Sleep initiation and maintenance disorders: Difference between revisions
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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]].<ref name="pmid19454639">{{cite journal| author=Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al.| title=Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 19 | pages= 2005-15 | pmid=19454639 | 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]].<ref name="pmid19454639">{{cite journal| author=Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al.| title=Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 19 | pages= 2005-15 | pmid=19454639 | ||
| 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=19454639 | doi=10.1001/jama.2009.682 }} <!--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=19454639 | doi=10.1001/jama.2009.682 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
Revision as of 11:02, 9 December 2009
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
- ↑ Anonymous (2024), Sleep initiation and maintenance disorders (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Kupfer DJ, Reynolds CF (1997). "Management of insomnia.". N Engl J Med 336 (5): 341-6. PMID 9011788.
- ↑ 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.
- ↑ Shub D, Darvishi R, Kunik ME (2009). "Non-pharmacologic treatment of insomnia in persons with dementia.". Geriatrics 64 (2): 22-6. PMID 19256583.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 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.
- ↑ 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
- ↑ 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.
- ↑ 10.0 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.
- ↑ 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.