Insomnia Problems Research Articles

具有改善睡眠功能的中草药研究进展

随着人们睡眠问题的日益突出，随着化学合成的镇静催眠药物缺点的日益显现，具有改善睡眠功能的中草药受到越来越多人的关注，大量具有改善睡眠功能的中草药被发现并证实。这些中草药有着来源广、安全性高、副作用小、不产生依赖性等优点，成为国内外学者研究的主要对象。本文对具有改善睡眠功能的中草药进行汇总，并从这些中草药的种类、有效成分、提取方法、改善睡眠功能的测定以及作用机理五个方面进行了介绍。 With the problem of insomnia becoming more serious and the disadvantages of sedative and hyp-notic drugs gotten by chemical synthesis becoming more obvious, Chinese herbal medicines with the function of improving sleep quality are getting more and more attention. A large number of Chinese herbal medicines with the function of improving sleep quality were found and proved. These Chinese herbal medicines have the advantages of wide sources, high safety, little side effects, no dependence and so on. They have become the main objects of the domestic and foreign scholars. In this paper, Chinese herbal medicines with the function of improving sleep quality were summarized and the kinds of Chinese herbal medicines, active ingredients, extraction methods, assay methods of the function of improving sleep quality and mechanism of action were introduced.

The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients

ObjectiveInsomnia is the most commonly diagnosed comorbidity disorder among patients with chronic pain. This circumstance requests brief and valid instruments for screening insomnia in epidemiological studies. The main object of this study was to assess the psychometric properties and factor structure of the Swedish version of the Insomnia Severity Index (ISI). The ISI is a short instrument designed to measure clinical insomnia and one of the most common used scales both in clinical and research practice. However there is no study in Sweden that guarantees neither its factor structure nor its feasibility in chronic pain patients. We further examined the measurement invariance property of the ISI across the two sexes. MethodsThe ISI was administered to 836 (269 men and 567 women) chronic pain patients from the Swedish Quality Registry for Pain Rehabilitation. This study used demographic data, the Hospital Anxiety and Depression Scale (HADS), the Mental Summary Component (MSC) of the Health Survey (SF-36) and the item 7 from Multidimensional Pain Inventory (MPI). The sample was divided into two random halves: exploratory factor analysis (EFA) was performed in the first sample (N1=334, 40%) and confirmatory factor analysis (CFA) in the second half of the sample (N2=502, 60%). The measurement and structural invariance of the proposed structure (4-item version) between the two sexes as well as reliability and validity indexes were further assessed. ResultsExploratory factor analysis using the principal axis factoring method generated one global factor structure for the ISI, explaining 63.1% of the total variance. The one factor solution was stable between the two sexes. Principal component analysis was also applied and indicated almost identical results. The structure was further assessed by CFA, resulting in an adequate fit only after omitting three items. The difference on structural and measurement invariance in the loadings by participants’ sex was not significant (Δχ2=10.6; df=3; p=.69 and Δχ2=2.86, df=3, p=41 respectively). The shorter version four-item Insomnia Severity Index (ISI-4) was analysed further. The Chronbach's alpha for the global ISI-4 score was 0.88. The construct validity of the ISI-4 was also supported by the, Hospital Anxiety and Depression Scale, the Mental Summary Component of quality of life and quality of sleep data. Pain intensity was significantly associated with the ISI-4 score (beta=.29, p<001) whereas no significant correlation between four-item Insomnia Severity Index score and age was observed (p>05). Conclusions and implicationsAlthough short, the four-item Insomnia Severity Index (ISI-4) version seemed to effectively assess insomnia in chronic pain patients. An important clinical implication is that the four-item Swedish Insomnia Severity Index can be used in chronic pain cohorts when screening for insomnia problems. Its measurement and structural invariance property across the two sexes shows that the ISI-4 is a valid measure of the insomnia across groups of chronic patients. Our results also suggest its utility both in pain clinical practice and research purposes.

Academic health centers and the growth of integrative medicine.

As evidenced by this issue of JNCI Monographs, integrative medicine is rapidly gaining ground as part of the practice of oncology in the United States. The Consortium of Academic Health Centers for Integrative Medicine—an organization comprised of 57 academic health centers and health systems in North America—defines inte grative medicine as follows: Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. As this definition implies, although an openness to using therapies such as acupuncture or massage is a component of the integrative approach, integrative medicine goes far beyond simply combining the therapies previously described as “complementary/alternative medicine” with conventional care. It describes a change in philosophy, which expands our role beyond that of treating disease to reaffirm the commitment to treating the whole person. Almost more than anywhere else in medicine, the practice of oncology and the work of caring for a patient with cancer and their family clearly call for this approach and for a commitment to whole-person care. Lifestyle counseling, behavioral medicine interventions, and spiritual support all play critical roles in this integrative approach, alongside the use of other therapeutic strategies rooted in a rigorous evidence-based approach to the best conventional care. This is integrative medicine for cancer. The mission of the Consortium of Academic Health Centers for Integrative Medicine (the Consortium) is to advance the principles and practices of integrative health care within academic institutions. Having grown significantly since its founding in 2002 with only 13 member institutions, the Consortium’s mission is accomplished through supporting and mentoring academic leaders, faculty, and students to advance integrative health-care curricula, research, and clinical care; disseminating information on rigorous scientific research, educational curricula in integrative health, and sustainable models of clinical care; and working to inform health-care policy. This issue is a perfect example of how the Consortium’s support for collaboration between researchers and institutions is critical in the emergence of this new field and in the effort to make healthcare practitioners aware of its potential for our patients. The idea emerged from our Research Working Group, chaired at the time by Dr Jun Mao, coeditor of this supplement. Dr Mao felt strongly that we had reached a critical mass of high-quality research on the role of integrative medicine in cancer survivorship and that there was a pressing need to provide an outlet to make this new knowledge available to the larger worlds of oncology and medicine. With support from his colleagues on the Research Working Group and with funding from their six member institutions, the Consortium at large, and the Society for Integrative Oncology, Dr Mao and Dr Cohen were successful in making this idea a reality. None of this would have been possible without the environment of supportive collaboration, which is the foundation of our organization. As we know, living through the treatment of a cancer and surviving in its aftermath pose daunting challenges for many of our patients. The recent advances in the treatment of many cancers notwithstanding, the impact on patients’ quality of life of both the treatment process and the fear of recurrence is staggering. This is an area where integrative medicine can play a very important role in cancer care. In this issue, authors present their findings on a wide variety of integrative approaches to different dimensions of this survivor experience, including the potential impact of mind–body therapies such as meditation and tai chi in addressing the common problems of insomnia and anxiety; the role of diet change and exercise in survivorship; and the impact of patients’ expectations and preferences on the effectiveness of integrative approaches to managing symptoms. The articles also demonstrate the wide range of patient populations and clinical settings in which integrative

Cognitive-behavior treatment of insomnia

Beside pharmacotherapy, cognitive-behavior therapy is an important approach to treating people with problem of insomnia. Cognitive-behavior therapy of insomnia is multicomponent treatment with some nonspecific components (like hygiene of sleeping) and some specific components directed to dysfunctional behavior and way of thinking, like sleep education, stimulus control, sleep restriction, relaxation training, and cognitive therapy. The advantage of this therapy vs. pharmacotherapy of insomnia is that there are no problems of addiction, tolerance, side effects etc. The results of clinical trials suggest that the cognitive- behavior therapy leads to better quality of sleeping of most people with problem of insomnia, but insufficient number of educated cognitive-behavior therapists limits the much wider use of cognitive-behavior therapy in the treatment of insomnia.

Evaluation of Insomnia Frequency, Beliefs and Attitudes Related Insomina in Primary Care

OBJECTIVE: Sleep disorders; are a health problem affecting the quality of life of individuals in society. We aimed to determine the prevalence of insomnia disorders, understand cognitive aprasials of pateints about their insomnia symptoms, and perpeutuating factors and coping mechanism to cope with insomnia problems. METHOD: In this study; patients with sleep problems were examined in a outpatient family medicine clinic in Ankara between 2009 and 2012. Insomnia Severity Index (ISI), and dysfunctional beliefs and attitudes about sleep (DBAS) ; were performed in patients with sleep disorder. Sleep problems history (difficulty falling asleep, excessive sleep, etc.), demographic information, additional chronic diseases, smoking, tea and coffee consumption and sleep habits were analyzed. RESULTS: 230 patients were enrolled to the study. Of those 180 (78.4%) were female and 50 (21.6%) male patients. 92 female patients (40.1%) stated that they were menopausal period. 137 patients (%60) had comorbid chronic disease, and 93 patients (%40) had no chronic diseases. DBAS score was significantly higher in female patients (p

2A2-G05 母親のあやし動作の再現による睡眠導入効果の検証 : 脳波解析に基づく睡眠段階判定による考察(感覚・運動・計測(2))

Recently, twenty percent of Japanese have insomnia problems. The final aim of our project is to develop a sleep inducing and relaxation machine having rocking motion. As rocking motion, the motion of a mother's embracing and rocking of a baby is adopted. In this paper, we verify sleep inducing effect by the mother's rocking motion. For this purpose, we analyze the mother's rocking motion and derive two models for baby's motion consisting of linear motion and rotation motion. We propose a judgment method of sleep stage using EEG signal. It is found that the mother's rocking motion has sleep inducing effect as compared with the case without rocking vibration. The mother's rocking motion is realized in the excitation apparatus which we have developed.

PND53 Patient Reported Sleep Problems in the UK

To assess the frequency, severity, use of hypnotics and impact of sleep problems in the community in the UK. Questionnaires were inserted in a national newspaper and patients with sleep problems requested to complete them and return by post. Two thousand and eighty-two questionnaires were returned. Within the questionnaires returned not all of the questions were answered with some questions being more frequently completed than others. We report the outcome for individually completed questions. Sixty-four percent of respondents were female, 92% aged forty or over and 57% over 60; 94% of patients reported insomnia for more than a year. Seventy-seven percent described sleep as bad or very bad. 64% complained of feeling tired after rising and starting the next day. Only 3% thought they got off to sleep in less than 20 minutes with 55% reporting taking greater than 1 hour to get to sleep. A total of 86% visited the doctor less than 4 times per year but apparently did not complain of insomnia; 44% reported having received hypnotics from the doctor in the past but only 2% currently taking them. Seven percent of patients attributed their sleep problems to pain; 42% of patients get up regularly to use the bathroom but in general did not attribute their sleep problems to this reason. In contrast 40% of respondents felt that their problems were purely age-related. Insomnia is a common, longstanding, serious problem which afflicts and impacts upon older rather than younger people. While most respondents had received hypnotics in the past they were not currently taking them despite continuing to suffer from insomnia. There appears a common acceptance that sleep problems are simply a function of ageing. This study demonstrates the need for patient education and for physicians to address the problem of insomnia in older age.

Treatment options for residual insomnia in schizophrenia

It is well documented that patients with schizophrenia demonstrate disturbances in sleep continuity and sleep architecture as well as disrupted circadian rhythmicity. These sleep disturbances are associated with reduced quality of life and social functioning. Insomnia might be secondary to the hyperarousal caused by positive psychotic symptoms. However, in recent years, it has been acknowledged that insomnia often persists beyond adequately dosed antipsychotic treatment. Residual insomnia in schizophrenia, defined as insomnia persisting beyond otherwise adequate antipsychotic treatment, covers a range of insomnia symptoms that could be secondary to other potentially treatable conditions such as medical or psychiatric comorbidity, substance use, use of medication that might interfere with sleep or a primary sleep disorder. A thorough evaluation of the insomnia diagnosis is therefore warranted. This includes a careful patient history and examination that addresses sleep and wake function, as well as common medical, psychiatric and medication-/substance-related conditions. The complex problem of residual insomnia in schizophrenia is currently addressed by substituting or adding sedating drugs, but current treatment guidelines suffer from a lack of information on the best clinical practice. Substituting an otherwise efficient antipsychotic drug-therapy with a more sedating drug carries the risk of psychotic relapse during the switch, and adding another drug carries the disadvantages of polypharmacy including increased rate of side-effects, drug–drug interactions, patient non-compliance and medication errors. To investigate the evidence base for the different treatment options in residual insomnia in schizophrenia, we performed a systematic literature review. We searched the major bibliographic databases for randomized clinical trials (search terms: sleep and schizophren*) supplemented by review of reference lists of relevant articles. We found only five randomized clinical trials investigating pharmacological treatment options for residual insomnia in schizophrenia. Two trials examined the efficacy of switching antipsychotic drug to, respectively, risperidone 1 or its active metabolite, paliperidone 2. The data suggest that risperidone might be a good choice for this particular indication, but methodological limitations and the lack of comparison with other second-generation antipsychotics weaken the suggestion. Three studies evaluating the efficacy of melatonin showed improvement in certain sleep characteristics (e.g. sleep duration and sleep efficiency) 3-5, but two of the studies 3, 4 came from the same group of researchers presumably using the same sample of patients. We found no published randomized clinical trials investigating non-pharmacological treatment of residual insomnia in schizophrenia. Thus, our attempt to review this clinically important subject was limited by the few interventions tested experimentally and difficulties making a thorough comparison of the tested interventions due to methodological limitations. These included small sample size, selective reporting, lack of specification of primary outcome measure and a high level of variability regarding assessment tools and allowed comedication. The benzodiazepines and benzodiazepine-like drugs (Z-drugs) are frequently prescribed as hypnotics, but they have not been investigated for residual insomnia in schizophrenia. These drugs are generally only recommended for short-term therapy due to the development of tolerance and dependence. Because residual insomnia in schizophrenia is a chronic condition, these drugs are generally not recommendable. An additional reason to avoid prescription of benzodiazepines is their deteriorating effect on cognitive function and their impairment (rather than correction) of sleep architecture. Particular care should be taken in patients' comorbid for a sleep-related breathing disorder or a comorbid history of alcohol or drug abuse. Other possible treatment options mentioned in the literature, but not systematically investigated in schizophrenia, include add-on treatment with drugs with antihistamine properties including various antidepressants, antipsychotics and antihistamines. They are extensively prescribed (or sold over-the-counter for some antihistamines), but scarce evidence exists regarding efficacy, tolerability and safety when used off-label as hypnotics. The use of classic antihistamines (e.g. diphenhydramine) is limited by anticholinergic (including cognitive impairment) and cardiovascular adverse effects. Some evidence suggests the use of low-dose doxepin and trazodone (tricyclic antidepressants) as efficacious hypnotic drugs in primary insomnia and not associated with tolerance, weight gain or abuse potential. However, they have only been sparsely investigated in insomnia not associated with depression and are not available in all countries. The addition of a low-dose quetiapine as hypnotic agent has gained widespread acceptance without any evidence base of randomized controlled trials to support its use. Observational studies have found that even the low doses are associated with the development of adverse metabolic effects. In conclusion, the evidence base is currently too scarce to extract any valid clinical recommendations regarding the treatment of residual insomnia in schizophrenia. Future studies should focus on rigorous evaluation of the switching and augmenting strategies currently applied in clinical practice and also on evaluation of psychological behavioural treatment methods. The latter is especially important in this vulnerable population of patients already chronically medicated. The authors report no financial or other relationship relevant to the subject of this article.

Sleep disturbance in relatives of palliative patients cared for at home

The aim of the present pilot study was to investigate insomnia, sleep quality, and daytime sleepiness in relatives of dying patients cared for at home. The study has a descriptive, comparative, and cross-sectional design. The sample consisted of relatives of patients cared for through palliative home care in Uppsala County on 3 specific days. Relatives completed a questionnaire consisting of demographic questions, and items from the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Richard Campell Sleep Questionnaire (RCSQ). Seventy-five relatives answered the questionnaire. The average total ISI score was 9.6, with 23% reporting moderate or severe clinical insomnia. The mean sleep duration was 6.5 hours, the mean assessed need of sleep was 8 hours, and the mean discrepancy was 1 hour. The total mean ESS score was 5.6 and only 15% of respondents reported excessive daytime sleepiness. Four percent scored very poor sleep quality, whereas 39% scored very good sleep quality (RCSQ). Two general age- and gender-related patterns were observed. Negative correlations were found between age and sleep problems, with younger relatives reporting more insomnia problems and more daytime sleepiness than did older relatives. The other general pattern was that womens' sleep quality was significantly inferior to that of men. A significant positive correlation was found between ISI and ESS, but not between RCSQ and ESS. The picture of the relatives' sleep condition is fairly complex. A minority reported clinical insomnia problems or excessive daytime sleepiness, and 73% reported getting less sleep than they wanted.

OA01.29. Evaluation of parasikayavanyadi capsule in the management of anidra w.s.r. to insomnia

Purpose: Insomnia is a sleeping disorder characterised by persistent difficulty in falling asleep or staying asleep despite the opportunity. It is one of the burning problems all over the world. Statistics shows that 20% - 40% adults encounter insomnia problems during a year time. Allopathic hypnotic drugs are useful for short term treatment in Insomnia which is due to acute stage. Long term uses of certain classes of sedatives cause physical dependence and withdrawal symptoms also have a number of side effects. In the present era, patient prefers readymade, cost effective, easily palatable drugs with fewer side effects for their health problems. For the present clinical trial, Parsikayavanyadi Capsule consisting of Parasikayavani, Jatamamsimoola, triturated with juice of Sankhpushpi and Kushmanda, was formulated to evaluate its efficacy in the management of insomnia Method: Total 32 patients of newly diagnosed case of insomnia who were randomly divided in to two groups. In Group P.V (Parasikayavanyadi group), 20 patients were administered 5 capsules of Pariskvayanadi Churna of 500 mg each with a cup of warm milk at bed time for one month. In Group P.C (Placebo group), 12 patients were given Starch Capsules of 500 mg each with same Anupana and duration. Assessment was done considering the overall improvement of insomnia according to Pittsburgh insomnia rating Scale, improvement of associated complains of insomnia, relieving of negative emotions, improving of positive emotions, relieving of level of anxiety according to Hamilton Anxiety Rating Scale and relieving of level of depression according to Hamilton Depression Rating scale before and after one month of treatment period. Result: parasikayavanyadi capsule provided significant effect in the management of insomnia. Conclusion: The study has revealed that parasikayavanyadi capsule provided significant effect in the management of insomnia in comparison to placebo.

Insomnia severity in chronic kidney disease patients with various therapies

Abstract The prevalence of insomnia is greater in end-stage renal disease. The aim of our study was to determine the frequency of insomnia and subclinical insomnia in patients with various dialysis therapy and kidney transplant recipients, in order to assess the severity of insomnia and examine whether there is a difference in severity among groups. In cross-sectional study, we evaluated 120 patients with terminal renal failure. Based on therapy, patients were divided into four groups: hemodiafiltration, standard bicarbonate dialysis, peritoneal dialysis and kidney transplant recipients. The severity of insomnia was evaluated through the use of the Insomnia Severity Index (ISI). Most patients who reported any kind of insomnia problems with ISI were on conventional dialysis (80%), followed by hemodiafiltration (76.7%) and peritoneal dialysis (63.3%). Transplant recipients had least difficulties with insomnia (46.7%). Insomnia Severity Index showed that insomnia in end-stage renal patients is not very severe. Most of the patients had “no clinically significant insomnia”. Our findings indicate that patients on hemodiafiltration and transplant recipients have a significantly lower score on Insomnia Severity Index. Patients with end-stage renal disease have high frequency insomnia problems. However, our study shows that insomnia in these patients is not severe. Insomnia is the most frequent and severest in patients on standard bicarbonate dialysis.

Habitual computer game playing at night is related to depressive symptoms

This study investigated whether the amount and circadian time of habitual computer game playing were related to depressive symptoms in adolescents and young adults. We expected that habitual late playing relates to more depressive symptoms beyond the effect of the total time of computer game playing as playing at night may involve short, irregular, and disturbed sleep as well as misalignment of the circadian rhythm. 646 adolescents and young adults (ages 13–30; 90.9% males) who play the internet role-playing game World of Warcraft completed an online questionnaire. Habitual computer game playing between 10 pm and 6 am was related to an increased risk of high depression scores independent of the total amount of playing. Adolescents (ages 13–17 years) were most vulnerable when habitually playing during early night (i.e., 10–12 pm), while emergent adults (ages 18–22 years) showed more vulnerability when habitually playing late at night (i.e., after 2 am). The effect was partly mediated by daytime sleepiness but not by sleep loss or insomnia problems.

Event-Related Potentials During the Transition to Sleep for Individuals With Sleep-Onset Insomnia

Event-related potentials may be applied to directly measure information-processing deficits associated with the problem of insomnia. This study is a systematic investigation of cortical hyperarousal during the sleep-onset period in participants with sleep-onset insomnia complaints. Thirteen poor sleepers and twelve good sleepers (GS) were administered an oddball task while awake in the morning and evening and during repeated sleep-onset attempts. Participants signaled detection of a higher pitch target tone as they fell asleep. P2 amplitude was significantly smaller for poor sleepers compared to GS, following standard stimuli at all fronto-central sites, in the pre-sleep waking period at sleep onset. Groups did not differ for N1, N350, or P300 in wake, Stage 1, or Stage 2. The smaller P2 indicates that poor sleepers failed to inhibit the irrelevant standard stimuli. This hyper-attentiveness may explain chronic problems with sleep initiation and could be the target of behavioral and pharmaceutical treatment strategies.

The Effects of Warm-Water Footbath on Relieving Fatigue and Insomnia of the Gynecologic Cancer Patients on Chemotherapy

Most patients experience fatigue during chemotherapy. Ignoring this fatigue can contribute to worsening overall health of patients and a slowed recovery process. We investigated the effectiveness of a warm-water footbath on relieving fatigue and insomnia problems in patients undergoing chemotherapy. This was a 2-group, longitudinal study design. Adults diagnosed with gynecologic cancer and receiving a 4-series platinum chemotherapy regimen were recruited and then followed up for 6 months. They completed fatigue and insomnia items on the 1st, 2nd, 4th, 7th, and 14th days after each scheduled chemotherapy. Participants in the experimental group soaked their feet in 41°C to 42°C warm water for 20 minutes every evening, starting from the eve of receiving the first chemotherapy, whereas participants in the comparison group did not do so. : There were 25 and 18 participants in the comparison and experimental groups, respectively, who completed the study. Participants in the experimental group reported a significant reduction in fatigue and improvement in sleep quality from the second session of chemotherapy and continued to improve during the study period. A warm-water footbath intervention resulted in reduced fatigue and insomnia symptoms for gynecologic cancer patients during chemotherapy. A warm-water footbath is local moist heat application. It is noninvasive and easy to apply at home. The findings provide empirical support that a warm-water footbath relieves fatigue and insomnia problems of patients undergoing chemotherapy. It can be a nonpharmaceutical method to help patients overcome fatigue and sleep problems during chemotherapy.

UARS presenting with the symptoms of anxiety and depression

Abstract Upper airway resistance syndrome (UARS) is a condition where the apnea-hypopnea index is less than 5 and respiratory-effort related arousal index is more than 10. The clinical presentation of UARS may be the same as obstructive sleep apnea-hypopnea syndrome (OSAS); it sometimes shows up with symptoms hardly suggestive of a sleep-disordered breathing. A 17 year-old male patient had applied to a local psychiatry clinic and complained of chronic fatigue, insomnia, behavioral and academic problems and was treated for anxiety and depression. After a period of unresponsive treatment, he was sent to a sleep center for evaluation of insomnia, which turned out to be a fragmented, unrefreshing sleep episode. Polysomnographical evaluation revealed that he had UARS without OSAS. His complaints decreased dramatically after he received CPAP treatment. This case shows that UARS should be considered in young patients with functional somatic syndromes even if the clinical presentation does not apparently imply the condition.

Insomnia: clinical experience with zolpidem (sanval)

The paper describes the present view of the problem of insomnia and gives a classification of sleep disorders and basic methods for their drug and non-drug therapy. Emphasis is placed on the role of the objective sleep study - polysomnography. The use of the current hypnotics belonging to a three Zs group and the minimization of administration of benzodiazepines are most important in pharmacotherapy for insomnia. The results of a clinical polysomnographic study of the effect of Zolpidem (Sanval) in patients with insomnia are presented. The subjective evaluation of the beneficial effect of a 10-day course of Sanval is confirmed by the objective studies of the sleep pattern undergoing positive changes in the most important indicators, such as the process of falling asleep, the time of intrasleep awakenings, and the duration of Δ-sleep. The high safety and good tolerability of Sanval permit the latter to be assessed as an effective agent for the treatment of insomnia.

Why treat insomnia?

To make the case that insomnia is better conceptualized, not as a symptom, but as a primary disorder. PubMed was searched from 1975-2009 using the search terms insomnia, insomnia and treatment, insomnia and cost, and insomnia and treatment and safety. English-language articles and other materials were selected to address the following claims: insomnia is unremitting, insomnia is disabling, insomnia is costly, insomnia is pervasive, insomnia is pernicious, and insomnia treatment is safe and effective. Insomnia, at least when chronic, should be conceptualized as a comorbid condition, one for which effective interventions are available. It is speculated that treatment for insomnia will only become the norm when it has been demonstrated that treatment not only addresses the problem of insomnia but also serves to reduce medical and psychiatric morbidity. At that time, the question will no longer be "Why treat insomnia?" but instead "When isn't insomnia treatment indicated?"

Factor structure of the Athens Insomnia Scale and its associations with demographic characteristics and depression in adolescents

The eight-item Athens Insomnia Scale (AIS-8) is an instrument that has been used frequently to assess insomnia problems. Previous research on adults has found that the AIS-8 functioned as a sole component. This study aimed to examine the prevalence rates of insomnia problems on the AIS-8, the factor structure of the AIS-8 in adolescents and its associations with demographic characteristics and depression in adolescents. A total of 8319 adolescent students (4334 girls and 3985 boys, mean age = 14.7 years, standard deviation = 1.7 years) in southern Taiwan were recruited into this study and completed the AIS-8. We performed an exploratory factor analysis to examine the factor structure of the AIS-8, and used the parallel analysis for making decisions regarding factor retention. We also used multiple regression analysis models to determine the associations between insomnia and demographic characteristics and depression. The results found that a high proportion of adolescents had insomnia problems as measured by the AIS-8. The AIS-8 was composed of two different factors when used among a large adolescent population, including insomnia symptoms (factor 1) and subjective sleep and daytime distress (factor 2). While being male, being younger, and having depression were associated positively with the severity of insomnia symptoms (factor 1), being older, living in urban areas, and having depression were associated positively with the severity of subjective sleep and daytime distress (factor 2). Clinicians and researchers should consider the different meanings of the two factors of the AIS-8 when using this tool to assess insomnia problems in adolescents.

Book Review: ‘Insomnia and other adult sleep problems’

Book Review: ‘Insomnia and other adult sleep problems’

Perceptions of nurses in nursing homes on the usage of benzodiazepines

This paper reports the findings of a qualitative study on how nurses perceive their own role in the use of benzodiazepines in nursing homes and to identify the factors that have an impact on the nurses' role in the use of benzodiazepines. The use of benzodiazepines in nursing homes is of particular concern, as nursing-home residents receive considerably more benzodiazepines than non-institutionalised older persons. Evidence of their long-term effectiveness is lacking. Nurses are important partners in the decision-making process of starting and discontinuation of benzodiazepines. Qualitative descriptive. Three focus group interviews and 10 additional semi-structured interviews were used with 33 registered nurses. The interviews were thematically analysed. Nurses' main concern is to work towards the comfort of the patient. Benzodiazepines are an easy option with not too many side effects and administration of benzodiazepines is experienced as a routine action. When prescribed they will almost automatically lead to chronic usage as there is no evaluation of their effect. There are three aspects that have an impact on nurse's perceptions of their role in benzodiazepine usage: their own individual attitude and perceptions, their knowledge and organisational factors. Nurses do not see benzodiazepines as a problem drug and once a prescription is initiated it will almost automatically lead to chronic usage. Nurses should work towards a pro-active promotion of addressing sleeping problems and they can play a key role in non-pharmacological interventions. Nurses can play a key role in suggesting non-pharmacological alternatives. Education to provide more insight into the problems of insomnia and anxiety may positively influence their attitudes and behaviour. All caregivers in nursing homes should be informed about the relevance of this issue.