in the classification, evaluation, and treatment of insomnia with efforts to establish greater consensus in how to define and measure insomnia. Cognitive behavioral and pharmacologic therapies have been shown to be effective treatment approaches. Insomnia is a complex entity, often multifactorial in its etiology; and as research and clinical guidelines are established and validated (leading to better data interpretation), continued enhancement of our understanding of this disorder is expected.
PMID: Insomnia cures 16840413 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006 Jun 28;295(24):2851-8 Authors: Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, Nielsen GH, Nordhus IH CONTEXT: Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the effects of these treatments are lacking. OBJECTIVE: To examine short- and long-term clinical efficacy of cognitive behavioral therapy (CBT) and pharmacological treatment in older adults experiencing chronic primary insomnia. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blinded, placebo-controlled trial of 46 adults (mean age, 60.8 y; 22 women) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients. INTERVENTION: CBT (sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation; n = 18), sleep medication (7.5-mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months. MAIN OUTCOME MEASURES: Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography) on all 3 assessment points. RESULTS: CBT resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures. For most outcomes, zopiclone did not differ from placebo. Participants receiving CBT improved their sleep efficiency from 81.4% at pretreatment to 90.1% at 6-month follow-up compared with a decrease from 82.3% to 81.9% in the zopiclone group. Participants in the CBT group spent much more time in slow-wave sleep (stages 3 and 4) compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all 3 groups; at 6 months, patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone. CONCLUSION: These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00295386.
PMID: Insomnia cures 16804151 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Pharmacologic management of insomnia in children and adolescents: consensus statement. Pediatrics. 2006 Jun;117(6):e1223-32 Authors: Mindell JA, Emslie G, Blumer J, Genel M, Glaze D, Ivanenko A, Johnson K, Rosen C, Steinberg F, Roth T, Banas B OBJECTIVE: The purpose of this work was to develop a consensus statement on the current status and future role for pharmacologic management of insomnia in children and adolescents. METHOD: The National Sleep Foundation, in collaboration with Best Practice Project Management, Inc, convened expert representatives involved in the study and treatment of pediatric insomnia and conducted a 2-day conference to examine the role of pharmacologic management of pediatric insomnia and to make recommendations regarding the development of clinical trials in this area. After a series of presentations providing background on the current knowledge of pediatric insomnia and its treatment alternatives, workgroups provided recommendations for the evaluation of pharmacologic treatment of insomnia in specific populations of children and adolescents and developed guidelines for the core methodologic issues relevant to the design of clinical trials. The group developed consensus recommendations for clinical trials in this area encompassing: (1) high-priority patient populations for research, (2) inclusion/exclusion criteria, (3) outcome measures, (4) ethical considerations unique to clinical trials involving children and adolescents, and (5) priorities for future research that will enhance the understanding of pediatric insomnia. RESULTS: Conference participants unanimously agreed that there is a need for pharmacologic management of pediatric insomnia. Furthermore, the widespread use of "hypnotic" and psychotropic medications for children in the absence of safety and efficacy data indicates a knowledge gap about the best pharmacologic practices for management of pediatric insomnia. Attendees reached consensus on methodologic issues in the study of pharmacologic treatment of pediatric insomnia including agreeing on a definition of pediatric insomnia as "repeated difficulty with sleep initiation, duration, consolidation, or quality that occurs despite age-appropriate time and opportunity for sleep and results in daytime functional impairment for the child and/or family." It was agreed that priority should be given to insomnia studies in children with attention-deficit/hyperactivity disorder and those with pervasive developmental disorders/autism spectrum disorder. There was also agreement on the need for pharmacokinetic and pharmacodynamic studies to determine appropriate dose levels and to evaluate safety with a wide range of doses. CONCLUSIONS: The treatment of pediatric insomnia is an unmet medical need. Before appropriate pharmacologic management guidelines can be developed, rigorous, large-scale clinical trials of pediatric insomnia treatment are vitally needed to provide information to the clinician on the safety and efficacy of prescription and over-the-counter agents for the management of pediatric insomnia.
PMID: Insomnia cures 16740821 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med. 2005 Nov 28;165(21):2527-35 Authors: Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR BACKGROUND: Insomnia is common and debilitating to fibromyalgia (FM) patients. Cognitive-behavioral therapy (CBT) is effective for many types of patients with insomnia, but has yet to be tested with FM patients. This study compared CBT with an alternate behavioral therapy and usual care for improving sleep and other FM symptoms. METHODS: This randomized clinical trial enrolled 47 FM patients with chronic insomnia complaints. The study compared CBT, sleep hygiene (SH) instructions, and usual FM care alone. Outcome measures were subjective (sleep logs) and objective (actigraphy) total sleep time, sleep efficiency, total wake time, sleep latency, wake time after sleep onset, and questionnaire measures of global insomnia symptoms, pain, mood, and quality of life. RESULTS: Forty-two patients completed baseline and continued into treatment. Sleep logs showed CBT-treated patients achieved nearly a 50% reduction in their nocturnal wake time by study completion, whereas SH therapy- and usual care-treated patients achieved only 20% and 3.5% reductions on this measure, respectively. In addition, 8 (57%) of 14 CBT recipients met strict subjective sleep improvement criteria by the end of treatment compared with 2 (17%) of 12 SH therapy recipients and 0% of the usual care group. Comparable findings were noted for similar actigraphic improvement criteria. The SH therapy patients showed favorable outcomes on measures of pain and mental well-being. This finding was most notable in an SH therapy subgroup that self-elected to implement selected CBT strategies. CONCLUSIONS: Cognitive-behavioral therapy represents a promising intervention for sleep disturbance in FM patients. Larger clinical trials of this intervention with FM patients seem warranted.
PMID: Insomnia cures 16314551 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
[Clinical observation on treatment of senile insomnia with application therapy on Shenque acupoint with gingkgo leaf preparation: a report of 25 cases] Zhong Xi Yi Jie He Xue Bao. 2005 Sep;3(5):398-9 Authors: Li HT, Liu JH, Zhu QX PMID: Insomnia cures 16159578 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
[Clinical evaluation and treatment of insomnia in childhood] J Pediatr (Rio J). 2005 Jul-Aug;81(4):277-86 Authors: Nunes ML, Cavalcante V OBJECTIVES: The aim of this article is to review and update the knowledge about insomnia in childhood. SOURCE OF DATA: The text was based on a MEDLINE search (publications from 1999 to 2004) using the keywords sleep disorders, insomnia, and childhood. Classic articles and textbooks about the subject were also included. The authors proposed a practical schedule to evaluate and treat insomnia in childhood. SUMMARY OF THE FINDINGS: The article was structured on descriptive topics containing the definition of insomnia, age-related clinical characteristics and therapeutics. CONCLUSIONS: Insomnia is a prevalent sleep disorder in pediatric outpatient clinics and is often misdiagnosed. Defining its etiology is the main goal to establish therapeutic procedures. In most cases, clinical history is sufficient to establish the diagnosis and reassure parents of the benign nature of this condition. PMID: Insomnia cures 16106311 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Eszopiclone (Lunesta) for treatment of transient and chronic insomnia. Am Fam Physician. 2005 Jun 15;71(12):2359-60 Authors: Wessell AM, Weart CW PMID: Insomnia cures 15999875 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Manifestations and management of chronic insomnia in adults. Evid Rep Technol Assess (Summ). 2005 Jun;(125):1-10 Authors: Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M PMID: Insomnia cures 15989374 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Long-term use of hypnotic agents in the treatment of chronic insomnia. Psychiatr Serv. 2005 Jun;56(6):752; author reply 752-3 Authors: Kramer M
PMID: Insomnia cures 15939957 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Insomnia in HIV infection: a systematic review of prevalence, correlates, and management. Psychosom Med. 2005 Mar-Apr;67(2):260-9 Authors: Reid S, Dwyer J OBJECTIVE: Insomnia in people with HIV and AIDS has been widely but inconsistently reported. We present the results of a systematic review of the subject. METHODS: MEDLINE, EMBASE, PSYCHLIT, and CINAHL databases were searched, and inclusion criteria were applied. The study results were then collated and described. RESULTS: Twenty-nine studies were identified, and there was wide variation in both method and quality. Insomnia was reported frequently and at all stages of HIV infection. Early reports of sleep-specific electroencephalographic changes were not confirmed. The role of immune dysregulation, virus progression, and adverse drug effects in contributing to insomnia is unclear. The presence of cognitive impairment, an AIDS-defining illness, and treatment with efavirenz were found to be significant risk factors, but the most notable association was with psychologic morbidity. There was limited evidence for the effect of specific treatments for insomnia in HIV infection. CONCLUSIONS: This review found that psychologic morbidity was a major determinant of insomnia in HIV infection. Further study would be of value in clarifying the role of other factors, as well as measuring the impact of insomnia on functioning and quality of life in this population. PMID: Insomnia cures 15784792 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005 Mar;56(3):332-43 Authors: Benca RM OBJECTIVE: Insomnia has high prevalence rates and is associated with significant personal and socioeconomic burden, yet it remains largely underrecognized and inadequately treated. METHODS: A PubMed search for English-language articles covering randomized controlled trials published between 1970 and 2004 was conducted. Search terms used were "insomnia," "behavioral therapy," and the generic names of agents commonly used to treat insomnia (the Food and Drug Administration-approved benzodiazepines and nonbenzodiazepines, trazodone, and over-the-counter agents). RESULTS: Evidence from epidemiologic studies, physician surveys, and clinical studies suggests that numerous patient and physician factors contribute to the fact that the needs of patients with insomnia remain unmet, including low reporting of insomnia by patients, limited physician training, and office-based time constraints, as well as misconceptions about the seriousness of insomnia, the advantages of treatment, and the risks associated with hypnotic use. Nonpharmacologic therapies produce long-lasting and reliable changes among people with chronic insomnia and have minimal side effects. Pharmacologic therapies have proven effective with improving wake time after sleep onset and sleep maintenance and reducing the number of nighttime awakenings. However, pharmacologic therapy has a greater chance of producing side effects. No conclusive evidence exists to favor either pharmacologic therapy or behavioral therapy. CONCLUSIONS: Insomnia is particularly challenging for clinicians because of the lack of guidelines and the small number of studies conducted in patient populations with behavioral and pharmacologic therapies. Current treatment options do not address the needs of difficult-to-treat patients with chronic insomnia, such as the elderly, and those with comorbid medical and psychiatric conditions. More research is necessary to determine the long-term effects of insomnia treatments. PMID: Insomnia cures 15746509 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Management and evolution of insomnia complaints among non-substance-misusers in a Swiss remand prison. Swiss Med Wkly. 2004 Aug 21;134(33-34):486-99 Authors: Elger BS QUESTIONS UNDER STUDY: Insomnia is a frequent though rarely investigated problem among prisoners. The study's aim was to examine the clinical management of insomnia complaints in non-substance-misusing (NSM) prisoners (quality of medical consultation, effectiveness of drug prescription), and the risk of leaving prison with ongoing hypnotic prescription which might provoke withdrawal symptoms and encourage further hypnotic use outside prison. METHODS: Retrospective study of the medical records of 112 NSM prisoners complaining of insomnia at medical consultation over a one year period at the outpatient-service of the Champ-Dollon remand prison (Geneva, Switzerland). We examined insomnia management by the general practitioners (anamnestic and clinical evaluation documented in the record), type, duration and effectiveness of treatment. RESULTS: The 112 records show a prescription of hypnotics to 111 patients (80% benzodiazepines or Zolpidem), a limited documented insomnia work-up (anamnestic information about sleep habits, sleep latency and previous hypnotic use for less than a third of the patients, about the impact of insomnia, such as fatigue, on daily activity in only 7%). In more than 60% of the patients, insomnia complaints persisted for more than 3 weeks. In 41 (37%) patients, improvement (defined subjectively based on patients' complaints) was complete, in 20 (18%) absent, and in 34 (30%) incomplete while taking the prescribed hypnotics. Patients without or with only partial improvement of insomnia received the highest number of hypnotics (mean 2.4, vs. 1.4 for patients with total improvement, 95% CI of the difference: 0.7-1.4). 55% of the 112 prisoners left prison with hypnotics still being prescribed. CONCLUSIONS: Our results show that prison physicians' evaluation for insomnia was incomplete. Drug prescription did not seem to have been an effective treatment for insomnia complaints in a sizeable number of patients. Many prisoners leave the prison with benzodiazepine prescription still ongoing and could be at risk for continued hypnotic use following imprisonment. PMID: Insomnia cures 15517501 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004 Sep 27;164(17):1888-96 Authors: Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW BACKGROUND: Chronic sleep-onset insomnia is a prevalent health complaint in adults. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy, singly and in combination, for chronic sleep-onset insomnia. METHODS: This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. The main outcome measures were sleep-onset latency as measured by sleep diaries; secondary measures included sleep diary measures of sleep efficiency and total sleep time, objective measures of sleep variables (Nightcap sleep monitor recorder), and measures of daytime functioning. RESULTS: In most measures, CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation. CONCLUSIONS: These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia. PMID: Insomnia cures 15451764 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Treatment of primary insomnia. J Am Board Fam Pract. 2004 May-Jun;17(3):212-9 Authors: Ringdahl EN, Pereira SL, Delzell JE Ten percent to 40% of adults have intermittent insomnia, and 15% have long-term sleep difficulties. This article provides a review of the classification, differential diagnosis, and treatment options available for insomnia. We performed a MEDLINE search using OVID and the key words "insomnia," "sleeplessness," "behavior modification," "herbs," "medicinal," and "pharmacologic therapy." Articles were selected based on their relevance to the topic. Evaluation of insomnia includes a careful sleep history, review of medical history, review of medication use (including over-the-counter and herbal medications), family history, and screening for depression, anxiety, and substance abuse. Treatment should be individualized based on the nature and severity of symptoms. Nonpharmacologic treatments are effective and have minimal side effects compared with drug therapies. Medications such as diphenhydramine, doxylamine, and trazodone can be used initially, but patients may not tolerate their side effects. Newer medications such as zolpidem and zaleplon have short half-lives and minimal side effects. Both are approved for short-term use in the insomniac. PMID: Insomnia cures 15226287 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation. Health Technol Assess. 2004 Jun;8(24):iii-x, 1-125 Authors: Dündar Y, Boland A, Strobl J, Dodd S, Haycox A, Bagust A, Bogg J, Dickson R, Walley T OBJECTIVES: To assess the clinical and cost-effectiveness of zaleplon, zolpidem and zopiclone (Z-drugs) compared with benzodiazepines. DATA SOURCES: Electronic databases, reference lists of retrieved articles and pharmaceutical company submissions. REVIEW METHODS: Randomised controlled trials (RCTs) that compared either benzodiazepines to the Z-drugs or any two of the non-benzodiazepine drugs in patients with insomnia were included in the review. Data on the following outcome measures were considered: sleep onset latency, total sleep duration, number of awakenings, quality of sleep, adverse effects and rebound insomnia. A search was also undertaken for any study designs that evaluated issues related to adverse events (e.g. dependency and withdrawal symptoms). Full economic evaluations that compared two or more options and considered both costs and consequences including cost-effectiveness, cost-utility analysis or cost-benefit analysis undertaken in the context of high-quality RCTs were considered for inclusion in the review. RESULTS: Twenty-four studies, involving a total study population of 3909 patients, met the inclusion criteria. These included 17 studies comparing a Z-drug with a benzodiazepine and seven comparing a Z-drug with another Z-drug. The diversity of possible comparisons and the range of outcome measures in the review may be confusing. Outcomes were rarely standardised and, even when reported, differed in interpretation. In addition, variations in assessment and variety in the level of information provided make study comparisons difficult. As a result, meta-analysis has been possible on only a small number of outcomes. However, some broad conclusions might be reached based on the limited data provided. The existing published economic literature in this area is very limited. No relevant economic evaluations were identified for inclusion in the review. The industry submissions did not include detailed evidence of cost-effectiveness. Given the lack of robust clinical evidence, no economic model describing the costs and benefits of the newer hypnotic drugs for insomnia was developed. The systematic review provided in this report suggests that an agnostic approach to cost-effectiveness is required at this stage. In the short-term, no systematic evidence is available concerning significant outcome variations between either the different classes of drugs or between individual drugs within each class. Within this short-term horizon, the one element that does vary significantly is the acquisition cost of the individual drugs. CONCLUSIONS: The short-acting drugs seem equally effective and safe with minor differences that may lead a prescriber to favour one over another in different patients. There is no evidence that one is more cost-effective than any other. Analysis of the additional costs to the NHS, depending on the rate of change from benzodiazepine prescriptions to Z-drug prescriptions, at current levels of hypnotic prescribing, range from GBP2 million to GBP17 million per year. There are clear research needs in this area; in particular, none of the existing trials adequately compare these medications. It is suggested that further consideration should be given to a formal trial to allow head-to-head comparison of some of the key drugs in a double-blind RCT lasting at least 2 weeks, and of sufficient size to draw reasonable conclusions. We would also recommend that any such trial should include a placebo arm. It should also collect good-quality data around sleep outcomes and in particular quality of life and daytime drowsiness. We do not believe that any formal study of risk of dependency is feasible at present. Finally, the management of long-term insomnia is suggested for further investigation: considering the frequency of this symptom and its recurring course, the short-term trial of medication and lack of long-term follow-up undermine attempts to develop evidence-based guidelines for the use of hypnotics in this condition, or indeed for its whole management. PMID: Insomnia cures 15193209 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Psychological treatment for insomnia in the regulation of long-term hypnotic drug use. Health Technol Assess. 2004 Feb;8(8):iii-iv, 1-68 Authors: Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M OBJECTIVES: To evaluate the clinical and cost impact of providing, in routine general practice settings, a cognitive-behaviour therapy (CBT) package for insomnia to long-term hypnotic drug users with chronic sleep difficulties; and to identify factors associated with variations in clinical outcomes. DESIGN: A pragmatic cluster randomised controlled trial with two treatment arms (a CBT-treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments starting at 3, 6 and 12 months. SETTING: Twenty-three general practices in Sheffield, UK. PARTICIPANTS: In total, 209 patients (aged 31-92 years) with chronic sleep problems who had been receiving repeat hypnotic drug prescriptions for at least 1 month (mean = 13.4 years) were recruited into the trial. INTERVENTIONS: The intervention consisted of six 50-minute sessions as follows: introduction and sleep assessment, basic sleep hygiene, stimulus control and sleep restriction procedures, progressive relaxation, cognitive treatments, and review and discharge. MAIN OUTCOME MEASURES: These included: global sleep quality [as measured by the Pittsburgh Sleep Quality Index (PSQI)], frequency of hypnotic drug use, mean dose of hypnotics consumed, health-related quality of life [as measured by the Short-Form 36 (SF-36)], NHS service costs and overall cost utility. RESULTS: At 3- and 6-month follow-ups, patients treated with CBT showed improved global PSQI scores as well as improvements in the SF-36 dimensions of vitality at 3 months and physical functioning and mental health at 6 months. CBT-treated patients also reported reductions in the frequency of hypnotic drug use compared with the control group, with many CBT-treated patients reporting zero drug use at the follow-up assessments. Clinical improvements were maintained within the CBT group at the 12-month follow-up, with PSQI scores and the frequency of hypnotic drug use continuing to show significant reductions relative to the control group. Multiple regression analyses of PSQI scores within the sleep clinic group alone indicated that the magnitude of pre- to post-treatment change in overall sleep quality was closely related to Hospital Anxiety and Depression Scale depression scores at 3-, 6-and 12-month follow-ups. In each model higher depression scores at baseline were associated with poorer treatment outcomes. No significant relationship was found between the patient's age and PSQI outcomes in any of these analyses. Within the sleep clinic group, reductions in drug use showed no significant association with the hypnotic product consumed. At the 3-month follow-up low-frequency drug use was reported by 22.9% (8/35) of temazepam users, 33.3% (5/15) of nitrazepam users and 38.9% (7/18) of zopiclone users. The total cost of service provision was GBP154.40 per patient (1999/2000 prices). The mean incremental cost per quality-adjusted life-year (QALY) at 6 months was GBP3418; this figure was insensitive to changes in costs. A simple model also showed that extending the evaluation period beyond 6 months may improve the cost-effectiveness of CBT. The incorporation of hidden costs associated with hypnotic drug treatment (e.g. accidents) also reduces the cost per QALY ratio, although to a much lesser degree. CONCLUSIONS: In routine general practice settings, psychological treatment for insomnia can improve sleep quality, reduce hypnotic drug use, and improve health-related quality of life at a favourable cost among long-term hypnotic users with chronic sleep difficulties. These positive outcomes appear robust over time, persisting for at least 1 year among the more treatment-adherent patients. While these benefits may be reduced among those patients presenting with higher levels of psychological distress, the present study clearly indicates that older age per se presents no barrier to successful treatment outcomes. Further research should assess the long-term clinical and cost-effectiveness of psychological treatments for insomnia among non-hypnotic-using patients, and establish the minimum psychological treatment input required. PMID: Insomnia cures 14960254 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial. Br J Gen Pract. 2003 Dec;53(497):923-8 Authors: Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M OBJECTIVE: To evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug users in general practice. DESIGN: A pragmatic randomised controlled trial with two treatment arms (a CBT treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments commencing at 3 and 6 months. SETTING: Twenty-three general practices in Sheffield, UK. PARTICIPANTS: Two hundred and nine serially referred patients aged 31-92 years with chronic sleep problems who had been using hypnotic drugs for at least 1 month (mean duration = 13.4 years). RESULTS: At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). Older age presented no barrier to successful treatment outcomes. The total cost of service provision was 154.40 per patient, with a mean incremental cost per quality-adjusted life-year of 3416 (at 6 months). However, there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilisation of primary care services. CONCLUSIONS: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favourable cost among long-term hypnotic users with chronic sleep difficulties. PMID: Insomnia cures 14960215 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psychiatry. 2004 Feb;161(2):332-42 Authors: Morin CM, Bastien C, Guay B, Radouco-Thomas M, Leblanc J, Vallières A OBJECTIVE: This study evaluated the effectiveness of a supervised benzodiazepine taper, singly and combined with cognitive behavior therapy, for benzodiazepine discontinuation in older adults with chronic insomnia. METHOD: Seventy-six older adult outpatients (38 women, 38 men; mean age of 62.5 years) with chronic insomnia and prolonged use (mean duration of 19.3 years) of benzodiazepine medication for sleep were randomly assigned for a 10-week intervention consisting of a supervised benzodiazepine withdrawal program (N=25), cognitive behavior therapy for insomnia (N=24), or supervised withdrawal plus cognitive behavior therapy (N=27). Follow-up assessments were conducted at 3 and 12 months. The main outcome measures were benzodiazepine use, sleep parameters, and anxiety and depressive symptoms. RESULTS: All three interventions produced significant reductions in both the quantity (90% reduction) and frequency (80% reduction) of benzodiazepine use, and 63% of the patients were drug-free within an average of 7 weeks. More patients who received medication taper plus cognitive behavior therapy (85%) were benzodiazepine-free after the initial intervention, compared to those who received medication taper alone (48%) and cognitive behavior therapy alone (54%). The patients in the two groups that received cognitive behavior therapy perceived greater subjective sleep improvements than those who received medication taper alone. Polysomnographic data showed an increase in the amount of time spent in stages 3 and 4 sleep and REM sleep and a decrease in total sleep time across all three conditions from baseline to posttreatment. Initial benzodiazepine reductions were well maintained up to the 12-month follow-up, and sleep improvements became more noticeable over this period. No significant withdrawal symptoms or adverse events were associated with benzodiazepine tapering. CONCLUSIONS: A structured, time-limited intervention is effective in assisting chronic users of benzodiazepine medication to discontinue or reduce their use of medication. The addition of cognitive behavior therapy alleviates insomnia, but sleep improvements may become noticeable only after several months of benzodiazepine abstinence. PMID: Insomnia cures 14754783 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Maintenance treatment of insomnia: what can we learn from the depression literature? Am J Psychiatry. 2004 Jan;161(1):19-24 Authors: Jindal RD, Buysse DJ, Thase ME Insomnia and depression are common problems with profound public health consequences. When left untreated, both conditions have high rates of persistence and recurrence. Maintenance treatment for depression is fairly well established, but there is no evidence-based consensus regarding the safety and efficacy of maintenance therapy for insomnia. Consequently, long-term treatment of insomnia is driven primarily by the individual choices of patients and their clinicians. This article compares and contrasts the current state of research in the maintenance therapy of depression and insomnia and highlights gaps in the insomnia literature. PMID: Insomnia cures 14702243 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
[Treatment of insomnia in children: pharmacological aspects] An Pediatr (Barc). 2003 Sep;59(3):239-45 Authors: Idiazábal Alecha MA, Estivill Sancho E In the last few years topics related to sleep in children have aroused increased interest. Most hypnotic drugs and sedatives used to treat adult insomnia are not recommended in children. Even so, 56% of pediatricians use medication to treat childhood sleep disorders. We review the different causes of insomnia in children from birth to school age. The various therapeutic options are discussed and the therapeutic methods that have been demonstrated to be most effective in the various types of insomnia. The most frequent hypnotic drugs used in insomnia treatment are benzodiazepines and non-benzodiazepine hypnotics such as imidazopyridine, pyrazolopyrimidine and cyclopyrrolone. Few studies have been published on the use of melatonin in insomnia although several reports suggest that is useful and relatively safe in the treatment of insomnia in school-aged children. In children with insomnia, pediatricians should first of all obtain information about the characteristics of insomnia and the environmental characteristics surrounding the child and his/her family. Once an organic cause has been ruled out, treatment should be based on informing the parents about sleep physiology and on training them in sleep hygiene and the acquisition of sleep habits. When pharmacological treatment is required, it should be carefully selected using the smallest effective doses. Melatonin seems to have a promising future in insomnia treatment in healthy children and in those with neurological disorders. PMID: Insomnia cures 12975116 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Treatment of primary insomnia with melatonin: a double-blind, placebo-controlled, crossover study. J Psychiatry Neurosci. 2003 May;28(3):191-6 Authors: Almeida Montes LG, Ontiveros Uribe MP, Cortés Sotres J, Heinze Martin G OBJECTIVE: To assess the hypnotic effect of melatonin in patients with primary insomnia. METHOD: Ten patients (mean age 50 yr, range 30-72 yr) who met the DSM-IV criteria for primary insomnia received, in random order, 0.3 mg of melatonin, 1.0 mg of melatonin or placebo 60 minutes before bedtime. A crossover design was used so that each patient received each of the 3 treatments for a 7-day period (with a 5-day washout period between). After each 7-day treatment, night time electroencephalographic (EEG) records were collected, and each morning, subjects completed sleep logs and analogue-visual scales to document the amount and subjective quality of sleep. RESULTS: There were no significant differences in sleep EEG, the amount or subjective quality of sleep or side effects between the placebo, 0.3-mg melatonin or 1.0-mg melatonin treatments. CONCLUSION: Melatonin did not produce any sleep benefit in this sample of patients with primary insomnia. PMID: Insomnia cures 12790159 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians. Pediatrics. 2003 May;111(5 Pt 1):e628-35 Authors: Owens JA, Rosen CL, Mindell JA OBJECTIVES: To examine clinical practice patterns, beliefs, and attitudes regarding the use of both nonprescription and prescription medications by community-based pediatricians for children with significant difficulties in initiating and/or maintaining sleep. METHODS: A survey was mailed to 3424 American Academy of Pediatrics members in 6 US cities. RESULTS: The final sample (n = 671) consisted of practitioners who identified themselves as primary care pediatricians. Three percent +/- 7% of visits in the respondents' practices were for pediatric insomnia, although there was a wide range in the numbers of children identified during a typical 6-month practice period. More than 75% of practitioners had recommended nonprescription medications, and >50% had prescribed a sleep medication. Specific clinical circumstances in which medications were most commonly used were acute pain and travel, followed by children with special needs (mental retardation, autism, and attention-deficit/hyperactivity disorder). Antihistamines were the most commonly reported nonprescription medications for sleep. Melatonin or herbal remedies had been recommended by approximately 15% of the respondents. alpha-agonists were the most frequently prescribed sleep medications (31%). The likelihood of prescribing medication for sleep was 2- to 4-fold greater in respondents who treated children with attention-deficit/hyperactivity disorder for daytime behavioral problems or nocturnal sleep problems, respectively. Practitioners expressed a range of concerns about sleep medication appropriateness, safety, tolerance, and side effects in children. CONCLUSIONS: The practice of prescribing or recommending sedatives and hypnotics for pediatric insomnia is common among community-based pediatricians, especially among special needs patients. An empirically based approach to the use of these medications is needed. PMID: Insomnia cures 12728122 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments. Age Ageing. 2003 Jan;32(1):19-25 Authors: Petit L, Azad N, Byszewski A, Sarazan FF, Power B BACKGROUND:primary and secondary insomnia, especially among older adults, is frequently encountered by family physicians. Pharmacological interventions, although effective in some circumstances, can be detrimental in others. Non-pharmacological management of insomnia may allow the patients to self-administer the treatment. OBJECTIVES:review of published literature of assessment tools and treatments for primary and secondary insomnia. RESULTS:two frequently used self-reporting methods for obtaining sleep data are sleep diaries and Pittsburg Sleep Quality Index. A large amount of research supports the use of non-pharmacological treatments such as stimulus control, sleep restriction, sleep hygiene education, cognitive therapy, multi-component therapy and paradoxical intention. CONCLUSION: assessing the nature of insomnia by using an effective assessment tool and providing patients with a non-pharmacological treatment should be the first intervention for insomnia. It is shown that non-pharmacological treatments for primary and secondary insomnia are feasible and effective alternatives to the use of benzodiazepines, and that family physicians should consider these when managing older patients with insomnia. PMID: Insomnia cures 12540343 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Management of insomnia--the role of zaleplon. MedGenMed. 2002 Mar 14;4(1):9 Authors: Richardson GS, Roth T, Kramer JA CONTEXT: Insomnia is the most frequently reported sleep symptom, severely affecting up to 15% of the US population. The need to effectively treat this disorder is underscored by the significant adverse consequences on the productivity, safety, overall health, and quality of life of the affected individual. Pharmacologic intervention has traditionally involved the use of benzodiazepine receptor agonists (BzRAs), for which efficacy and general safety have been established. OBJECTIVE: The purpose of this paper is to examine the potentially unique role of zaleplon in the treatment of insomnia. DATA SOURCE: The clinical experience of the authors was critically applied to peer-reviewed published papers or abstracts regarding zaleplon, which were identified via MEDLINE (1995-September 2000). RESULTS: Adverse effects, usually related to residual sedation, impose limits on the use of older BzRAs and have prompted the development of new sleep medications with advantageous adverse event profiles. Zaleplon demonstrates a very rapid onset and offset of effect that permits symptomatic rather than prophylactic administration, resulting in comparable efficacy and reduced risk of the adverse effects associated with longer half-life agents. CONCLUSIONS: The characteristics of zaleplon may translate into distinct and significant clinical advances in the treatment of insomnia. PMID: Insomnia cures 11965211 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Herbal treatment of insomnia. Hong Kong Med J. 2001 Dec;7(4):392-402 Authors: Wing YK Insomnia is a common problem requiring appropriate recognition and management. Despite recent advances in the development of newer hypnotics in western medicine, a significant proportion of patients with insomnia, both locally and internationally, consume herbal hypnotics regularly. The safety and efficacy of these herbal remedies remains uncertain. In this paper, details of different herbs used in western and traditional Chinese medicine for the treatment of insomnia are reviewed. Although current data suggests the use of some herbal treatments in insomnia may be efficacious, further laboratory and clinical studies are required. PMID: Insomnia cures 11773674 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002 Jan;159(1):5-11 Authors: Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, Buysse DJ OBJECTIVE: Although four meta-analytic reviews support the efficacy of pharmacotherapy and behavior therapy for the treatment of insomnia, no meta-analysis has evaluated whether these treatment modalities yield comparable outcomes during acute treatment. The authors conducted a quantitative review of the literature on the outcome of the two treatments to compare the short-term efficacy of pharmacotherapy and behavioral therapy in primary insomnia. METHOD: They identified studies from 1966 through 2000 using MEDLINE, psycINFO, and bibliographies. Investigations were limited to studies using prospective measures and within-subject designs to assess the efficacy of benzodiazepines or benzodiazepine receptor agonists or behavioral treatments for primary insomnia. Benzodiazepine receptor agonists included zolpidem, zopiclone, and zaleplon. Behavioral treatments included stimulus control and sleep restriction therapies. Twenty-one studies summarizing outcomes for 470 subjects met inclusion criteria. RESULTS: Weighted effect sizes for subjective measures of sleep latency, number of awakenings, wake time after sleep onset, total sleep time, and sleep quality before and after treatment were moderate to large. There were no differences in magnitude between pharmacological and behavioral treatments in any measures except latency to sleep onset. Behavior therapy resulted in a greater reduction in sleep latency than pharmacotherapy. CONCLUSIONS: Overall, behavior therapy and pharmacotherapy produce similar short-term treatment outcomes in primary insomnia. PMID: Insomnia cures 11772681 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Am J Psychiatry. 2001 Dec;158(12):2043-7 Authors: Krakow B, Johnston L, Melendrez D, Hollifield M, Warner TD, Chavez-Kennedy D, Herlan MJ OBJECTIVE: Insomnia and nightmares are perceived as secondary phenomena in posttraumatic stress disorder (PTSD). Scant treatment research has targeted these two sleep disturbances. This study reports on an open-label trial of cognitive behavior therapy for insomnia and disturbing dreams in crime victims with PTSD. The relationship among nightmares, sleep disturbances, and PTSD symptoms is discussed. METHOD: Sixty-two participants completed a 10-hour group treatment consisting of imagery rehearsal for nightmares and sleep hygiene, stimulus control, and sleep restriction for insomnia. Nightmare frequency, sleep quality, sleep impairment, and ratings for PTSD, anxiety, and depression symptoms were assessed at baseline and at the 3-month follow-up. RESULTS: All measures demonstrated improvement that was roughly equivalent to changes in clinical severity from severe to moderate for sleep quality, sleep impairment, and nightmare frequency, from borderline severe to borderline moderate for PTSD symptoms, and from extremely severe to borderline severe for anxiety and depression symptoms. CONCLUSIONS: In this uncontrolled study, successful treatment for insomnia and nightmares in crime victims was associated with improvement in symptoms of PTSD, anxiety, and depression. Participants with clinical improvements in PTSD symptoms demonstrated significantly greater improvement in sleep quality and nightmare frequency than those whose PTSD symptoms did not improve. PMID: Insomnia cures 11729023 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30 Authors: Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU Older people typically exhibit poor sleep efficiency and reduced nocturnal plasma melatonin levels. The daytime administration of oral melatonin to younger people, in doses that raise their plasma melatonin levels to the nocturnal range, can accelerate sleep onset. We examined the ability of similar, physiological doses to restore nighttime melatonin levels and sleep efficiency in insomniac subjects over 50 yr old. In a double-blind, placebo-controlled study, subjects who slept normally (n = 15) or exhibited actigraphically confirmed decreases in sleep efficiency (n = 15) received, in randomized order, a placebo and three melatonin doses (0.1, 0.3, and 3.0 mg) orally 30 min before bedtime for a week. Treatments were separated by 1-wk washout periods. Sleep data were obtained by polysomnography on the last three nights of each treatment period. The physiologic melatonin dose (0.3 mg) restored sleep efficiency (P < 0.0001), acting principally in the midthird of the night; it also elevated plasma melatonin levels (P < 0.0008) to normal. The pharmacologic dose (3.0 mg), like the lowest dose (0.1 mg), also improved sleep; however, it induced hypothermia and caused plasma melatonin to remain elevated into the daylight hours. Although control subjects, like insomniacs, had low melatonin levels, their sleep was unaffected by any melatonin dose. PMID: Insomnia cures 11600532 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
[Insomnia. Prevalence and treatment of patients in general practice] Can Fam Physician. 2001 Apr;47:759-67 Authors: Blais FC, Morin CM, Boisclair A, Grenier V, Guay B OBJECTIVE: To evaluate the prevalence of insomnia and the treatments used by patients attending general practice clinics. DESIGN: Survey of outpatients. SETTING: Quebec city, Que. metropolitan area. PARTICIPANTS: Two hundred eighteen patients recruited in waiting rooms of general practice clinics. MAIN OUTCOME MEASURES: Participants completed a survey on sleep and use of substances for insomnia, a questionnaire documenting their medical history and use of health care services, and three indices measuring presence of worry and symptoms of anxiety and depression. RESULT: Close to 38% of respondents suffered from insomnia: 26.2% had chronic insomnia and 11.4% had short-term insomnia. Prevalence was higher among women and people 35 to 54 years old. Among respondents who used substances to help them sleep, those 55 years and older consumed more prescription and medications (benzodiazepines); those 35 to 54 years old used mainly natural products; and those 16 to 34 years old consumed mainly over-the-counter medications. Respondents suffering from insomnia made heavier use of health care services and reported more worry and symptoms of anxiety and depression than those who slept well. CONCLUSION: Patients attending general practice clinics have a high prevalence of insomnia. Physicians must be on the lookout for these sleep disturbances so they can offer appropriate treatment. PMID: Insomnia cures 11340757 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA. 2001 Apr 11;285(14):1856-64 Authors: Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE CONTEXT: Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking. OBJECTIVE: To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 to July 1997. PATIENTS: Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years). INTERVENTIONS: Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), or a quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months. MAIN OUTCOME MEASURES: Objective (polysomnography) and subjective (sleep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep-related self-efficacy, and mood. RESULTS: Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment. For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%. CONCLUSIONS: Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up. PMID: Insomnia cures 11308399 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Treatment of primary insomnia. CMAJ. 2000 Aug 22;163(4):389-91 Authors: Montplaisir J PMID: Insomnia cures 10976252 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Pharmacologic or behavioural therapy for elderly people's insomnia. Which is better? Can Fam Physician. 2000 Jul;46:1430-2 Authors: Pimlott NJ PMID: Insomnia cures 10925757 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Treatment of insomnia: an alternative approach.
Altern Med Rev. 2000 Jun;5(3):249-59 Authors: Attele AS, Xie JT, Yuan CS Insomnia is the most common sleep disorder, and is often associated with significant medical, psychological, and social disturbances. Conventional medical treatment for insomnia includes psychological and pharmacological approaches; however, long-term use of frequently prescribed medications can lead to habituation and problematic withdrawal symptoms. Therefore, herbal and other natural sleep aids are gaining popularity, as herbs commonly used for their sedative-hypnotic effects do not have the drawbacks of conventional drugs. Whether alternative therapies possess activity similar to conventional therapies needs further evaluation. PMID: Insomnia cures 10869104 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Meta-analysis of benzodiazepine use in the treatment of insomnia.
CMAJ. 2000 Jan 25;162(2):225-33 Authors: Holbrook AM, Crowther R, Lotter A, Cheng C, King D OBJECTIVE: To systematically review the benefits and risks associated with the use of benzodiazepines to treat insomnia in adults. DATA SOURCES: MEDLINE and the Cochrane Controlled Trials Registry were searched for English-language articles published from 1966 to December 1998 that described randomized controlled trials of benzodiazepines for the treatment of insomnia. Key words included "benzodiazepines" (exploded), "randomized controlled trial" and "insomnia." Bibliographies of relevant articles were reviewed for additional studies and manufacturers of benzodiazepines were asked to submit additional randomized controlled trial reports not in the literature. STUDY SELECTION: Articles were considered for the meta-analysis if they were randomized controlled trials involving patients with insomnia and compared a benzodiazepine with placebo or another active agent. Of the 89 trials originally identified, 45 met our criteria, representing a total of 2672 patients. DATA EXTRACTION: Data were extracted regarding the participants, the setting, details of the intervention, the outcomes (including adverse effects) and the methodologic quality of the studies. DATA SYNTHESIS: The meta-analyses of sleep records indicated that, when compared with placebo, benzodiazepines decreased sleep latency by 4.2 minutes (non-significant; 95% confidence interval (CI -0.7 to 9.2) and significantly increased total sleep duration by 61.8 minutes (95% CI 37.4 to 86.2). Patient-reported outcomes were more optimistic for sleep latency; those randomized to benzodiazepine treatment estimated a sleep latency decrease of 14.3 minutes (95% CI 10.6 to 18.0). Although more patients receiving benzodiazepine treatment reported adverse effects, especially daytime drowsiness and dizziness or light-headedness (common odds ratio 1.8, 95% CI 1.4 to 2.4), dropout rates for the benzodiazepine and placebo groups were similar. Cognitive function decline including memory impairment was reported in several of the studies. Zopiclone was not found to be superior to benzodiazepines on any of the outcome measures examined. INTERPRETATION: The use of benzodiazepines in the treatment of insomnia is associated with an increase in sleep duration, but this is countered by a number of adverse effects. Additional studies evaluating the efficacy of nonpharmacological interventions would be valuable. PMID: Insomnia cures 10674059 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach.
CMAJ. 2000 Jan 25;162(2):216-20 Authors: Holbrook AM, Crowther R, Lotter A, Cheng C, King D Insomnia, or the dissatisfaction with the quantity, quality or timing of sleep, is a common complaint. Because the definition of "normal" sleep is not well established, the estimates of the prevalence and severity of insomnia vary widely. Insomnia is often secondary to underlying psychiatric and medical conditions, and these should be evaluated and treated as a first measure. Nonpharmacological interventions for insomnia including sleep hygiene manoeuvres and exercise are recommended, although the success of these interventions has not been well documented. Benzodiazepines have been the pharmacologic agents of choice for the treatment of insomnia, but there is reason to exercise caution with their use; their overall benefit compared with placebo appears to be minor, and they are often associated with adverse cognitive effects. Unfortunately, no other class of drugs has proven to be superior to the benzodiazepines in terms of benefit:risk ratio. Given the importance of sleep for health and normal daily functioning the diagnosis, prognosis and treatment of insomnia should be a research priority. PMID: Insomnia cures 10674058 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Gabapentin treatment for insomnia associated with alcohol dependence.
Am J Psychiatry. 2000 Jan;157(1):151 Authors: Karam-Hage M, Brower KJ PMID: Insomnia cures 10618048 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Insomnia: assessment and management in primary care. National Heart, Lung, and Blood Institute Working Group on Insomnia. Am Fam Physician. 1999 Jun;59(11):3029-38
Authors: Patients with insomnia may experience one or more of the following problems: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning and nonrefreshing sleep. In addition, daytime consequences such as fatigue, lack of energy, difficulty concentrating and irritability are often present. Approximately 10 percent of adults experience persistent insomnia, although most patients do not mention it during routine office visits. Asking sleep-related questions during the general review of systems and asking patients with sleep complaints to keep a sleep diary are helpful approaches in detecting insomnia. Behavior and pharmacologic therapies are used in treating insomnia. Behavior approaches take a few weeks to improve sleep but continue to provide relief even after training sessions have ended. Hypnotic medications are safe and effective in inducing, maintaining and consolidating sleep. Effective treatment of insomnia may improve the quality of life for many patients. PMID: Insomnia cures 10392587 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
[Study on insomnia treatment by family physicians] Can Fam Physician. 1996 Mar;42:426-32
Authors: Baillargeon L, Demers M, Grégoire JP, Pépin M OBJECTIVES: To describe treatment of insomnia in general practice and to identify family physicians' training needs in this area. DESIGN: Mail survey using Dillman's total design method. PARTICIPANTS: A sampling of 484 general practitioners in the Quebec City area was done to provide roughly equal representation of six practice settings. The response rate was 65%; 295 of the 315 questionnaires returned were selected for analysis. RESULTS: Most physicians reported treating insomnia with general advice and lifestyle changes; 25% reported prescribing hypnotics frequently; 56% reported they prescribed them occasionally. Although 58% often recommend relaxation techniques, only 8% taught these techniques to their patients. Other cognitive and behavioral approaches are rarely used. Most felt that training in treating insomnia should be offered. CONCLUSION: Cognitive and behavioral approaches are very effective approaches are very effective nonpharmacological treatments for insomnia. General practitioners make little use of these treatments that could be easily integrated into clinical practice. Strategies for increasing their use discussed. PMID: Insomnia cures 8616283 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
ABC of sleep disorders. Practical management of insomnia: behavioural and cognitive techniques. BMJ. 1993 Feb 20;306(6876):509-11
Authors: Espie CA PMID: Insomnia cures 8448467 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Midazolam and oxazepam in the treatment of insomnia in hospitalized patients. Br J Clin Pharmacol. 1983;16 Suppl 1:145S-149S
Authors: Gallais H, Casanova P, Fabregat H Fifty-nine hospitalized patients participated in a double-blind study: 19 received 15 mg midazolam, 20 received 50 mg oxazepam, and 20 placebo. The three groups were comparable with regard to age, sex, height, weight, and degree and type of insomnia. The sleep-onset latency was shorter with midazolam than with placebo or oxazepam (Mann-Whitney test, alpha less than 0.05). With regard to total sleep duration and the number of nocturnal awakenings, there was no difference between the midazolam and oxazepam groups, whereas there was a difference between these two groups and placebo. More subjects of the midazolam group felt calm and refreshed on awakening. Safety, assessed by clinical examination and laboratory tests, was excellent. This study confirms the usefulness of midazolam in treating 'early' insomnia, i.e. difficulty in falling asleep. PMID: Insomnia cures 6138068 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Relaxation treatment of pseudoinsomnia and idiopathic insomnia: an electroencephalographic evaluation. J Appl Behav Anal. 1979;12(1):37-54
Authors: Borkovec TD, Grayson JB, O'Brien GT, Weerts TC Twenty-nine insomniacs underwent four consecutive sleep laboratory evaluations before and after receiving tension-release relaxation training, no-tension-release relaxation training, or no-treatment. On the basis of the discrepancy between subjective and EEG-defined measures of latency to sleep onset, subjects were classified as pseudoinsomniacs or idiopathic insomniacs. As predicted, tension-release relaxation was significancy more effective than the other two conditions on subjective sleep measures, regardless of insomnia subtype and on objective sleep measures only for idiopathic insomniacs. Subjective improvement was maintained at 12-month followup. Numerous differences between the two subtypes emerged on pretherapy and during-therapy measures distinct from the latency measures, but changes on those variables were unrelated to outcome improvement. PMID: Insomnia cures 381276 [PubMed - indexed for MEDLINE ( Insomnia cures) ]
Treatment of insomnia. Br Med J. 1968 May 25;2(5603):479-80
Authors: PMID: Insomnia cures 5648296 [PubMed - indexed for MEDLINE ( Insomnia cures) ] Ask about insomnia cures
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