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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There are few data about the prevalence and characteristics of reported sleep disorders in chronic dialysis patients and, although insomnia is often used as a marker of uremia, there are few data relating complaints of sleep to adequacy of dialysis. We therefore surveyed 48 hemodialysis (HD) patients, 22 continuous peritoneal dialysis (PD) patients, and 41 healthy control subjects about disordered sleep. The questionnaire included demographic data, questions characterizing the reported sleep problems, and linear analogue scales quantitating the severity of the sleep disturbance and feelings of anxiety, worry, and sadness. Kt/V determinations were also made for each dialysis patient. Fifty-two percent of the HD, 50% of the PD, and 12% of the control subjects reported problems sleeping (P less than 0.001, all dialysis patients v controls). No differences between HD and PD in characteristics of sleep problems were seen. Sleep severity scale results confirmed sleep disorders (7.2 in those with v 0.95 in those without sleep disorders, where 0 = sleep a little problem and 10 = a big problem, P less than 0.001). Caffeine intake (P less than 0.05) and worry (P less than 0.004) were the only factors associated with reported sleep disturbances. Kt/V values (1.4 +/- 0.3) did not predict reported sleep problems. Mean reported hours of sleep per night (5.5 +/- 2 v 5.8 +/- 1.4) and desired hours of sleep per night (8.3 +/- 2 v 7.6 +/- 1.3) were similar among dialysis patients and controls reporting sleep problems. Dialysis patients and controls without self-reported sleep disorders slept a mean of 7.1 +/- 2.4 and 7 +/- 1.1 h/night, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of reported sleep disorders in patients on chronic hemodialysis and continuous peritoneal dialysis. 173 98

A cross-sectional study of insomnia and hypnotic use was performed in a sample of the French population. The quota method was used to select the sample of 1,003 subjects, with less than 3% substitution. Subjects were 15 years old and older and were representative of the French population based on gender, age, marital status and living environment. Subjects were asked questions relevant to the complaint of insomnia and hypnotic use and filled out questionnaires measuring anxiety and depression. The complaint of insomnia is common, even in the 15-24-year-old group. Overall, more women than men were afflicted. The largest group of insomniac subjects, and the group who most often used hypnotics "frequently and chronically", were women 45 years and older. Men presented a sharp increase in hypnotic use after 65 years of age. Ten percent of the entire sample used hypnotics, 8% for more than 6 months and 6.17% on a chronic and frequent basis. Retired and unemployed elderly were also chronic and frequent hypnotic users: aging and social isolation correlate with chronic and frequent hypnotic usage. Higher scores on anxiety and depression scales correlate with more frequent complaints of nocturnal sleep disturbances. Young individuals are a significant complainer group but use hypnotics rarely. A rural environment was associated, overall, with fewer insomnia complaints, but environment had much less impact on complaints and hypnotic use in the elderly than in other age groups. One may question whether, in the French population, hypnotic prescription and intake are not responses to a social rather than a medical problem.
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PMID:Insomnia and use of hypnotics: study of a French population. 175 90

Quality of sleep influences the level of daytime functioning, including stress levels, psychosomatic complaints, general health, and overall well-being. As people age, they complain more about disturbed sleep, insomnia, increased time in bed, and sleep fragmentation. These complaints can be related to circadian rhythm desynchronization, hypnotic or other medication use, chronic bedrest, napping, dementia, or to sleep apnea, a disorder of respiratory cessation which is quite prevalent in the elderly. We review here the results of 12 years of research on sleep in the elderly. In studies of three populations of elderly, it was found that between 24% and 42% had five or more apneas per hour of sleep and 4%-14% had 20 or more apneas per hour of sleep. Since apnea is related to dementia and even to mortality, this high prevalence of apnea is of extreme importance.
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PMID:Prevalent sleep problems in the aged. 176 Apr 57

Although Halcion has received a great deal of attention and scrutiny, Halcion and the other benzodiazepines have a place in the pharmacotherapy of anxiety, panic, and sleep disturbances. Obviously, any physician's prescribing practices are going to be influenced by a variety of factors, including the popular press, to some extent. However, by paying careful attention to prudent and appropriate prescribing practices, following indications and guidelines for safety, efficacy, and patient acceptance, and by prescribing Halcion with the same cautions one would prescribe any other short-acting benzodiazepine or other hypnotic, this medication can be safe, efficacious, and a useful adjunct to the treatment of insomnia. Side effects--even such rare ones as musical hallucinations--will occur, to a greater or lesser extent, as with any medication, but these can be managed by the prudent physician, taking into account the risk/benefit considerations of Halcion, or any benzodiazepine, as a physician would in prescribing any medication for any reason.
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PMID:What about Halcion? 176 3

Sleep disturbances are common in cancer patients, but there are few specific data on their prevalence. Among other things, sleep problems may be a symptom of the cancer itself, part of a stress reaction to having cancer, a sequela to some other cancer symptom such as pain, or a side effect of cancer treatment. Insomnia is the more common sleep problem, although hypersomnia also occurs. Most insomnias are related either to pain or to psychophysiologic factors. Treatment should start with identification of a specific cause of sleeplessness; after that, behavioral interventions, medication, or psychotherapy may be helpful. When using medications, keep in mind possible complications, such as daytime sedation, tolerance, and rebound insomnia.
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PMID:Management of sleep problems in cancer patients. 183 74

Recently there have been reports that long-term use of estrogen- containing oral contraceptives (OCs) can induce folic acid and vitamin B deficiency which can lead to hematopoiesis. The symptoms are paleness, forgetfulness, sleeplessness, and euphoric and depressive states. This deficiency occurs when serum folic content falls below 8 nmol/1 or 3 ng/ml. According to a nutrition group blood folic acid level declined up to 40% in patients taking OCs. In a Sri Lanka study of healthy women aged 20-45 taking Ovulen 50 (.05 mg of ethinyl estradiol and 1 mg of ethynodiol diacetate) folic acid level dropped in the 1st 6 months stabilizing at 2.2 ng/ml in those from the lowest social classes and at 2.9 ng/ml in those from privileged classes. Prophylactic substitution of folic acid in the diet was recommended by WHO, but it is less effective since it appears in the diet as polyglutamate that has to be broken down to absorbable monoglutamate. A US study found that taking OCs for 60 months resulted in a 40% reduction of the vitamin B12 serum level, while vitamin B12 concentrations in erythrocytes and peripheral blood stayed normal. Vitamin B12 helps recover tetrahydrofolic acid from N-methyltetrahydrofolic acid. Possibly this is another manifestation of OC-induced folic acid hypovitaminosis. OCs can also influence tryptophan metabolism reducing its blood concentration whereby less 5-hydroxytryptamine (serotonin) is produced. This results in headache, concentration decreases irritability, and sleep disturbances. In addition, lower riboflavin (vitamin B2) and thiamin concentration in erythrocytes was reported after using OCs. Counseling on the possible effect on vitamin stores and on proper nutrition including folic acid as monoglutamate is necessary for women who use OCs or estrogen substitution therapy for postmenopause or for osteoporosis prophylaxis.
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PMID:[Folic acid and vitamin deficiency caused by oral contraceptives]. 192 42

Sleep disorders related to depressive illness are now well documented. However, sleep disturbances associated with anxiety have only been explored in recent time. All types of anxiety (generalized anxiety, obsessive-compulsive disorders, panic attack) are associated with sleep disorders such as early insomnia, sleep interruption and low efficiency of sleep. The EEG approach gives different results according to the type of anxiety. Generalized anxiety is associated with total sleep time reduction and low efficiency of sleep. Sleep is unstable with numerous awakenings. Longer periods of stage 1 and 2 sleep are observed and slow wave sleeps as well as REM sleep time is reduced. REM sleep latency may be reduced in obsessive compulsive disorders. Although sleep abnormalities observed in anxiety disorders differ from those observed in depressive disorders, none of these features can be considered specific of anxiety.
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PMID:[Sleep disorders related to anxiety]. 198 13

The National Institutes of Health Consensus Development Conference on the Treatment of Sleep Disorders of Older People brought together clinical specialists in pulmonology, psychiatry, psychology, geriatrics, internal medicine, other health care providers, and the public to address the cause, diagnosis, assessment, and specific treatments of sleep disorders of older people. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the scientific evidence and prepared a consensus statement. Among their findings, the panel concluded that although sleep patterns change during the aging process most older people with sleep disturbances suffer from any of a variety of medical and psychosocial disorders. The panel recommended that the diagnostic evaluation of sleep disorders begin with a careful clinical evaluation performed by an informed primary care physician. When necessary, referrals should be made to individuals or centers with specialized skills and tools for therapy. The panel recognized two types of disorders for which treatment may be beneficial: obstructive sleep apnea and insomnia. The mainstay for treatment for sleep apnea is the use of nasal continuous positive airway pressure. A thorough medical evaluation is essential prior to initiating treatment for insomnia, as its causes may be of psychiatric, pharmacological, or medical origin. The panel recommended that hypnotic medications not be the mainstay of treatment for insomnia as they may have habit forming potential if overused. The full text of the consensus panel's statement follows.
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PMID:The treatment of sleep disorders of older people. 209 80

All night EEG sleep recordings and clinical assessments of sleep quality were performed in normal controls, patients with generalized anxiety disorder and primary dysthymia. Patients were selected according to DSM-III R. Changes of sleep architecture, namely a reduction of slow wave sleep, are similar in generalized anxiety and dysthymia. Also the two groups do not exhibit the REM sleep disturbances usually observed in affective illness. Duration and continuity measures are unchanged in dysthymics, but anxious patients show some features of insomnia. The analysis of subjective aspects of sleep showed no relevant differences between the two groups of patients. Using a conventional set of EEG sleep parameters, primary dysthymia seems closer to anxiety disorders than to affective illness. However, the reduction of slow wave sleep in dysthymics and anxious patients may have different pathogenic meanings and the analysis of nonconventional sleep parameters may prove useful in this regard.
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PMID:Clinical and EEG sleep changes in primary dysthymia and generalized anxiety: a comparison with normal controls. 213 64

Insomnia is a problem that extends beyond the nighttime. People who experience sleep disturbances complain that they stay awake for a long time before they fall asleep. They may wake up several times during the night and cannot return to sleep and/or they wake up early in the morning. As a result, they feel sleepy during the day and are less alert. Various forms of insomnia are described that require--as much as possible--an individualized treatment approach. Besides sleeping hygiene, benzodiazepines certainly occupy a place in the treatment of insomnia. Triazolam, a triazolobenzodiazepine, closely approaches the characteristics of an ideal hypnotic: pharmacological activity at the level of the receptors, moderate absorption, short-acting, and rapid elimination. It is effective and safe if prescribed correctly and at the appropriate dosage.
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PMID:Appropriately treating insomnia with triazolam. 218 4


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