Secondary insomnia: diagnostic challenges and intervention opportunities (original) (raw)

Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments

Age and Ageing, 2003

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.

Emerging research on the treatment and etiology of secondary or comorbid insomnia

Sleep Medicine Reviews, 2006

Secondary insomnia is defined as difficulty initiating or maintaining sleep that occurs as a consequence of another primary medical or psychiatric disorder. This distinction from primary insomnia has been thought to be important from a diagnostic standpoint so that treatment for secondary insomnia can appropriately target the primary disorder. By convention, treating insomnia directly has only been recommended with primary insomnia. However, a number of recent studies of cognitive-behavioral treatment for a wide range of secondary insomnias have demonstrated that this approach is an effective treatment in this population. These results are not predicted by the traditional conceptualization of secondary insomnia. Results of epidemiological research also argue against viewing insomnia that is comorbid with another disorder as being caused by that disorder. A revised model is needed to understand insomnia that is comorbid with medical and/or psychiatric illness, in addition to re-evaluating standard treatment protocols for comorbid insomnia. Q

Treatment of insomnia in older adults

Clinical Psychology Review, 2005

Insomnia outcome studies from the last 15 years show consistent success for behavioral treatment with older adults. The present review of evaluation and treatment covers the effects of aging on ability to sleep, the insomnia classification system, the treatment efficacy database, and critical outcome research methodology. Clinical trial methodology with older adults includes familiar challenges; for example, the need for placebo controls, and frequent failures to document the adequacy of treatment implementation. Recommendations for improving methodology are offered. A new review of treatment for primary insomnia in older adults shows strong improvement and consistent results for popular behavioral treatments. Older adult clinical trials show proven efficacy of behavioral treatment for primary insomnia, efficacy for secondary insomnia, and efficacy for insomnia associated with hypnotic dependency. D

Manifestations and Management of Chronic Insomnia in Adults: Evidence Report/Technology Assessment, Number 125

PsycEXTRA Dataset

Insomnia, or inability to sleep, is the most commonly reported sleep problem in the industrialized world. 1 Estimates suggest that between 40 and 70 million Americans are affected by either intermittent or chronic sleep problems, representing approximately 20 percent of the population. 2 The Sleep in America Poll, conducted by the National Sleep Foundation, revealed that almost 50 percent of people surveyed had complaints of frequent insomnia, but only 6 percent were formally diagnosed. 3 Moreover, approximately, 30 to 35 percent of respondents complained of nightly insomnia. 3 The most prevalent symptoms of insomnia, experienced at least a few nights a week by people with insomnia, include waking up feeling unrefreshed (34 percent) and being awake often during the night (32 percent). 3 The symptoms of difficulty falling asleep and waking up too early are less common, but still experienced at least a few nights a week by about one-fourth of adults with insomnia (23 to 24 percent). 3 Risk Factors for Insomnia Although some risk factors and etiologies of insomnia have been identified, the nature of the relationships has not been fully elucidated. Some risk factors for insomnia that have emerged from data related to insomnia include female gender 3 and old age. 4 Additional risks factors include less education, unemployment, separation or divorce, and medical illness. 1 Insomnia may be primary or secondary to other sleep problems and may be associated with a number of co-morbidities. An association has been found between insomnia and psychiatric (depression and anxiety) and psychological disorders. 4 There is increasing evidence that chronic insomnia may predispose individuals to the development of psychiatric disorders. 5-6 Persistent insomnia increases the risk of depression, substance abuse, and anxiety disorders. Environmental factors such as irregular sleep schedules, use of caffeine or other stimulants, co-morbid medical conditions, and/or shift work may also predispose vulnerable individuals to insomnia. Consequences of Insomnia Insomnia has significant direct and indirect effects on the health and wellness of affected individuals. Insomnia has been correlated with frequent use of medical services, 7-8 chronic health problems, 9-10 increased drug use, 7-8 and perceived poor health, 11 and has been associated with medical problems including heart disease, 12 hypertension, 13 and musculoskeletal problems. 12 The daytime consequences of chronic insomnia often include increased healthcare utilization, increased risk of depression, 14 poor memory, reduced concentration, poor work performance, and perceived or real risk of failure at work. 15 The economic implications of insomnia and

Treatment of Primary Insomnia

2004

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. (J Am Board Fam Pract 2004;17:212-9.)

Chronic insomnia: current issues

Clinical cornerstone, 2004

Insomnia is a common problem in the general population and has a higher prevalence in persons with medical and psychiatric disorders. Although insomnia is most often transient, occurring as a result of identifiable stressors, a substantial portion of insomnia cases involve persistent sleep difficulty. This chronic form of insomnia may be associated with a wide range of adverse consequences. An understanding of the characteristics and causes of this disorder and the available therapeutic strategies will promote more effective identification and treatment of patients with chronic insomnia.

Management of chronic insomnia in elderly persons

American Journal of Geriatric Pharmacotherapy, 2006

Background: Chronic insomnia is common among the elderly. These elderly patients are often viewed as difficult to treat, yet they are among the groups with the greatest need of treatment.

Integrating modern concepts of insomnia and its contemporary treatment into primary care

Postgraduate medicine, 2014

Insomnia affects one-third of the adult population. Ten percent of adults surveyed in America consider it a serious problem. Chronic insomnia is associated with poor quality of life and the potential for various psychiatric and medical conditions, notably depression and cardiovascular disease. Since most patients with insomnia are unlikely to disclose obvious sleeping difficulties, the first step in diagnosing and managing patients is having a high index of suspicion in patients with specific complaints, comorbidities, and risk factors. This is followed by a complete evaluation of the patient's medical and physical history to determine if the insomnia is primary or comorbid with another disease. The management of insomnia should consider the extent of impairment associated with the disorder, as well as duration, causes, and comorbidities. In some cases, referral to a specialist is warranted. Recently, there have been new definitions of insomnia proposed; elucidation of the role ...