Daytime Well-being Research Articles

Insomnia

Patients with insomnia suffer from problems falling asleep and/or maintaining sleep. This has a negative effect on their daytime wellbeing and performance. Insomnia is primarily diagnosed by a detailed clinical history, supplemented by questionnaires and sleep diaries. Polysomnography may be necessary for the differential diagnosis of organic sleep disorders. Insomnia is a frequent comorbidity of most mental disorders and many physical diseases. It is treated according to guidelines with cognitive behavioural therapy for insomnia (CBT-I). CBT-I is offered in individual or group format as well as online-supported treatment. If behavioural therapy is not effective or not available, pharmacotherapy can be discussed.

Sleep related rhythmic movement disorder: phenotypic characteristics and treatment response in a paediatric cohort

ObjectiveTo describe phenotypic, polysomnographic characteristics, impact, and treatment response in children with sleep related rhythmic movement disorder (SR-RMD). BackgroundThere is limited research on SR-RMD. We have developed a systematic clinical evaluation of children with SR-RMD to improve understanding and treatment. MethodsA retrospective chart review of 66 children at a UK tertiary hospital. Baseline assessment included validated screening questionnaires to study autism spectrum characteristics, general behaviour and sensory profile. A standardised questionnaire assessed impact on sleep quality and daytime wellbeing of child and family. Polysomnography data were collated. ResultsChildren were aged 0.9–16.3 years (78.8% male). 51.5% had a neurodevelopmental disorder, most commonly autism spectrum disorder. High rates of behavioural disturbance and sensory processing differences were reported, not confined to children with neurodevelopmental disorders. Parents reported concerns about risk of injury, loss of sleep and persistence into adulthood. Daytime wellbeing was affected in 72% of children and 75% of other family members. Only 31/48 children demonstrated rhythmic movements during video-polysomnography, occupying on average 6.1% of time in bed. Most clusters occurred in the settling period but also arose from N1, N2 and REM sleep and wake after sleep onset. Melatonin was prescribed to 52 children, all but one were extended-release preparations. 24/27 children with available data were reported to improve with melatonin. ConclusionsSR-RMD places a significant burden on child and family wellbeing. Our novel findings of sensory processing differences in this population and parent reported therapeutic response to extended-release melatonin offer potential avenues for future research.

Temporal tuning of illuminance and spectrum: Effect of a full-day dynamic lighting pattern on well-being, performance and sleep in simulated office environment

Dynamic lighting is a potentially promising solution to meet the individual's chronobiologic and psychological needs at specific times of day or for specific activities. Yet, few studies have investigated the impact of dynamic lighting patterns on daytime functioning and nocturnal sleep, and the optimal dynamic lighting pattern remains largely unknown. The current study assessed the effects of a daylong dynamic lighting (DL) pattern with modulations in intensity and spectrum vs. static office lighting (SL) on markers of well-being, cognitive performance, visual experiences, and sleep in a simulated office environment. Twenty-one subjects participated in the 48-h balanced crossover laboratory study. The findings revealed time-of-day and experimental-day dependent benefits of the DL vs. SL pattern on daytime vitality, sleepiness, state self-control, mood, performance on a sustained attention task and subsequent subjective sleep quality. Complementing earlier research outcomes reported in the literature, the current study suggests that a dynamic lighting approach could be a practical strategy to support office workers' daytime well-being and nocturnal sleep. Yet, the results revealed no consistent pattern across assessments nor across the different types of metrics at a specific assessment, thus additional research regarding the optimization of lighting parameters and pattern is needed.

Secondary psychiatric care patients’ experiences of internet CBT for insomnia – a qualitative study

BackgroundInsomnia is very common, especially among psychiatric patients in secondary care. It is experienced as a 24 h problem affecting several domains of life. Cognitive behavioural therapy for insomnia (CBT-I) is widely regarded as the first-line treatment and often improves comorbid disorders. Despite this, many patients are not offered CBT-I. Internet based CBT for insomnia (iCBT-I) is just as effective as face-to-face treatments and could considerably increase availability. However, it is unclear whether iCBT-I is suitable for patients with more severe and comorbid psychiatric illnesses in secondary care.MethodsEleven Swedish participants (24–68 years old) in outpatient secondary psychiatric care who underwent iCBT-I treatment were interviewed. The semi-structured interviews were analysed using content analysis. The purpose was to map their experiences, motivation and suggestions for improvement.ResultsPrior to the treatment, most participants were highly motivated to take the opportunity to address their insomnia. The treatment was perceived as well-structured and interesting. The most difficult aspect was counteracting the fatigue. It was also hard to continue the treatment when faced with major life events. During this phase, contact with the therapist motivated them to continue the treatment. Several desired more face-to-face meetings. It was also motivating to gain insights into and a sense of control over sleep. Several described better sleep, improved daily routines, a more predictable everyday life and increased energy. Daytime well-being was improved in some, partly because they had more energy but also because they filled their days with more activities.ConclusionThe treatment has the potential to be very useful in secondary psychiatric care where insomnia is common and affects comorbid disorders. Psychiatric patients might have more difficulties continuing with iCBT-I treatment, but those who manage to complete the program have a good chance of obtaining benefit. Extensive psychological groundwork early in treatment is likely to pay off later when motivation is needed. Additional social support and other adjustments may also enhance treatment outcomes. Participants’ stories are particularly valuable, as therapists and treatment developers receive less feedback from patients in internet-based treatments compared to face-to-face treatments.

Sleep-related healthcare use prevalence among adults with insomnia symptoms in Hebei, China: a population-based cross-sectional study

ObjectiveThis study investigated the prevalence of sleep-related healthcare use and the factors associated with it among adults with different insomnia symptoms.Design and settingThis was a population-based study with a cross-sectional...

Daily Sleep, Well-Being, and Adult Day Services Use Among Dementia Care Dyads

Care of adults with Autism Spectrum Disorder (ASD) is a public health priority and costs are projected to be 549 billion US dollars by 2025. Middle and older adult FCGs of adults with ASD often provide lifelong care, experience chronic stress, consequently, are at risk of poor mental health and QOL. An integrative review examined factors associated with resilience in studies of middle and older adult FCGs of adults with ASD. A comprehensive literature search found 10 reports of 8 studies published in peer-reviewed scholarly journals before October 13, 2020. Studies and/or reports of factors associated with resilience in middle and older adult FCGs of adults with ASD were examined using PRISMA, and quality checklists. Some 340 articles met search criteria, 14 were fully reviewed, and 10 were included. Findings suggest FCGs of adults with ASD show capacity for resilience consistent with research on FCGs of children with ASD significant chronic stress. A broad range of resilience factors were studied, and resilience was associated with positive social support, higher QOL, self-efficacy, and problem and meaning-focused coping styles. There is a dearth of research on middle and older adult FCGs of adults with ASD. Increased reporting of social determinants of health and participation of underrepresented groups is needed. Future research must address FGC heterogeneity and specify theoretically grounded conceptual and operational definitions of resilience. Identifying resilience factors is necessary for intervention studies to enhance resilience.

Sleep as a biological rhythm: clinical aspects

Insomnia is a widespread disorder affecting not only sleep quantity and quality, but also daytime well-being and performance, as well as having a negative impact on physical and mental health. Many people have problems falling asleep and maintaining sleep that do not reach the clinical criteria of insomnia. For all the prevalence of such sleep disorders, specialists often overlook a fundamentally important factor that affects sleep and wakefulness cycle, ease of falling asleep and daytime performance. These are circadian rhythms of the body under the control of the biological clock.This review highlights the specifics of the human biological clock and its relationship to insomnia and complaints of poor sleep. The phenomenon of the human chronotype as a set of individual preferences in sleep-wake rhythm is considered. Late chronotype, tat tends to wake up late and be active in the evening turns out to be the most vulnerable to the appearance of complaints of poor sleep and development of insomnia. This result is typical for different age groups. The reason for problems sleep for the late chronotype is the need to adjust to social demands and to fall asleep and wake up too early relative to the phase of one’s own circadian rhythm.Circadian rhythms may contribute to the formation and maintenance of insomnia. Both chronic and acute insomnia may have a chronobiological component that is not always considered. Late chronotype may be a factor further exacerbating the course of insomnia. The regularity of circadian rhythms may also be impaired in insomnia.The importance of the biological clock in the regulation of sleep and wakefulness also explains the successful approach to insomnia treatment with melatonin, which plays an important signaling role in the circadian regulation of the body.

The dynamics of sleep quality in patients with chronic insomnia during the complex spa treatment with the inclusion of transcranial magnetic therapy

To assess the sleep quality dynamics in patients with chronic insomnia getting the complex spa treatment with the inclusion of transcranial magnetic therapy (TCMT). It was examined 122 patients (mean age 54.0±0.92 years) with a verified diagnosis of chronic insomnia; 68.9% were women and 31.1% were men. The patients were randomized into 2 groups: the main group included 62 patients who received a spa complex and TCMT; the comparison group included 60 patients who received an identical treatment complex without TCMT. All patients were evaluated by polysomnography (PSG) data, insomnia severity index (ISI) and subjective symptoms of daytime functioning. As a result of treatment program implementation the patients of both groups showed a decrease in ISI and a subjective improvement in daytime well-being. In the main group the treatment led to an increase in the number of patients with mild disorders by 51.7%, a decrease in patients with moderate disorders by 16.2%, severe disorders by 45.2%, and the formation of a group of 6 people (9.7%) without sleep disorders. In the comparison group after treatment the proportion of patients with mild disorders increased by 33.3%, with moderate disorders by 3.3%, the number of patients with severe disorders decreased by 41.6%, and 3 (5%) patients had no symptoms. The mean value of ISI in the main group decreased by 35.9% (p<0.001), in the comparison group - by 23.1% (p<0.001), the difference was 12.8% (p<0.001). From clinical perspective, patients noted an improvement in the process of falling asleep, a decrease in the number of nighttime awakenings, an increase in the duration of sleep, and an improvement in functioning while awake. After the use of therapeutic complexes in patients of both groups there was a favorable reliable dynamics in the change in PSG indicators that was more pronounced in the main group. The difference between the groups in terms of PSG was: for the wakefulness time during sleep 16.3% (p<0.005), for the number of awakenings during sleep 12.8% (p<0.001), for the latency of falling asleep 13.9% (p<0.05), for micro-activation index 14.6% (p<0.05), for sleep efficiency 4.9% (p<0.05). The inclusion of TCMT in complex spa treatment can significantly reduce ISI, the symptoms' severity of impaired daytime functioning and improve sleep quality indicators according to PSG data in patients with chronic insomnia.

Changes in Subjective-Objective Sleep Discrepancy Following Inpatient Cognitive Behavior Therapy for Insomnia

Discrepancy between objective and subjective sleep parameters is a frequent symptom in persons suffering from insomnia. Since it has an impairing effect on daytime well-being and neglects possible positive objective improvements, it would be useful if it was treated. Apart from hypnotics, cognitive behavior therapy (CBT-I) is the therapy of choice for chronic forms of insomnia. However, there is limited information about whether CBT-I can also improve subjective-objective sleep discrepancy. We investigated a large sample of patients showing chronic forms of insomnia regarding their subjective-objective sleep discrepancy pre and post CBT-I. Objective sleep data were obtained from 3 nights (2 baseline nights and 1 night after therapy) using polysomnography in our sleep laboratory. All 92 patients participated in a 14-day inpatient program with CBT-I including psychoeducation about subjective-objective sleep discrepancy. Repeated measures analyses showed an improvement in subjective-objective sleep discrepancy parameters after CBT-I. Those parameters were also correlated with perceived quality of sleep. We conclude that CBT-I is a useful tool to improve subjective-objective sleep discrepancy in patients showing chronic forms of insomnia.

Insomnia and sexual dysfunction associated with severe worsening of the quality of life in sexually active hysterectomized women.

Introduction Hysterectomy is a common gynecologic surgery carried out to remove the pathologic uterus. Objective: To establish if sleep disorders and sexual function are associated with deterioration of the quality of life (QoL) in hysterectomized and sexually active women. Methods: A cross-sectional study was carried out with inhabitants from two cities of the Colombian Caribbean. The pollsters invited women aged between 40-59 years to participate; in their communities they applied surveys with demographic characteristics: Female Sexual Function Index, Atenas Insomnia Scale and Menopause Rating Scale. Sexually active women were selected; then the association was established with logistic regression. Results: 522 women were studied with an average age of 50 years: 30% oophorectomized, 59.8% Hispanic, 40.2% afro-descendants and 22.2% hormonal therapy users. 80% of them had somato/vegetative, psychological or urogenital deterioration; 29.1% with severe deterioration of QoL and 47.5% with insomnia. Out of 390 (74.7%) with sexual activity, 59.7% suffered from sexual dysfunction. Insomnia: OR:3.05 [95%CI:1.86-4.99], sexual dysfunction OR:3.52 [95%CI:2.01-6.17], dissatisfaction about sexuality OR:4.77 [95%CI:2.08-10.93], low or non-existent sexual desire OR:2.94 [95%CI:1.65-5.25], daytime drowsiness OR:3.15 [95%CI:1.59-6.24] and decrease in daytime well-being OR:3.18 [95%CI:1.79-5.64]. These were factors associated with severe worsening of QoL, while the presence of genital lubrication was protective, OR: 0.44 [95%CI:0.21-0.93], p=0.0332. Conclusion: It was observed that insomnia and sexual dysfunction behaved as factors associated with three times more severe deterioration of the QoL in climacteric and sexually active women previously hysterectomized.

Obstructive Sleep Apnea Syndrome in Company Workers: Development of a Two-Step Screening Strategy with a New Questionnaire

To develop and evaluate a screening questionnaire and a two-step screening strategy for obstructive sleep apnea syndrome (OSAS) in healthy workers. This is a cross-sectional study of 1,861 employees comprising healthy blue- and white-collar workers in two representative plants in the Netherlands from a worldwide consumer electronic company who were approached to participate. Employees were invited to complete various sleep questionnaires, and undergo separate single nasal flow recording and home polysomnography on two separate nights. Of the 1,861 employees, 249 provided informed consent and all nasal flow and polysomnography data were available from 176 (70.7%). OSAS was diagnosed in 65 (36.9%). A combination of age, absence of insomnia, witnessed breathing stops, and three-way scoring of the Berlin and STOPBANG questionnaires best predicted OSAS. Factor analysis identified a six-factor structure of the resulting new questionnaire: snoring, snoring severity, tiredness, witnessed apneas, sleep quality, and daytime well-being. Subsequently, some questions were removed, and the remaining questions were used to construct a new questionnaire. A scoring algorithm, computing individual probabilities of OSAS as high, intermediate, or low risk, was developed. Subsequently, the intermediate risk group was split into low and high probability for OSAS, based on nasal flow recording. This two-step approach showed a sensitivity of 63.1%, and a specificity of 90.1%. Specificity is important for low prevalence populations. A two-step screening strategy with a new questionnaire and subsequent nasal flow recording is a promising way to screen for OSAS in a healthy worker population. Development and validation of a screening instrument for obstructive sleep apnea syndrome in healthy workers. Netherlands Trial Register (www.trailregister.nl), number: NTR2675.

Vasomotor and depression symptoms may be associated with different sleep disturbance patterns in postmenopausal women.

This study aims to explore the association of vasomotor symptoms (VMS) and depression symptoms with different symptoms of subjective sleep disturbance in postmenopausal women. This is a cross-sectional study of 163 postmenopausal women (not taking hormone therapy) attending a university menopause clinic. Measures included the Athens Insomnia Scale, Greene Climacteric Scale, and Symptom Checklist-90-Revised depression subscale. Covariate-adjusted ordinal logistic regression was used to investigate the association of VMS and depression with each item of the Athens Insomnia Scale. Controlling for confounding factors, we found VMS to be significantly associated with awakenings during the night (odds ratio [OR], 1.85; P < 0.001), overall quality of sleep (OR, 2.00; P < 0.001), well-being during the day (OR, 1.63; P = 0.008), functioning capacity during the day (OR, 1.72; P = 0.01), and sleepiness during the day (OR, 1.66; P = 0.03); whereas we found Symptom Checklist-90-Revised depression subscale scores to be associated with sleep induction (OR, 2.09; P < 0.001), final awakening earlier than desired (OR, 2.21; P < 0.001), total sleep duration (OR, 1.62; P = 0.01), overall quality of sleep (OR, 1.64; P = 0.009), well-being during the day (OR, 1.67; P = 0.006), functioning capacity during the day (OR, 1.68; P = 0.01), and sleepiness during the day (OR, 1.57; P = 0.04). VMS and depression symptoms are associated with different patterns of sleep disturbance. Although both symptoms are related to sleep quality, daytime functioning, and daytime well-being, depression is uniquely associated with difficulty falling asleep and waking up earlier than desired, whereas VMS are related to frequent awakenings during sleep. The findings are limited by the cross-sectional design and relatively small sample size of the study. Recommendations for future research are discussed to guide this line of inquiry and to gain a better understanding of the complex relationship between climacteric and mood symptoms and their contribution to the development of sleep disturbances during menopause.

Depression is associated with worse objectively and subjectively measured sleep, but not more frequent awakenings, in women with vasomotor symptoms

Depression occurs more commonly during the menopausal transition in women with vasomotor symptoms (VMS) than in those without, but most women with VMS do not develop depression. It has been hypothesized that VMS are associated with depression because VMS lead to repeated awakenings, which impair daytime well-being. We aimed to determine if objectively measured sleep and perceived sleep quality are worse in depressed women with VMS than in nondepressed women with VMS. Objectively and subjectively measured sleep parameters were compared between 52 depressed women with VMS and 51 nondepressed controls with VMS. Actigraphic measures of objective sleep conducted in the home environment and subjective measures of sleep quality (Pittsburgh Sleep Questionnaire Index) were compared using linear regression models. On objective assessments, depressed women with VMS spent less time in bed (by 64.8 min; P < 0.001) and had shorter total sleep time (by 47.7 min; P = 0.008), longer sleep-onset latency (by 13.8 min; P = 0.03), and lower sleep efficiency (by 3.2 percentage points; P = 0.09), but did not awaken more or spend more time awake after sleep onset than nondepressed controls with VMS. Depressed women also reported worse sleep quality (mean Pittsburgh Sleep Questionnaire Index 12.0 vs 8.3; P < 0.001). Adjustment for VMS frequency and important demographic characteristics did not alter these associations. Sleep quality and selected parameters of objectively measured sleep, but not sleep interruption, are worse in depressed than in nondepressed women with VMS. The type of sleep disturbance seen in depressed participants was not consistent with the etiology of depression secondary to VMS-associated awakenings.

Psychoneuroendokrinologie der Insomnie - Der Circulus vitiosus der psychophysiologischen Insomnie auf psychologischer, elektrophysiologischer und endokriner Ebene

The concept of psychophysiological insomnia based on a vicious cycle of hyperarousal, insomnia and impaired daytime well-being. There is increasing evidence that the psychological hyperarousal and insomnia is caused by and perceived as chronic stress. Beside this psychological factor neuroendocrine dysfunctions are supposed to maintain insomnia. Impaired morning and daytime well-being, arousal-related sleep fragmentation, and an increased activation of the hypothalamic-pituitary-adrenal (HPA) axis are major psychoneuroendocrinological pathomechanisms in generating and maintaining insomnia. In contrast, the decreased nocturnal melatonin secretion reflects the chronification of insomniac disturbances and is a contributing factor in maintaining insomnia. These findings could be summarized in a psychoneuroendocrinological vicious cycle of insomnia, whose underlying neuroendocrinological dysfunctions might be true for all non-organic insomnia independent of their origin.

Acute effects of zolpidem on daytime alertness, psychomotor and physical performance

In a double-blind cross-over study, seven athletes received zolpidem (10 mg) or placebo in two sessions over two nights. Residual effects on subsequent daytime functions were evaluated objectively by measuring psychomotor and physical performance using a combined test of finger dexterity, a simple discriminatory reaction test, critical flicker fusion test (CFF), vertical jump, and 50-m sprint, as well as subjectively, by visual analog scales. Zolpidem shortened self-estimated sleep latency and increased total sleep at nighttime. There was no change in alertness and fatigue scales on the following day in the zolpidem session, but realm of daytime well-being was slightly worsened. The CFF test showed significantly better results in the zolpidem group than in the placebo group. Zolpidem did not have effects in athletic evaluation. Zolpidem has a hypnotic activity without disturbing psychomotor and physical performance on the following day when given to healthy adults, suggesting zolpidem may be used in healthy athletes to adjust their extrinsic sleep disturbances and their consecutive psychomotor and physical impairments.

Zolpidem: an update of its pharmacology, therapeutic efficacy and tolerability in the treatment of insomnia.

Zolpidem is an imidazopyridine agent that is indicated for the short term (< or = 4 weeks) treatment of insomnia (recommended dosage 10 mg/day in adults and 5 or 10 mg/day in the elderly or patients with hepatic impairment). Data have shown that the hypnotic efficacy of zolpidem is generally comparable to that of the benzodiazepines flunitrazepam, flurazepam, nitrazepam, temazepam and triazolam as well as nonbenzodiazepine hypnotic agents such as zopiclone and trazodone in the treatment of elderly and adult patients with insomnia. The comparative efficacy of a recently available nonbenzodiazepine hypnotic zaleplon and zolpidem has yet to be established. There was no evidence of tolerance developing to the hypnotic effects of zolpidem in a number of studies of up to 6 months' duration. However, tolerance has been described in a few patients taking the drug at high dosages for periods of up to several years. Zolpidem is well tolerated in patients with insomnia and the most common adverse events are generally nausea, dizziness and drowsiness. Although zolpidem produced some psychomotor and memory impairment over the first few hours after administration, it had few next-day effects (including effects on daytime well-being and morning coordination). In this respect, it was comparable or superior to flunitrazepam and flurazepam and comparable to other benzodiazepines in patients with insomnia. Zolpidem appears to have a low potential for abuse. Zolpidem is effective and well tolerated in patients with insomnia, including the elderly. Studies have shown that zolpidem generally has similar efficacy to other hypnotics including benzodiazepines and zopiclone. Zolpidem appears to have minimal next-day effects on cognition and psychomotor performance when administered at bedtime. In addition, there is little evidence of tolerance to the hypnotic effects of zolpidem, or rebound insomnia or withdrawal symptoms after discontinuation of the drug when it is given as recommended (10 mg/day for < 1 month) or over longer periods.

Paroxetine in the Treatment of Primary Insomnia

Article AbstractBackground:Primary insomnia is a persistent and recurrent disorder as well as a risk factor for depression. The goal of this study was to determine whether paroxetine, a nonsedating antidepressant, would be effective in the treatment of patients with primary insomnia. Method: Fifteen patients meeting DSM-IV criteria for primary insomnia received paroxetine at bedtime for 6 weeks in an open, flexible-dose trial (median dose = 20 mg). Patients were assessed with daily sleep diaries, baseline and treatment polysomnography, and weekly standardized clinical evaluations. Results: Of the 14 patients who completed the study (1 dropped out owing to side effects), 11 improved with treatment, and 7 of these 11 no longer met diagnostic criteria for insomnia. Although self-reported sleep quality (measured by the Pittsburgh Sleep Quality Index) and daytime well-being (measured by the Profile of Mood States) improved with treatment, the quantity of sleep, measured by diary and by polysomnography, did not change consistently with these improvements. Power spectral analysis suggested that paroxetine treatment may be associated with decreases in power in frequencies within the delta and alpha frequency ranges. Conclusion: These results support the effectiveness of paroxetine in the acute treatment of primary insomnia. Further evaluation with controlled and longitudinal designs is warranted.

A new tongue advancement technique for sleep-disordered breathing: side effects and efficacy.

We examined the efficacy and the acceptance of an oral device (SnorEx) causing a forward displacement of the tongue for the treatment of sleep-disordered breathing (SDB). Twenty-three consecutive subjects with SDB were investigated. Noncompliance (NC) of use of the oral appliance was observed in 74% (17 of 23) of the subjects. NC patients were characterized by unacceptable local side effects of the prosthesis, lacking improvement of indicators of daytime well-being, and a missing reduction of the respiratory disturbance index (RDI). The device was tolerated without side effects in 26% (6 of 23) of the subjects. In these compliant (C) subjects the RDI, EDS, and snoring improved significantly (p < 0.05) compared with baseline values. After 6 mo using the device, five of the six C patients were still using it. We conclude that the high rate of noncompliance and the low efficacy of the SnorEx prosthesis preclude large-scale use of this treatment modality in patients with SDB and snoring since the local side effects are the principal cause of NC. No useful predictive parameter of treatment compliance or treatment success was found. Thus, this dental appliance should be prescribed only for selected patients failing other treatment modalities seen by an experienced sleep-disorders specialist.

Adult Psychophysiologic Insomnia and Positive History of Childhood Insomnia

Sixty-five adults diagnosed with "psychophysiologic chronic insomnia" following the criteria of the Association of Sleep Disorders Centers were investigated. They were subdivided into two groups based on whether onset of the insomnia had occurred in childhood or adulthood. Fifty similar-aged patients with obstructive sleep apnea syndrome (OSAS) were also investigated and served as a contrast group. All subjects were given polygraphic recordings and structured interviews, and all completed sleep questionnaires after reviewing the questions with an investigator. On many indices evaluating subjective daytime alertness and well-being, the psychophysiologic insomnia patients had scores similar to the OSAS patients. There were no significant differences between the childhood-onset and adult-onset psychophysiologic insomnia patients on most of the investigated items. However, the childhood-onset psychophysiologic insomniinacs had moderately but significantly higher reports of nightmares. This group also reported having had longer sleep latencies, significantly more "fear of the dark" and more frequent nightmares during childhood than the adult-onset group. These statistically significant findings reflected only a moderate increase in subjective scores, however, and in general the childhood-onset and adult-onset psychophysiologic insomnia patients were very similar.

Clinical management of patients with insomnia. The role of zopiclone.

Insomnia, especially when chronic, is associated with disturbances in daytime well-being and performance, resulting in a poor quality of life for those affected. Zopiclone has been proven as a drug that favourably balances sleep induction and maintenance as well as an improvement in daytime well-being (efficacy) with a low potential for adverse effects (safety) in the symptomatic treatment of insomnia. Management of chronic insomnia with zopiclone needs a multidimensional approach involving the proper diagnosis of possible underlying causes, and combined use of causal treatment, general sleep hygiene measures, basic elements of psychological treatment and adjunctive medication. It is recommended that therapy with the nonbenzodiazepine hypnotic zopiclone should conform to the guidelines for the use of hypnotics, which are valid for all benzodiazepine receptor agonists.