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Chronic Insomnia (chronic + insomnia)
Selected AbstractsLate-life insomnia: A reviewGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Arne Fetveit Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio- and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short-term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long-term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions. [source] Effects of long-term exposure to ramelteon, a melatonin receptor agonist, on endocrine function in adults with chronic insomniaHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2009Gary Richardson Abstract Objective To evaluate the effects of ramelteon, an MT1/MT2 melatonin receptor agonist used to treat insomnia, on endocrine function in adults with chronic insomnia. Methods This was a double-blind, placebo-controlled, trial of adults (18,45 years) with chronic insomnia. Subjects received either ramelteon 16,mg or placebo nightly for 6 months. Hormonal measures of the thyroid, reproductive, and adrenal axes were analyzed monthly and compared with baseline and placebo values. Results While isolated changes were detected at some time points, there were no consistent statistically significant differences between treatments on measures of thyroid function (total T4, free T4, TSH, and total T3), adrenal function (AM cortisol, and ACTH), or on most reproductive endocrine measures [LH, FSH, estradiol (women), total, and free testosterone (men)]. Prolactin concentrations were increased overall in women in the ramelteon group compared with placebo (p,=,0.003). No clinical effects of elevated prolactin were reported; average menstrual cycle length, duration of menses, and ovulation probability did not differ between groups. Conclusions Long-term exposure to ramelteon 16,mg, a potent melatonin receptor agonist, resulted in mild, transient increase in prolactin, in women only, that were not associated with measurable reproductive effects. There were no consistent changes in other endocrine measures. Copyright © 2008 John Wiley & Sons, Ltd. [source] Dose-response effects of zaleplon as compared with triazolam (0·25 mg) and placebo in chronic primary insomniaHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2000Christopher L Drake Abstract The effects of two nights of treatment with the short-acting benzodiazepine receptor agonist zaleplon, triazolam, or placebo was assessed in chronic primary insomniacs using two concurrent, multi-center, randomized, double-blind, Latin Square crossover studies. Study 1 (n = 47) compared zaleplon (10 and 40 mg) to triazolam (0·25 mg) and placebo. Study 2 (n = 36) compared zaleplon (20 and 60 mg) to triazolam (0·25 mg) and placebo. For each study, polysomnographically recorded sleep parameters and patient reports of sleep quality were collected during baseline and two consecutive nights during the four treatment phases in each study. All doses of zaleplon produced significant decreases in latency to persistent sleep. Although no minimally effective dose could be determined, dose-response effects were apparent. Triazolam 0·25 mg produced a decrease in latency to persistent sleep that was comparable to that of zaleplon 10 mg. Only the triazolam dose and the 60 mg dose of zaleplon produced significant increases in total sleep time over placebo. Zaleplon 40 and 60 mg and triazolam produced decreases in the percentage of REM sleep compared to placebo. Patient reports of efficacy were consistent with objective findings. In addition, all doses of zaleplon tended to increase while triazolam decreased the percentage of stage 3/4 sleep. There was no evidence of residual daytime impairment for any of the zaleplon doses, however, triazolam administration produced significant impairment in performance on a digit copying test. A higher number of adverse events were seen with the 40 and 60 mg doses of zaleplon compared to triazolam (0·25) and placebo. At higher doses, zaleplon is more effective than triazolam at reducing latency to persistent sleep in chronic insomnia and is not associated with the decrease in slow-wave sleep or residual impairment observed with triazolam. However, increases in total sleep time were apparent only at doses which produced concomitant increases in the number of adverse events. In contrast, triazolam (0·25 mg) produced increases in total sleep time (,25 min) and decreases in latency to persistent sleep at a dose of 0·25 mg. Copyright © 2000 John Wiley & Sons, Ltd. [source] The Effect of Insomnia Definitions, Terminology, and Classifications on Clinical PracticeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005Andrew D. Krystal MD There is a need for newer, more clinically useful classifications for insomnia. Identification of specific subtypes of insomnia helps anchor research, allows for prediction of prognosis/course of the condition, and may allow for individualization of treatment. Existing classifications differ, and many terms remain inadequately defined, which leads to diagnostic confusion. Historically, insomnia has been classified according to symptom type, symptom duration, and underlying cause, but these classifications have not been based on evidence of their utility, and newer research suggests the need for change. Symptoms may include difficulty falling asleep, trouble staying asleep, and not feeling restored by sleep, although it has not been clear that it is possible to identify distinct subtypes of patients by symptom or that distinguishing symptom type affects the course of clinical treatment. Classification of insomnia by duration most commonly involves three categories: transient (no more than a few days), short-term (up to 3 weeks), and long-term (more than 3 weeks). This categorization is of uncertain utility and has been primarily based on nonempiric concerns about treatment with sedative-hypnotic medications for periods longer than several weeks. The subtyping of insomnia in terms of whether there is an identifiable underlying cause such as a psychiatric or medical illness was based on an unproven assumption that in most instances other disorders caused insomnia. Recent studies suggest the need to revisit these classification strategies. Evidence that symptom types typically overlap and change over time complicates the categorization of subjects by whether they have difficulty falling asleep or staying asleep or have nonrestorative sleep. New studies of the treatment of chronic insomnia change the perspective on duration of treatment and, as a result, classification of duration of disease. Two studies of nightly pharmacotherapy for insomnia including more than 800 insomnia patients have not identified any increase in the risks after 3 to 4 weeks of treatment. In addition, nonpharmacological treatments demonstrate long-lasting efficacy in patients with chronic insomnia, and the development of abbreviated cognitive-behavioral therapies, which are particularly well suited to primary care practice, have improved their applicability. Newer studies of the relationships between insomnia and associated medical and psychiatric conditions undermine the notion that insomnia is always a symptom and caused by an underlying condition. They suggest that, although it is important to identify and treat these conditions, this may not be sufficient to alleviate the insomnia, which may adversely affect the course of the associated disorder. As a result, treatment targeted specifically to the insomnia should be considered. All of these developments point to an increasing ability to tailor therapy to the particular needs of patients and to optimize the clinical management of insomnia. [source] Variations in sleep hygiene practices of women with and without insomnia,RESEARCH IN NURSING & HEALTH, Issue 4 2004Rita E. Cheek Abstract Sleep hygiene education is a basic component of behavioral treatment for chronic insomnia, yet the actual sleep hygiene practices of people with insomnia have not been well documented. In this descriptive secondary analysis, midlife women ages 41,55 years with either chronic insomnia (n,=,92) or good sleep (n,=,29) kept diaries of sleep perceptions and sleep hygiene practices during 6 nights of somnographic monitoring at home. In both groups few reported smoking cigarettes (<10%), most drank caffeine (>80%), and many averaged 30 min of exercise per day (,50%). Very few in either group (<10%) had regular (<30 min variation) bedtimes or getting-up times. Compared to women with good sleep, those with insomnia reported drinking less caffeine per day, being more abstinent from alcohol, and having smaller variations in day-to-day alcohol intake and bedtimes. Although some women with insomnia limit or refrain from caffeine and alcohol intake, many have not optimized behaviors believed to help prevent or modulate insomnia. © 2004 Wiley Periodicals, Inc. Res Nurs Health 27:225,236, 2004 [source] | ||||||||||