Chronic Insomnia In Adults Research Articles

Evaluation of Insomnia in the Adult Client

Insomnia is a prominent public health concern and the second most common complaint in primary care. 1 Schutte-Rodin S Broch L Buysse D Dorsey C Sateia M Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4: 487-504 PubMed Google Scholar Insomnia is defined as the subjective perception of daytime function impairment accompanied by difficulty initiating sleep, maintaining sleep, or experiencing non-restorative sleep despite adequate opportunity and conditions. 2 Judd B Sateia M Classification of sleep disorders. Up-To-Date. http://www.uptodate.com/contents/classification-of-sleep-disorders Google Scholar The American Cancer Society conducted a survey of 1.1 million Americans and found that persons who slept around 7 hours per night had the lowest rates of mortality, while men who slept less than 4.5 hours and women who slept less than 3.5 hours had a 15% increase in mortality. 3 Kripke D Garfinkel L Wingard D Klauber M Marler M Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002; 59: 131-136 Crossref PubMed Scopus (1229) Google Scholar Risk factors for insomnia include advanced age; female gender; psychiatric, medical, sleep, or substance abuse disorders; shift work; and, perhaps, lower socioeconomic status and unemployment. 1 Schutte-Rodin S Broch L Buysse D Dorsey C Sateia M Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4: 487-504 PubMed Google Scholar

JuSt - a multimodal program for treatment of insomnia in adolescents: a pilot study.

Insomnia is the most prevalent sleep disorder in adolescents. A number of studies have evaluated the efficacy of the management of chronic insomnia in adults. Behavioral therapy for insomnia is the treatment of first choice, encompassing education about sleep and sleep hygiene, stimulus control, relaxation techniques, and cognitive strategies to combat nocturnal ruminations. Special programs for adolescents are lacking. In this study an age-oriented treatment program for adolescents (JuSt) was developed and evaluated. Eighteen adolescents and their parents participated in a psychological short-term treatment comprising six sessions. First results show that the treatment was well accepted by the adolescents and their parents and led to a significant reduction in sleep problems, such as sleep onset, sleep efficacy, sleep duration, and feeling rested as well as in cognitive parameters, such as ruminations and mental health. Randomized controlled studies are needed to evaluate the efficacy of this new approach to treat insomnia in adolescents.

The Anxious Sleeper

The Anxious Sleeper

Evaluation and Management of Chronic Insomnia in Adults

Evaluation and Management of Chronic Insomnia in Adults

The role of eszopiclone in the treatment of insomnia

Insomnia is a common and underdiagnosed condition that can result in significant economic and clinical consequences. Despite numerous behavioral and pharmacotherapeutic treatment options available for insomnia, few receive adequate treatment, and sleep maintenance (staying asleep) remains a significant problem. To date, available sedative-hypnotic agents have limitations that have lead to inadequate treatment of insomnia. This review provides an overview of eszopiclone and its role in the treatment of insomnia. Electronic databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts) were searched for applicable primary literature and review articles. Mechanisms of action at the gamma-amino butyric acid (GABA) receptor sites and pharmacologic and pharmacokinetic characteristics are presented. Eszopiclone, a nonbenzodiazepine S-enantiomer of racemic zopiclone, is highlighted as the first sedative-hypnotic agent to be approved by the United States Food and Drug Administration for the treatment of sleep onset latency and sleep maintenance insomnia with no short-term restrictions. Recently, the European Medicines Agency recommended marketing authorization of eszopiclone. Eszopiclone has been shown to be an efficacious and cost-effective option for the treatment of transient and chronic insomnia in adults.

NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults

NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults

Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults

Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia 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.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, "insomnia" refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.

Comparison of Meta-Analytic Results of Indirect, Direct, and Combined Comparisons of Drugs for Chronic Insomnia in Adults: A Case Study

Our Center recently conducted a systematic review of the manifestations and management of chronic insomnia in adults. The efficacy and safety of benzodiazepines and nonbenzodiazepines, relative to placebo, were compared indirectly. Determine how the results of indirect comparisons made in the review compare with the results of direct comparisons, as well as with estimates derived from Bayesian mixed treatment comparisons. Establish general appropriateness of the use of results of indirect or mixed treatment comparisons. Treatments were compared using frequentist direct, indirect, and combined methods, as well as Bayesian direct and mixed methods. Estimates for comparisons tended to be clinically and statistically similar across methods. Estimates obtained through indirect comparisons were not biased and were similar to those obtained through direct analysis. Results of indirect comparisons made in the review, accurately reflected the current evidence. Frequentist and Bayesian methods of analysis of indirect comparisons should be considered when performing meta-analyses.

The Efficacy and Safety of Drug Treatments for Chronic Insomnia in Adults: A Meta-analysis of RCTs

Hypnotics have a role in the management of acute insomnia; however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear. The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults. Twenty-one electronic databases were searched, up to July 2006. Randomized double-blind, placebo-controlled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model. One hundred and five studies were included in the review. Sleep onset latency, as measured by polysomnography, was significantly decreased for benzodiazepines (BDZ), (weighted mean difference: -10.0 minutes; 95% CI: -16.6, -3.4), non-benzodiazepines (non-BDZ) (-12.8 minutes; 95% CI: -16.9, -8.8) and antidepressants (ADP) (-7.0 minutes; 95% CI: -10.7, -3.3). Sleep onset latency assessed by sleep diaries was also improved (BDZ: -19.6 minutes; 95% CI: -23.9, -15.3; non-BDZ: -17.0 minutes; 95% CI: -20.0, -14.0; ADP: -12.2 minutes; 95% CI: -22.3, -2.2). Indirect comparisons between drug categories suggest BDZ and non-BDZ have a similar effect. All drug groups had a statistically significant higher risk of harm compared to placebo (BDZ: risk difference [RD]: 0.15; non-BDZ RD: 0.07; and ADP RD: 0.09), although the most commonly reported adverse events were minor. Indirect comparisons suggest that non-BDZ are safer than BDZ. Benzodiazepines and non-benzodiazepines are effective treatments in the management of chronic insomnia, although they pose a risk of harm. There is also some evidence that antidepressants are effective and that they pose a risk of harm.

Sleep and Residual Sedation After Administration of Zaleplon, Zolpidem, and Placebo During Experimental Middle-of-the-Night Awakening

To assess the efficacy of zaleplon 10 mg and zolpidem 10 mg administered during experimental middle-of-the-night awakenings in patients with sleep-maintenance insomnia using objective polysomnographic measures and to assess daytime residual sedation 4 to 7 hours after dosing using sleep-latency testing. A randomized, double-blind, placebo-controlled, 3-period, crossover design was used to study 37 adults with insomnia who received treatment during an experimental awakening 4 hours after bedtime. Latency to persistent sleep and total sleep time before and after awakening were recorded. The primary residual sedation measure was a sleep latency test conducted hourly from 4 to 7 hours after treatment. Self-report measure of alertness and concentration and digit symbol substitution tests were examined concurrently. Sleep disorders centers. Thirty-seven adults with sleep-maintenance insomnia. Zaleplon 10 mg, zolpidem 10 mg, or placebo. Thirty-one patients had efficacy-evaluable data; 37 patients received at least 1 dose of study medication and were included in the safety analysis. Compared with placebo, latency to persistent sleep after both zaleplon and zolpidem was shorter and total sleep time after administration of the drugs was longer (overall p < .001, Dunnett p < .001 for all posthoc comparisons). Significant differences from placebo were not found with zaleplon in daytime-sedation measures. At 4, 5, and 7 hours after zolpidem, sleep onset on sleep latency testing was shorter than after placebo (overall p < .001 for all, Dunnett tests for posthoc comparisons p < .001, p < .001, p < .05, respectively). Self-report measures of concentration (4, 5, and 6 hours, overall p < .05, Dunnett p < .05 for each time point) and alertness (4 hours, overall p < .05, Dunnett p < .05), and Digit Symbol Substitution Test scores (4 and 5 hours, overall p < .001, Dunnett p < .01 for both time points) after zolpidem were also lower than with placebo. Zaleplon 10 mg and zolpidem 10 mg effectively shorten sleep latency and lengthen sleep duration after dosing, when administered during experimental nocturnal awakening. Residual sedation was not detected as little as 4 hours after zaleplon 10 mg, whereas residual sedation was detected with zolpidem 10 mg up to 7 hours after treatment. These findings suggest that zaleplon may be an appropriate treatment for use when patients awaken during the night and have difficulty reinitiating sleep.

Eszopiclone for the treatment of insomnia

Eszopiclone, a single-isomer, non-benzodiazepine hypnotic agent, is approved for use in the US for the treatment of insomnia for patients who have difficulty falling asleep (sleep latency) as well as for those who have difficulty staying asleep (sleep maintenance). Efficacy in sleep maintenance has not been consistently demonstrated with previous hypnotics, and long-term efficacy and safety data are lacking for these agents. In clinical trials, eszopiclone 3 mg significantly improved objective and subjective sleep measures in transient and chronic insomnia in adults. Nightly treatment with eszopiclone 1 mg effectively induced sleep in elderly patients and the 2-mg dose effectively induced and maintained sleep. The ability of eszopiclone 2 mg to significantly improve next-day functioning and daytime alertness (as demonstrated by a reduction in the number and duration of naps) in the elderly is an important finding in clinical trials, and is unique to the class of hypnotic agents for the treatment of insomnia. Eszopiclone was well tolerated in clinical trials ≤ 12 months duration, with no clinically significant evidence of pharmacological tolerance, rebound insomnia or dependence. The most frequently reported adverse event was unpleasant taste. Eszopiclone is the only non-benzodiazepine sedative-hypnotic (in the Schedule IV class under the Controlled Substances Act) to be evaluated as a long-term treatment for chronic insomnia.

Systematic Review of the Efficacy and Safety of Drug Treatments and Combination Treatments in the Management of Chronic Insomnia in Adults

Free AccessSystematic Review of the Efficacy and Safety of Drug Treatments and Combination Treatments in the Management of Chronic Insomnia in Adults Manisha Witmans, M.D. Manisha Witmans, M.D. University of Alberta and Pediatric Sleep Program and Pediatric Sleep Medicine, Stollery Children&rsquo;s Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada Search for more papers by this author Published Online:October 15, 2005https://doi.org/10.5664/jcsm.26403SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Volume 01 • Issue 04 • October 15, 2005ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Published onlineOctober 15, 2005 Information© 2005 American Academy of Sleep MedicinePDF download

Systematic Review of the Prevalence, Incidence, Natural History, and Factors Associated With Chronic Insomnia in Adults

Free AccessSystematic Review of the Prevalence, Incidence, Natural History, and Factors Associated With Chronic Insomnia in Adults Manisha Witmans, M.D. Manisha Witmans, M.D. University of Alberta and Pediatric Sleep Program and Pediatric Sleep Medicine, Stollery Children&rsquo;s Hospital and University of Alberta Hospital, Edmonton, Alberta, Canada Search for more papers by this author Published Online:October 15, 2005https://doi.org/10.5664/jcsm.26394SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Volume 01 • Issue 04 • October 15, 2005ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Published onlineOctober 15, 2005 Information© 2005 American Academy of Sleep MedicinePDF download

Systematic Review of the Efficacy and Safety of Nondrug and Sequential Treatments in the Management of Chronic Insomnia in Adults

Systematic Review of the Efficacy and Safety of Nondrug and Sequential Treatments in the Management of Chronic Insomnia in Adults

The Diagnosis and Treatment of Chronic Insomnia in Adults

INSOMNIA, THE MOST COMMON SLEEP COMPLAINT THAT AFFECTS THE LIVES OF MILLIONS, HAS BEEN LEFT “BEHIND” IN TERMS OF RESEARCH FOCUS OVER the last 10-15 years. The National Institutes of Health State of the Science Conference Statement is a major step towards recognizing that gap. The following points are offered in the spirit of contributing to a dialogue that is at its very beginning, and I appreciate the opportunity that was made possible by the Editor of SLEEP. One of the proposals included in the Statement is the use of the term “comorbid insomnia” in lieu of terms such as “secondary” or “primary” insomnia. This proposal is based on the recognition that chronic insomnia is usually comorbid with psychiatric and physical conditions and that currently there is limited understanding of the nature of their association or direction of causality. The term “comorbid” suggests the presence of 1 or more disorders (or diseases) in addition to a primary disease or disorder. It does not imply either causality or association. The strong association of insomnia with psychiatric conditions appears to be the single most important association and the most consistent finding across almost all studies in the last 30 years. For example, in a multicenter field trial sponsored by NIMH, insomnia was associated with another diagnosable psychiatric condition in 90-93% of the cases depending on the diagnostic system used (DSM-IV vs. International Classification of Diseases (ICD-10)). 1 Also, in a recent study in 1741 men and women of a random general population sample, depression was the single strongest variable, followed by female gender. 2 Physical disorders were also associated with insomnia but to a much lesser degree, eg, odds ratio (OR) for depression of 5.5 vs. OR for colitis of 1.3. Sleep apnea, defined as an OHI ≥ 15, was not associated with insomnia, which is consistent with earlier findings from clinical samples. Do these data support any causal link between insomnia and psychiatric conditions? Certainly not, as correctly pointed out in the Statement. Despite the clinical evidence that emotional stress or depression precedes the onset of insomnia and that insomnia is a risk factor for depression, there is a need for long-term prospective studies to understand the nature of the association between insomnia and psychiatric conditions. In the meantime, physicians and the public should be informed about the strong association of insomnia with mental health and appropriate diagnostic evaluation and treatment of insomnia should always include a mental health assessment, even in a brief office visit of a busy practitioner. This message is very important, particularly now that many insomniacs are treated by their primary care physicians, and a large number of sleep specialists have no psychiatric background.