Insomnia Use Research Articles

EDITORIAL: Addiction medicine: a new medical specialty in a new age of medicine

EDITORIAL: Addiction medicine: a new medical specialty in a new age of medicine

Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey

ObjectiveTo examine clinical practice patterns regarding non-prescription and prescription medication use for insomnia by child and adolescent psychiatrists. MethodsSurvey mailed to 6018 members of the American Academy of Child and Adolescent Psychiatry. ResultsThe final sample (N=1273) reported that insomnia was a major problem in almost a third of their school-aged and adolescent patients and endorsed using medication to treat the insomnia in at least a quarter of these patients. Overall, 96% of respondents recommended at least one of the listed prescription medications in a typical month, and 88% recommended an over-the-counter medication. Alpha agonists were the most commonly prescribed insomnia medication for ADHD (81%), significantly higher than in MR/DD (67%), mood (40%), or anxiety disorders (31%). Trazodone was the most commonly prescribed insomnia medication for children with mood (78%) and anxiety disorders (72%). Antidepressants as a class were also commonly used for children in these diagnostic groups. Atypical antipsychotics, anticonvulsants, and short-acting hypnotics were also more likely to be used in children with mood disorders. Melatonin was recommended by more than one-third of respondents. Mitigation of the effects of sleep disruption on daytime functioning was endorsed as an important rationale for the use of sleep medication; concerns about side effects and the lack of empirical support regarding efficacy were cited as significant barriers to their use. ConclusionsInsomnia is a significant clinical problem in children treated by child psychiatrists for a variety of behavioral, neurodevelopmental, and psychiatric conditions. Management with a broad array of psychotropic medications is common and indicates a highly variable clinical approach to insomnia in this pediatric population.

Prevalence and cost of insomnia in a state Medicaid fee-for-service population based on diagnostic codes and prescription utilization

Objectives The aims of this research were to estimate prevalence of insomnia, describe the utilization patterns of physician office services and prescription medications for insomnia, and estimate related costs in a Medicaid population. Methods A cross-sectional descriptive analysis using data from the West Virginia (WV) Medicaid fee-for-service paid claims records for the year 2003 was conducted. Recipients with a diagnosis related to insomnia or a prescription claim for an FDA-approved drug for insomnia or trazodone were selected as the study sample. Costs were from the perspective of WV Medicaid. Results The overall prevalence of insomnia was 74.3 per 1000 recipients. Adults 45–64 years of age, females, and whites had the highest prevalence and office visit rates for insomnia among demographic groups. A majority of dollars spent on insomnia treatment was for prescription drugs. Zolpidem and trazodone accounted for 88% of prescription claims; however, 84% of the total dollars paid for prescriptions was for zolpidem. Conclusions Among the WV Medicaid population, rates of insomnia and office visit use for insomnia varied by demographic groups. There was greater use of zolpidem and trazodone than benzodiazepine drugs. This study provides baseline estimates that can be used for ongoing surveillance of insomnia.

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

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

Emphasizing the Complementary in CAM

Emphasizing the Complementary in CAM

Sedative and hypnotic activities of the ethanol fraction from Fructus Schisandrae in mice and rats

Fruits of Fructus Schisandrae have been used as medicine for the treatment for insomnia in traditional Chinese medicine. In the present research, the sedative and hypnotic activities of the ethanol fraction of Fructus Schisandrae fruit (SY3) were studied in mice and rats. In the open field test, SY3 (25, 50 and 100 mg/kg) significantly inhibited the motor activity of mice compared to the normal. Results also showed SY3 potentiated pentobarbital-induced sleep by not only increasing the number of falling asleep and prolonging sleeping time but also reducing sleep latency. Furthermore, sleep–wake stages of rats were evaluated by polytrophic recording for 3 h after treatment. The results demonstrated that SY3 at doses of 20, 40 and 80 mg/kg behaved remarkable action on sleep architecture of rats, which contain the increase of total sleeping time, the rate of deep slow wave sleep (SWS) and mean episode duration of deep SWS, and the decrease of the latency of deep SWS. Therefore, these results suggest that the ethanol fraction of Fructus Schisandrae fruit possesses potent sedative and hypnotic activity, which supported its therapeutic use for insomnia.

Sleep Maintenance Insomnia: Strengths and Weaknesses of Current Pharmacologic Therapies

Although insomnia is highly prevalent, sleep disturbances often go unrecognized and untreated. When insomnia is recognized, considerable emphasis has been placed on improving sleep onset; however, there is growing evidence that improving sleep maintenance is an equally important treatment goal. A MEDLINE literature search was performed using the search parameters "insomnia," "zolpidem," "zaleplon," "flurazepam," "estazolam," "quazepam," "triazolam," and "temazepam," as these agents are FDA-approved for the treatment of insomnia. Per reviewer comments, the search criteria was later expanded to include lorazepam. A literature search using the terms "trazodone" and "insomnia" was also performed, as this is the second-most commonly prescribed agent for treating insomnia. Sleep efficacy endpoints from randomized, placebo-controlled clinical trials in adult populations and key review articles published between 1975 and 2004 were included in this review. As only one randomized placebo-controlled trial evaluated trazodone use in primary insomnia, the trazodone search was expanded to include all clinical trials that evaluated trazodone use in insomnia. Relevant texts and other articles that evaluated side effect profiles of these agents were also included, one of which was published in January of 2005. In all publications, impact of treatment on sleep maintenance parameters (wake time after sleep onset, number of awakenings) and measures of next-day functioning were evaluated, in addition to sleep onset parameters (sleep latency, time to sleep onset/induction) and sleep duration data (total sleep time). Many of the currently available agents used to treat insomnia, including the antidepressant trazodone, the non-benzodiazepine hypnotics zolpidem and zaleplon, and some of the benzodiazepines, have not consistently demonstrated effectiveness in promoting sleep maintenance. Furthermore, the benzodiazepines with established sleep maintenance efficacy are associated with next-day sedation, the risk of tolerance and dependence, or both. New agents that offer relief of sleep maintenance insomnia without residual next day impairment while improving next day function are needed. Several compounds currently under development may offer clinicians a more effective and safer treatment for this common disorder.

Substance use for insomnia in Metropolitan Detroit

Objective: People with insomnia are not typically treated medically for their insomnia. Studies have reported approximately 30% of insomniacs self-medicate with alcohol or over-the-counter (OTC) medications. This study was done to identify determinants and risks of different insomnia therapeutics. Methods: A random-digit-dial, computer-assisted survey of a representative sample of adults in Metropolitan Detroit, aged 18–65 years, is being conducted. A sample of all respondents over an 18-month period was collected ( n=1324) with a 68% response rate. Exclusive past-year use of alcohol for sleep was reported by 10% ( n=132), prescription medications by 8% ( n=108), and OTC medications by 10% ( n=135). Five percent used both alcohol and sleep medications. The three exclusive-use groups formed the comparison groups of the study. Results: The prescription drug group used medications for more consecutive nights and for more total nights than the alcohol and OTC users. Alcohol users were predominately male, while OTC and prescription drug users were predominately female. Alcohol users were more likely to be single than the others, and prescription drug users were older than the others. Prescription drug users had more severe insomnia and had greater disability, neuroticism, and daytime fatigue than the others. In contrast, the alcohol users had greater daytime sleepiness than the others. Conclusions: In Metropolitan Detroit, insomniacs receiving medical treatment have more severe insomnia and greater disability than those who self-treat. However, while the insomnia of those self-treating is less severe, it is still associated with some risks.