Special Considerations for Treatment of Insomnia (original) (raw)
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What’s new in insomnia? Diagnosis and treatment
Arquivos de Neuro-Psiquiatria
Although, insomnia is one of the most common diseases that health professionals face in their practice, it receives little attention in medical training. Diagnosis is based on a careful history taking, and physicians must be aware of the diagnostic criteria. Insomnia should not be considered a symptom, but a comorbid condition. Although cognitive behavioral therapy (CBT) has been the mainstay treatment for insomnia for many years, it is usually regarded as a novel therapeutic strategy, both because of scarcity of qualified psychologists and of limited knowledge about insomnia among physicians. GABA receptor acting drugs are being abandoned in the treatment of insomnia because of abuse and dependence potential and accident risk. Two main current therapeutic options with the best scientific evidence are the tricyclic antidepressant, doxepin, and a new melatoninergic receptor agonist, ramelteon. Newer drugs to treat insomnia are in the pipeline. Hypocretine blocking agents will be mark...
Insomnia: A New World Nightmare
Mantech Publications, 2021
Insomnia disorder affects an oversized proportion of the population on a situational, perennial or chronic basis and is among the foremost common complaints in practice. The disorder is preponderantly characterised by discontentment with sleep length or quality and difficulties initiating or maintaining sleep, at the side of substantial distress and impairments of daytime functioning. A sleep study isn't habitually indicated for analysis of sleep disorder. psychological feature behavioral medical care for sleep disorder (CBT-I) is that the mainstay of treatment and may be a safe and effective approach. The key challenge of CBT-I is that the lack of clinicians to implement it. The newer generation nonbenzodiazepines (e.g., zolpidem, zaleplon) area unit used as first-line pharmacotherapy for chronic sleep disorder. Newer medication active on targets apart from the gammaaminobutyric acid receptor area unit currently obtainable, however clear treatment tips area unit required. 1 We can use flavourer medication for sleep disorder like this, Sarpagandha,
Assessment and diagnosis of insomnia in non-pharmacological intervention studies
Sleep Medicine Reviews, 2002
A number of non-pharmacologic interventions have been developed and studied for the treatment of primary insomnia in adults. Fifty-four non-pharmacological intervention studies published over the last 20 years were reviewed to determine how primary insomnia was assessed and to characterize patients participating in the studies. The main objectives were to inform clinicians who look to the literature for information on the treatment of insomnia about selection and diagnosis of participants, and to examine differences between clinic-based and research-based studies. Mean age for all patients was 47 years; 65% were women. Studies typically used interview procedures to assess participants. The most common exclusion criteria overall was insomnia secondary to medical illness or psychiatric disorder. Methods for assessing these criteria varied widely across studies. Inclusion most commonly required a 6month duration of insomnia, and sleep difficulty at least 3 nights per week. There were significant differences between clinic-and research-based studies in the screening assessments, exclusion criteria, and participant drop-out rate. The heterogeneity in assessment and diagnosis complicates comparison across studies. Some studies were more likely to include severe insomnia sufferers and/or individuals with secondary insomnia. Comprehensive assessment and complete reporting of research methods is essential to determining the relative efficacy and clinical utility of interventions. Clinicians should be aware of the differences across studies from research vs. clinical settings. To enhance the generalizability of research-based studies to clinical practice, careful screening and description of study participants is essential. When participants are well-described, research-based studies can be useful and informative to clinicians. 2002 Published by Elsevier Science Ltd multiple risks including increased likelihood of auto-Insomnia complaints and increased risk for major depression compared Insomnia has been defined as "a perception by the to individuals without insomnia complaints [2-4]. A patient that their sleep is inadequate or abnormal" Consensus Development Conference held by the [1]. Individuals with insomnia complaints suffer from National Institute of Mental Health estimated that 35% of USA adults complain of having "trouble sleeping in the last year," half of whom complained Correspondence should be addressed to: S. Ancoli-Israel, that their sleep difficulties were "severe" in nature Veterans Affairs San Diego Healthcare System, Department of [5]. These data often are used to suggest that over Psychiatry,
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
Sleep Medicine Reviews, 2009
For many years practitioners have had limited data from double-blind, placebo-controlled studies to guide the types of decision-making needed to optimally manage patients with insomnia in clinical practice. However, in recent years there has been a great increase in insomnia research studies that address issues of clinical importance. This body of work represents an increasingly useful empirical basis for making clinical practice decisions. The purpose of this article is to compile the body of work on the pharmacological management of insomnia to make it available in as accessible form as possible for optimal application in clinical practice with the hopes that doing so will decrease the gap separating the available research and the clinical management of insomnia and, thereby, improve the care of the many individuals who suffer from this condition. The review of studies consists of the following sections: 1) basic pharmacology; 2) double-blind, placebo-controlled trials in adults with primary insomnia; 3) double-blind, placebo-controlled trials in elderly patients with primary insomnia; 4) adverse effects reported in placebo-controlled trials in elderly primary insomnia patients; 5) double-blind, placebocontrolled trials in adults and the elderly as a function of treatment duration; 6) double-blind, placebocontrolled trials of the treatment of comorbid insomnia. Issues related to the application of these data to clinical practice are discussed in the text.
Cognitive-Behavioral and Pharmacological Treatments for Insomnia: A Combined Approach
2020
Insomnia is the most prevalent sleep disorder (10-40%). It is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep and that results in some form of daytime impairment. Among the typical symptoms, there are fatigue, decreased mood or irritability, general malaise, and cognitive impairment. According to the International Classification of Sleep Disorders 3 rd edition, ICSD-3, it has been defined as chronic (lasting more than three months) or short-term insomnia (less than three months). In clinical practice, the usual therapeutic approach is pharmacological (benzodiazepines, z drugs, slow wave sleep enhancers), even if the American Academy of Sleep Medicine (AASM), the American College of Physicians (ACP), and the European Sleep Research Society (ESRS) guidelines suggest that the first clinical choice should be non-pharmacological (cognitive behavioral therapy). A combined (non...
Insomnia causes, consequences, and therapeutics: An overview
Depression and Anxiety, 2003
There is growing interest in insomnia both from the perspective of recent advances in clinical management as well as research aimed at elucidating its pathophysiology. This theoretical overview of insomnia describes the negative impact, etiological considerations, and pharmacological and behavioral treatments for the disorder, with an emphasis on areas receiving increased research attention. Insomnia, the most prevalent sleep disorder, affects 10-15% of the general population. In population-based studies severe insomnia has been shown to last for a median of 4 years. In addition, insomnia has a significant negative impact on an individual's work, physical, and social performance as well as overall quality of life. Furthermore, the economic cost of insomnia related to lost productivity, work-related accidents, absenteeism, and health-care costs are enormous. There is increasing evidence linking the precipitation of insomnia to stress, and converging evidence from cognitive, endocrine, neurological, and behavioral domains provide clear evidence for hyperarousal in insomnia. However, there remains no consensus regarding the specific etiological mechanisms of this disorder. Although the pathophysiology of primary insomnia remains an enigma, numerous treatments both pharmacological and behavioral have been developed and found to be efficacious in controlled studies. Despite the wide availability of pharmacological treatments and increased knowledge of behavioral interventions, the vast majority of individuals with insomnia do not appear to be receiving adequate treatment. The inadequate treatment of insomnia leads to several important and under-recognized consequences including subsequent development of psychiatric disease and increased substance use.