Sleep initiation and maintenance disorders: Difference between revisions

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{{supgages}}
In [[medicine]], '''sleep initiation and maintenance disorders''', including '''insomnia''', are "disorders characterized by impairment of the ability to initiate or maintain sleep. This may occur as a primary disorder or in association with another medical or psychiatric condition."<ref>{{MeSH}}</ref><ref name="pmid16120860">{{cite journal| author=Silber MH| title=Clinical practice. Chronic insomnia. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 8 | pages= 803-10 | pmid=16120860  
In [[medicine]], '''sleep initiation and maintenance disorders''', including '''insomnia''', are "disorders characterized by impairment of the ability to initiate or maintain sleep. This may occur as a primary disorder or in association with another medical or psychiatric condition."<ref>{{MeSH}}</ref><ref name="pmid16120860">{{cite journal| author=Silber MH| title=Clinical practice. Chronic insomnia. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 8 | pages= 803-10 | pmid=16120860  
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16120860 | doi=10.1056/NEJMcp043762 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=16120860 | doi=10.1056/NEJMcp043762 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>

Revision as of 10:22, 17 October 2010

Template:Supgages In medicine, sleep initiation and maintenance disorders, including insomnia, are "disorders characterized by impairment of the ability to initiate or maintain sleep. This may occur as a primary disorder or in association with another medical or psychiatric condition."[1][2]

Treatment

Treatment options for geriatric patients have been reviewed.[3]

Non-drug treatment

No-drug treatments such as light therapy, exercise, and sleep-hygiene modification have been reviewed.[4]

A combination of education, sleep hygiene, exercise, and light therapy helped patients with Alzheimer's disease in the NITE-AD randomized controlled trial.[5]

Indirect evidence suggests a warm bath may help.[6]

Exercise, perhaps by raising body temperature, may help.[6]

Medications

GABA agonists

These medications are agonists of the GABA-A receptors.

BZ1 selective agonists

These medications include zopiclone, eszopiclone, zolpidem, and zaleplon. In treating persistent insomnia in adults, 6 weeks of zolpidem 10 mg nightly along with weekly sessions of cognitive behavioral therapy followed by 6 months of monthly sessions and no medications yielded the most remission of insomnia in a randomized controlled trial.[7]

In geriatrics, the benefits of zolpidem for insomnia to not clearly exceed the drug toxicity.[8][9]

The benefit of eszopiclone may not be strong.[10]

Melatonin agonists

Ramelteon is one available agonist. Its magnitude of benefit may be small. among outpatients.[10]

Tasimelteon can help transient insomnia due to shift changes related to employment..[11]

References

  1. ↑ Anonymous (2024), Sleep initiation and maintenance disorders (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Silber MH (2005). "Clinical practice. Chronic insomnia.". N Engl J Med 353 (8): 803-10. DOI:10.1056/NEJMcp043762. PMID 16120860. Research Blogging.
  3. ↑ Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH et al. (2009). "Evidence-based recommendations for the assessment and management of sleep disorders in older persons.". J Am Geriatr Soc 57 (5): 761-89. PMID 19484833. PMC PMC2748127.
  4. ↑ Shub D, Darvishi R, Kunik ME (2009). "Non-pharmacologic treatment of insomnia in persons with dementia.". Geriatrics 64 (2): 22-6. PMID 19256583.
  5. ↑ McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV, Teri L (2005). "Nighttime insomnia treatment and education for Alzheimer's disease: a randomized, controlled trial.". J Am Geriatr Soc 53 (5): 793-802. DOI:10.1111/j.1532-5415.2005.53252.x. PMID 15877554. Research Blogging.
  6. ↑ 6.0 6.1 Horne JA, Moore VJ (1985). "Sleep EEG effects of exercise with and without additional body cooling.". Electroencephalogr Clin Neurophysiol 60 (1): 33-8. PMID 2578352.
  7. ↑ Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al. (2009). "Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial.". JAMA 301 (19): 2005-15. DOI:10.1001/jama.2009.682. PMID 19454639. Research Blogging.
  8. ↑ Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE (2005). "Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits.". BMJ 331 (7526): 1169. DOI:10.1136/bmj.38623.768588.47. PMID 16284208. PMC PMC1285093. Research Blogging. Review in: ACP J Club. 2006 Jul-Aug;145(1):14 Review in: Evid Based Med. 2006 Aug;11(4):110 Review in: Evid Based Nurs. 2006 Jul;9(3):87
  9. ↑ Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF, Kupfer DJ (1997 Dec 24-31). "Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy.". JAMA 278 (24): 2170-7. PMID 9417012.
  10. ↑ 10.0 10.1 Schwartz LM, Woloshin S (2009). "Lost in transmission--FDA drug information that never reaches clinicians.". N Engl J Med 361 (18): 1717-20. DOI:10.1056/NEJMp0907708. PMID 19846841. Research Blogging.
  11. ↑ Rajaratnam SM, Polymeropoulos MH, Fisher DM, Roth T, Scott C, Birznieks G et al. (2009). "Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials.". Lancet 373 (9662): 482-91. DOI:10.1016/S0140-6736(08)61812-7. PMID 19054552. Research Blogging.
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