Treatment Option For Insomnia Research Articles

Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomized Clinical Trial.

Insomnia inflicts mental burden and decreases physical productivity and affects life quality. Transcutaneous vagus nerve stimulation (ta-VNS) may be an effective treatment option for insomnia. This study aims to evaluate the effect and safety of ta-VNS and compare it with transcutaneous nonvagus nerve stimulation (tn-VNS). A multicenter, randomized, clinical trial was conducted at 3 hospitals in China enrolling 72 insomnia participants from May 2016 to June 2017. Participants were randomly assigned (1 : 1) to receive 40 sessions of ta-VNS or tn-VNS treatment. 63 participants completed the trial. ta-VNS treatment significantly decreased the Pittsburgh Sleep Quality Index score, Epworth Sleepiness Scale score, Flinders Fatigue Scale score, Hamilton Depression Scale score, and Hamilton Anxiety Scale score over 4 weeks compared with those of the baseline. Moreover, it also significantly increased the 36-item Short-Form Health Survey Questionnaire scores compared with that of the baseline. However, it did not show significant differences compared with tn-VNS in changes of primary and secondary outcomes. The incidence of adverse events was low. ta-VNS significantly relieved insomnia over 4 weeks. Moreover, it also alleviated fatigue and improved participants' quality of life as well as other concomitant symptoms such as depression and anxiety. This trial is registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn) with the registration number: ChiCTR-TRC-13003519.

Sleep health and insomnia treatment options

Sleep health and insomnia treatment options

Psychoactive Medications and Adverse Outcomes among Older Adults Receiving Hemodialysis.

Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis. Observational cohort study. National registry of patients receiving hemodialysis (US Renal Data System). A total of 60 007 adults 65 years or older receiving hemodialysis with Medicare Part D coverage in 2011. The predictors were use of sedative-hypnotics and anticholinergic antidepressants (modeled as separate time-varying exposures). The outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, and fracture (modeled separately). Overall, 17% and 6% used sedative-hypnotics and anticholinergic antidepressants, respectively, in 2011. In multivariable-adjusted Cox regression, anticholinergic antidepressant use was associated with a 25%, 27%, and 39% higher hazard of altered mental status, fall, and fracture, respectively, compared with no use. Use of sedative-hypnotics was not associated with adverse outcomes. Anticholinergic antidepressants were associated with adverse outcomes in older hemodialysis patients, and alternative treatments should be considered. Sedative-hypnotics were not associated with the risks evaluated in this study, but further investigation of the harms of this class of agents is warranted before their recommendation as a treatment option for insomnia in this population. J Am Geriatr Soc 67:449-454, 2019.

The efficacy of biofeedback for the treatment of insomnia: a critical review

BackgroundThe popularity of biofeedback as a non-pharmacological treatment option for insomnia has increased in recent times despite inconsistent empirical evidence for its therapeutic efficacy. ObjectiveThe purpose of the current review was to systematically assess the efficacy of using biofeedback to treat insomnia. Methods and resultsA search of electronic databases (PubMED, MEDLINE, OvidSP, Ovid EMBASE, PsychInfo, The Cochrane Library including Cochrane Reviews), clinical trials databases and registries (Clinical Trials Database [US], Australian New Zealand Clinical Trials Registry [ANZCTR]) and online journal (eg, SLEEP, Sleep Medicine) identified 92 studies. Of these, 50 publications were descriptive or review papers about use of biofeedback for the treatment of insomnia, while an additional 37 did not meet the detailed inclusion criteria (ie not original research, participants do not meet the diagnostic criteria for insomnia). Six full-text articles met inclusion criteria and were included in this review. Methodological flaws including poor study design (small sample size, lack of control group) limit the validity of the body of work in this field to date and fail adequately to account for other unspecified factors likely to drive the observed changes, such as care and attention of those administering the treatment, as well as the expectations and motivations of the patient. ConclusionThere is an urgent need for future studies to clarify the role of unspecific placebo effects when reporting biofeedback effects for the treatment of insomnia.

An Update on Dual Orexin Receptor Antagonists and Their Potential Role in Insomnia Therapeutics

Current pharmacological options for the treatment of insomnia insufficiently meet the needs of all insomnia patients. Approved treatments are not consistently effective in improving sleep onset and sleep maintenance, while also having complicated safety profiles. These limitations highlight the unmet need for additional medications and treatment strategies. Initial research suggests that the dual orexin receptor antagonists (DORAs) may offer an additional pharmaceutical option to treat insomnia in some patients. We reviewed the existing literature on dual orexin receptor antagonists in PubMed databases using the search terms "orexin receptor antagonist," "almorexant" "filorexant," "lembroexant" and "suvorexant"; searches were limited to English language primary research articles, clinical trials, and reviews. Targeting the orexin receptor system for treatment of insomnia offers an additional and alternative pharmacological approach to more common gamma aminobutyric acid agonist sedative hypnotic treatment. Effectiveness is not well established in the current literature; however, the literature does suggest efficacy. Preclinical reports also suggest the potential for treatment in individuals with comorbid Alzheimer disease and insomnia. DORAs offer an additional treatment option for insomnia. More clinical trials are needed to robustly evaluate their safety and effectiveness in several subclasses of individuals with insomnia. Given the published literature, head-to-head comparisons to existing treatment for insomnia are warranted.

Pharmacologic Treatment Options for Insomnia in Patients with Schizophrenia.

Background: Symptoms of sleep disorders, such as disturbances in sleep initiation and continuity, are commonly reported in patients with schizophrenia, especially in the acute phase of illness. Studies have shown that up to 80% of patients diagnosed with schizophrenia report symptoms of insomnia. Sleep disturbances have been shown to increase the risk of cognitive dysfunction and relapse in patients with schizophrenia. Currently, there are no medications approved specifically for the treatment of insomnia in patients with schizophrenia. Methods: A literature search was performed through OVID and PubMed to compile publications of pharmacotherapy options studied to treat insomnia in patients with schizophrenia. Articles were reviewed from 1 January 2000 through 1 March 2018 with some additional earlier articles selected if deemed by the authors to be particularly relevant. Results: Pharmacotherapies collected from the search results that were reviewed and evaluated included melatonin, eszopiclone, sodium oxybate, and antipsychotics. Conclusions: Overall, this review confirmed that there are a few evidence-based options to treat insomnia in patients with schizophrenia, including selecting a more sedating second-generation antipsychotic such as paliperidone, or adding melatonin or eszopiclone. Further randomized controlled trials are needed.

Insomnia Pharmacotherapy: a Review of Current Treatment Options for Insomnia in Menopause

Women are living longer and spending nearly one third of their lives in the climacteric period with the consequences of hypoestrogenism. Insomnia is the major clinical manifestation of this period. The aim of this chapter is to sum up current treatment options for menopausal insomnia and related symptoms. The paper summarizes some main treatment alternatives to treatment of insomnia in women, especially during the menopausal transition and postmenopause: What are the alternatives for treatment of insomnia in this population? What is the level of evidence of each of them? Previous studies have shown that the studies use very heterogeneous groups of women with different types of insomnia. This lack of standardized methods makes it difficult to identify the best therapeutic option for insomnia after menopause. However, this does not mean that it is impossible to define the best treatment intervention. The findings from each therapy were categorized according to the level of evidence, based on the scientific knowledge. We highlight the importance of the patient being evaluated by a multidisciplinary team, and of taking a broad approach which considers both the pharmacological and biopsychosocial context to deliver the most effective treatment.

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment.

Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions. A survey was conducted within the VA health care system. Primary care providers completed surveys electronically. A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%). Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia. A commentary on this article appears in this issue on page 937.

Online CBT for Insomnia Offers Long-Term Benefit

Online CBT for Insomnia Offers Long-Term Benefit

Is mindfulness meditation an effective treatment for insomnia?

EVIDENCE-BASED ANSWER Yes. Mindfulness meditation, including mindfulness based stress reduction, is an effective treatment option for insomnia (SOR: B, small RCTs).

Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea.

Background Obstructive sleep apnoea (OSA) is a common sleep disorder characterised by partial or complete upper airway occlusion during sleep, leading to intermittent cessation (apnoea) or reduction (hypopnoea) of airflow and dips in arterial oxygen saturation during sleep. Many patients with recognised and unrecognised OSA receive hypnotics, sedatives and opiates/opioids to treat conditions including pain, anxiety and difficulty sleeping. Concerns have been expressed that administration of these drugs to people with co-existing OSA may worsen OSA. Objectives To investigate whether administration of sedative and hypnotic drugs exacerbates the severity of OSA (as measured by the apnoea-hypopnoea index (AHI) or the 4% oxygen desaturation index (ODI)) in people with known OSA. Search methods We searched the Cochrane Airways Group Specialised Register (CAGR) of trials. The search was current as of March 2015. Selection criteria Randomised, placebo-controlled trials including adult participants with confirmed OSA, where participants were randomly assigned to use opiates or opioids, sedatives, hypnotics or placebo. We included participants already using continuous positive airway pressure (CPAP) or a mandibular advancement device. Data collection and analysis We used standard methodological procedures as recommended by The Cochrane Collaboration. Main results Fourteen studies examining the effects of 10 drugs and including a total of 293 participants contributed to this review. Trials were small, with only two trials, which used sodium oxybate, recruiting more than 40 participants, and all but three trials were of only one to three nights in duration. Most participants had mild to moderate OSA with a mean AHI of 11 to 25 events/h, and only two trials recruited patients with severe OSA. Two trials investigating the effects of ramelteon, a treatment option for insomnia, recruited adults over 60 years of age with OSA and concomitant insomnia.The drugs studied in this review included remifentanil (infusion) 0.75 mcg/kg/h, eszopiclone 3 mg, zolpidem 10 and 20 mg, brotizolam 0.25 mg, flurazepam 30 mg, nitrazepam 10 mg to 15 mg, temazepam 10 mg, triazolam 0.25 mg, ramelteon 8 mg and 16 mg and sodium oxybate 4.5 g and 9 g. We were unable to pool most of the data, with the exception of data for eszopiclone and ramelteon.None of the drugs in this review produced a significant increase in AHI or ODI. Two trials have shown a beneficial effect on OSA. One study showed that a single administration of eszopiclone 3 mg significantly decreased AHI compared with placebo (24 ± 4 vs 31 ± 5; P value Authors' conclusions The findings of this review show that currently no evidence suggests that the pharmacological compounds assessed have a deleterious effect on the severity of OSA as measured by change in AHI or ODI. Significant clinical and statistical decreases in minimum overnight SpO2 were observed with remifentanil, zolpidem 20 mg and triazolam 0.25 mg. Eszopiclone 3 mg and sodium oxybate 4.5 g showed a beneficial effect on the severity of OSA with a reduction in AHI and may merit further assessment as a potential therapeutic option for a subgroup of patients with OSA. Only one trial assessed the effect of an opioid (remifentanil); some studies included CPAP treatment, whilst in a significant number of participants, previous treatment with CPAP was not stated and thus a residual treatment effect of CPAP could not be excluded. Most studies were small and of short duration, with indiscernible methodological quality.Caution is therefore required when such agents are prescribed for patients with OSA, especially outside the severity of the OSA cohorts and the corresponding dose of compounds given in the particular studies. Larger, longer trials involving patients across a broader spectrum of OSA severity are needed to clarify these results.

Preferences for different insomnia treatment options in people with schizophrenia and related psychoses: a qualitative study.

Symptoms of psychosis such as hallucinations and delusions can be intrusive and unwanted and often remain treatment-resistant. Due to recent progress in basic and clinical sciences, novel approaches such as sleep-based interventions are increasingly becoming offered to address the physical and mental health issues of people with severe mental illness. While the primary outcome is to improve sleep, studies have demonstrated that interventions that target symptoms of insomnia can also produce improvements in the severity of psychotic symptoms, quality of life, and functional outcomes. This study presents qualitative data on the attitudes and preferences of people with schizophrenia and schizo-affective disorders to three different types of therapies for insomnia (standard pharmacological, melatonin-based, and cognitive and/or behavior therapy). Interviews included discussions regarding the perceived advantages and limitations of different therapies, enablers to taking up the preferred option, as well as personal strategies that have helped respondents with sleep problems in the past. Results showed that, when given the choice, these individuals prefer psychological and behavioral-type therapy to other sleep interventions because of its potential to support and empower them in taking responsibility for their own recovery. Pharmacological therapies, by contrast, are viewed as useful in managing acute sleep problems, but only as a short-term solution. Overall, the findings underscore the need for patients’ active engagement when making decisions about treatment options.

Pharmacotherapy in Insomnia

Insomnia is one of the most prevalent sleep disorders. Patients with insomnia tend to have altered quality of life, impaired daytime functioning and increased risk of road traffic accidents. Insomnia is commonly associated with chronic medical conditions and psychiatric illness like depression and anxiety. However, it is now being recognized as an independent disorder. All patients of Insomnia should receive therapy for any medical illness, psychiatric disorders, substance abuse or sleep disorders that might precipitate insomnia. In this review, we discuss the current pharmacotherapeutic options for treatment of insomnia. Research for newer therapeutics for insomnia is often complicated by multifactorial etiology. of insomnia. Understanding the molecular and receptor mechanisms involved in promoting sleep may provide further approaches tothe development of newer drugs.

Insomnia

Insomnia is frequently present in patients with a variety of psychiatric conditions. Both the Diagnostic and Statistical Manual of Mental Disorders , fifth edition and the International Classification of Sleep Disorders , third edition include definitions that emphasize symptoms of difficulty initiating or maintaining sleep in the face of adequate opportunity for sleep. Although insomnia has historically been thought of as merely a symptom of various psychiatric conditions, more recent research indicates that psychiatric patients with comorbid insomnia benefit from identification and specific treatment of the sleep disorder. This review provides an introduction to the changing definitions of insomnia disorder, discusses the complex relationship with psychiatric conditions, and outlines the most effective available treatment options for insomnia, including cognitive behavioral therapy and hypnotic agents. [ Psychiatr Ann. 2015;45(1):14–18.]

Consumers using the Internet for insomnia information: The who, what, and why

Information obtained from the Internet often influences the treatment choices of patients with insomnia. This study explored patterns of online information seeking and utilization among patients with insomnia. A total of 1013 participants took part in an online survey about sleep health information between July 2012 and March 2013. Participants also completed the Insomnia Severity Index and the Dysfunctional Beliefs and Attitudes about Sleep Scale. The results showed that those seeking insomnia-related information resources frequently searched online, and the information found appeared to influence important health behaviors such as treatment decisions, taking medication and whether to seek professional care. Information of interest revolved around insomnia treatment options and symptomology. While no predictors for Internet use were identified, the Internet does represent an important health-care portal for insomnia patients and warrants further investigation as targeted e-health interventions become more prominent in the routine management of insomnia.

Absence of Pharmacokinetic and Pharmacodynamic Interactions between Almorexant and Warfarin in Healthy Subjects

Background and ObjectiveAlmorexant is the first representative of the new class of orexin receptor antagonists, which could become a new treatment option for insomnia. The present study investigated the potential interaction between almorexant and warfarin.MethodsIn this open-label, two-way crossover, drug–drug interaction study, healthy male subjects received, in a randomized fashion, almorexant 200 mg once daily for 10 days and a single dose of 25 mg warfarin co-administered on day 5 (treatment A) and a single dose of 25 mg warfarin on day 1 (treatment B). Serial blood samples for warfarin pharmacokinetics and pharmacodynamics were drawn during both treatments.ResultsOf the 14 enrolled subjects, one withdrew due to an adverse event and 13 completed the study. Almorexant had no effect on the pharmacokinetics of warfarin. The geometric mean ratios (90 % confidence interval) for the area under the plasma concentration–time curve to infinity (AUC0–∞) of S- and R-warfarin were 0.99 (0.89, 1.09) and 1.05 (0.95, 1.16), respectively, and for the maximum plasma concentration (Cmax) were 0.99 (0.86, 1.14) and 1.00 (0.88, 1.13), respectively. The main pharmacodynamic variable was the AUC for the international normalized ratio (AUCINR). Almorexant had no effect on this variable as demonstrated by a geometric mean ratio of 0.99 (0.82, 1.19). Secondary pharmacodynamic variables including maximum effect (Emax), the time to the maximum INR, and factor VII plasma concentrations were also not affected by almorexant.ConclusionNo dose adjustment of warfarin is necessary when concomitantly administered with almorexant.

Cognitive and Behavioral Treatment Options for Insomnia

Insomnia is a costly disorder that affects a significant number of people. In many cases, insomnia is comorbid with other illnesses, which complicates its diagnosis and treatment. Most often it is treated with medication; however, patients are not always safe using hypnotics, and medication does not attack the source of the disorder. Cognitive behavioral therapies are better for long-term treatment because they address factors causing or perpetuating insomnia, as opposed to treatments that focus on symptoms. This article examines various nonpharmacological treatments for insomnia. In addition, because circadian rhythm disorders may exhibit symptoms similar to insomnia, there is also a brief overview of 2 common circadian rhythm disorders, delayed sleep phase syndrome and advanced sleep phase syndrome.

Hypocretin receptor antagonists for insomnia: rationale and clinical data

Loss of hypocretin neurons leads to sleep attacks and cataplexy in a rare sleep disorder known as narcolepsy. The hypocretin system stabilizes states of wakefulness and sleep through complex neural pathways. Insomnia, on the other hand, is a common sleep disorder characterized as difficulty initiating or maintaining sleep. Current treatment options for insomnia are limited to cognitive-behavioral therapy and pharmacological agents such as non-benzodiazepine receptor agonists. The discovery of hypocretin and deficiency of these peptides in narcolepsy spurred the development of pharmacological agents that antagonize hypocretin receptors for the treatment of sleep disorders such as insomnia. Preclinical and limited clinical data on hypocretin antagonists have shown favorable outcomes in the treatment of insomnia but concerns of theoretical adverse effects still remain.

Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review

BackgroundInsomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I).MethodsIn accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE.ResultsFive studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes.ConclusionsCBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia.

Current treatment options for insomnia

Patient complaints of insomnia continue to perplex many physicians because of the vast array of potential causes and multiple strategies to treat this symptom complex. The present review summarizes available pharmacological and nonpharmacological interventions for insomnia. A specialized assessment and treatment plan is required for all patients, taking into account all aspects of their life and the characteristics of their sleep disturbance.