Treatment Of Insomnia Disorders Research Articles

Pharmacological and nonpharmacological treatment of insomnias with regard to sleep medicine

Insomnia - one of the most prevalent sleep complain - has a great impact on the everyday life. Basically two different form of insomnia can be defined: the insomnia disorder and the co-morbid insomnias. To treat adequately determination of background pathology is essential, which is based on the help of Sleep Medicine Centers. According to the newest guidelines, the treatment of insomnia disorder is based on cognitive behavioural therapies followed by pharmaceutical intervention. In this review we provide the short description of cognitive behavioural therapies and basic principles of hypnotic drugs. Despite the availability of insomnia guidelines the huge variation of the insomnia medication can be seen in the daily practice. Due to the above mentioned reasons we summarize the good clinical practice of hypnotic drug administration for insomnia patients.

Interpretation of "Guidelines for the diagnosis and treatment of insomnia disorder in China"

In June 2016, in order to provide a standardized clinical reference for the diagnosis and treatment of insomnia, "Guidelines for the diagnosis and treatment of insomnia disorder in China" compiled by Chinese Sleep Research Society (CSRS) was published. The guideline was compiled according to the standards of evidence-based medicine and the latest International Classification of Sleep Disorders Third Edition (ICSD - 3). It emphasized the role of cognitive behavioral treatment (CBT) in the treatment of insomnia, and enriched the assessment and interventions for special populations. This paper intends to provide an explanation and supplement to the compiling process and key elements of the guideline in details, in order to offer some help and guidance for clinicians for better understanding and application of the guideline. DOI: 10.3969/j.issn.1672-6731.2017.09.002

Clinical practice guidelines for insomnia disorder

Insomnia disorder is defined as difficulty in falling asleep, maintaining sleep, and early morning awakenings. Common daytime consequences experienced are fatigue, mood instability and impaired concentration. In chronic insomnia these symptoms persist over a period of at least three months. Chronic insomnia can also be a symptom of a variety of disorders. The pathophysiology of insomnia is theorised as a disorder of nocturnal and daytime hyper-arousal as a result of increased somatic, cortical and cognitive activation. The causes of insomnia can be categorized into situational, medical, psychiatric and pharmacologically-induced. To diagnose insomnia, it is required to evaluate the daytime and nocturnal symptoms, as well as psychiatric and medical history. The Diagnostic and Statistical Manual 5 Criteria (DSM-5) also provides guidelines and criteria to be followed when diagnosing insomnia disorder. Goals of treatment for insomnia disorder are to correct the underlying sleep complaint and this, together with insomnia symptoms, their severity and duration, as well as co-morbid disorders will determine the choice of treatment. In the majority of patients, insomnia can be treated without pharmacological therapy and cognitive behavioural therapy is considered first-line therapy for all patients with insomnia. The most common pharmacological insomnia treatments include benzodiazepines and benzodiazepines receptor agonists. To avoid tolerance and dependence, these hypnotics are recommended to be used at the lowest possible dose, intermittently and for the shortest duration possible. A combination of cognitive behavioural therapy and pharmacological treatment options is recommended for chronic insomnia.

Insomnia and Emotion Regulation: Recent Findings and Suggestions for Treatment

Recent findings suggest that insomnia and emotion regulation are closely connected. Insomnia is widely associated with medical and psychiatric conditions as well as with impaired quality of life and emotional functioning. Additionally empirical evidence suggests that emotional dysregulation plays a crucial role in the onset and maintenance of psychopathological disorders. Although these seem to interact, very few studies investigated the relationship between disturbed sleep and problems in emotion regulation. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been demonstrated to be effective in comorbid insomnia. However, emotion regulation skills are not included in this intervention. After reviewing the recent findings of the literature, we aim to discuss future directions for the inclusion of emotion regulation training in the treatment of insomnia disorder.