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

There are three fundamental principles for understanding sleep; the sleeping brain is not a resting brain, the sleeping brain functions in a different manner from the waking brain and the activity and work of the sleeping brain are purposeful. The sleeping brain does fail and this failure is manifest in a variety of clinical symptoms; all sleep complaints should be taken seriously and investigated. Transient insomnia is uniformly associated with objective sleep disturbances which have been documented following phase shifts of the major sleep period such as that caused by transmeridian travel. However, the degree to which the individual responds to these factors is variable. There is a consensus that sleep medications are indicated for transient and short-term insomnia. Benzodiazepine hypnotics are commonly used to induce and maintain sleep, and improve daytime alertness.
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PMID:Normal sleep, disturbed sleep, transient and persistent insomnia. 288 27

The effects of 400-600 mg trazodone on the sleep patterns of ten depressed in-patients treated for 5 weeks were studied during the initial (days 1-3) and terminal (days 26-28) treatment periods. The sleep parameters were compared to those obtained from three sleep recordings performed just prior to the initiation of the treatment and after 2 adaptation nights at the end of a 2-week drug-free period. At the same time, the clinical evolution of patients was evaluated weekly using MADRS and Hamilton-Anxiety scales for anxiety-depression symptomatology and Spiegel and Norris sleep scales. Weekly blood samples were collected to measure plasma levels of trazodone and, at the end of the study, the elimination half-life at steady state was calculated by repeated measurements of plasma levels. Clinical improvement, as assessed by a reduction of more than 60% in MADRS scale scores, was accompanied by evidence of the definitely beneficial effects of trazodone on the disturbed sleep of these depressed patients. From the beginning of treatment, there was a hypnotic-like effect (increase in total duration of sleep and stage II, decrease in sleep latency and intrasleep awakenings). In addition, records at the end of the study showed an increase in delta sleep and an increase in REM latency, an effect classically associated with an antidepressant action. These particularly valuable effects of trazodone on sleep would suggest that this drug should especially be given in cases of depression with major insomnia.
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PMID:Effects of trazodone on the sleep of depressed subjects--a polygraphic study. 313 13

Previous studies on the prevalence of sleep disturbances have shown that insomnia occurs in 3.2-42% of different populations. The wide reported variation in prevalence prompted a rigorous definition of insomnia to be introduced in this study. Randomly selected members of the population aged 30 to 65 years from two geographically different rural parts of central Sweden answered a sleep questionnaire. The response rates were 69.2% and 70.2%, respectively. Females significantly more often reported difficulty in falling asleep (7.1% of the women and 5.1% of the men). Among women 8.9 and among men 7.7% of individuals reported trouble with nocturnal awakenings. Using a stringently defined concept of insomnia as a disorder of initiating sleep (DIS), the prevalence rate of insomnia among women was 1.1% and among men 0.5%. Defining insomnia as a disorder of maintaining sleep (DMS), the prevalence among both women and men was 1.1%. Defining insomnia as a disorder of initiating and maintaining sleep (DIMS), the prevalence rate was 1.7% among women and 1.4% among men. This prevalence, which is lower than previously reported, demonstrate the importance of an operational definition of insomnia.
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PMID:The prevalence of insomnia: the importance of operationally defined criteria. 321 10

As part of an intensive survey of institutionalized elderly in 5 non-government homes for the aged in Singapore, mental health assessment of the residents was carried out systematically. Among 359 respondents, 30.1% often felt sad or cried often. Sleep disturbances affected 47.7% of the total respondents. Females were more prone to both depression and insomnia even after controlling for age difference; about 50% of the females aged 60-74 years and 70% of the females aged 75 years and above had frequently experienced these problems. A review of the literature on mental health and suicidal behaviour among the elderly is also presented.
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PMID:Mental status of residents in old people's homes. 359 78

The present study was concerned with the relationship between chronic stress and sleep disturbance. Previous research has provided evidence of chronic stress responding among people living near the Three Mile Island nuclear generating facility. Compared to control subjects, the TMI group has exhibited greater symptom reporting, poorer performance on behavioral measures of concentration, and elevated levels of urinary norepinephrine and epinephrine. Other research has suggested a relationship between arousal and insomnia. The extent to which stress and sleep disturbances were experienced by residents at TMI was examined and compared to levels of stress and sleep disturbance among a group of control subjects. The relationship between stress and sleep disturbances was also examined. Results indicated that TMI area residents exhibited more stress than the controls and reported greater disturbance of sleep. Modest relationships among stress and sleep measures suggested that the symptoms of stress measured in this study were not primary determinants of sleep problems.
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PMID:Chronic stress, catecholamines, and sleep disturbance at Three Mile Island. 361 54

Thirty-two patients in remission were followed by regular ratings during a prospective neuroleptic withdrawal study. They were outpatients who fulfilled the DSM-III criteria of schizophrenia and who were motivated for drug withdrawal. The relapse rate was 81%. The results from the rating scales confirm the hypothesis that a symptom increase occurs before psychotic relapse. In the order statistical differences occurred, the factors predicting relapse were those concerned with positive psychopathology, motor dysfunction, impaired affects and sleep disturbances. The corresponding symptoms and signs were mainly concerned with thought disorders, paranoid ideation, overactivity, depression and insomnia middle, all of nonpsychotic degree of severity. If prodromes appear, the patient should resume his neuroleptic treatment, or other preventive measures should be taken. By such therapeutic interactions, psychotic relapse may be prevented, or can be dealt with in an outpatient setting.
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PMID:Schizophrenic relapse after drug withdrawal is predictable. 370 94

The diagnostic importance of vegetative symptoms for melancholia was examined through DSM-III, the Newcastle Scale, and Extracted Criteria for melancholia. Statistically significant differences were diagnostically unimpressive in the case of DSM-III and the Newcastle criteria. With the Extracted Criteria, initial insomnia, early waking, anorexia, weight loss, loss of libido, and worsened mood in the morning were all significantly more common in melancholia than in non-melancholic depression, while increased appetite was more common in non-melancholia. Only diurnal variation of mood (worse in the morning) showed predictive value for melancholia; whereas the other traditional vegetative symptoms (disturbed sleep, weight, and libido) did not. Increased appetite and diurnal variation of mood (worse in the evening) were predictive for non-melancholia.
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PMID:Diagnostic significance of vegetative symptoms in depression. 373 Jul 11

Forty-eight normal subjects had sleep recordings and multiple sleep latency tests (an EEG measure of sleepiness) before and after a 12-hour shift of sleep-wake schedule. After 2 baseline days, subjects postponed sleep until 12:00 noon, then for three 24-hour periods were in bed from 12:00 noon until 8:00 PM. Treatment in parallel groups were administered before shifted sleeps. Sleep disturbance was greatest in the last quarter of shifted nights (6.5 to 8.5 hours after medication). Subjects taking placebo showed significant sleep loss on shifted nights and increased sleepiness the next day. Triazolam, 0.5 mg, reversed the sleep loss and consequent daytime sleepiness associated with the shifted sleep schedule. Triazolam, 0.25 mg, was not significantly better than placebo. In a dose-related manner, flurazepam mitigated the insomnia, but carryover effects left both dose groups more sleepy than were the placebo control subjects. Whether these laboratory results are applicable to clinically occurring forms of transient insomnia remains to be seen.
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PMID:Dose-related effects of triazolam and flurazepam on a circadian rhythm insomnia. 374 36

The publication of a new nosology of sleep and arousal disorders in 1979 established the need for differential diagnosis of sleep disorders based on polysomnographic evaluations as well as medical history and physical examination. This review of recent developments in diagnosing and treating sleep disorders covers such topics as prevalence, findings related to sleeping pills and insomnia, effects of depression on sleep, and managing the elderly patient with disturbed sleep. The authors caution against misuse of hypnotic drug therapy for treatment of insomnia and encourage physicians to inquire about sleep patterns even when a patient is presenting a seemingly unrelated problem.
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PMID:Recent developments in the diagnosis and treatment of sleep disorders. 390 66

The evaluation and treatment of sleep disorders represent an important area of research and clinical practice. Attempts to improve disturbed sleep are often needed, and treatment of the primary disorder associated with the insomnia, rather than the symptom of sleep disturbance, is always desirable. Our insight into sleep physiology and homeostasis is, however, rather limited. There may be several causative factors behind sleeping problems, and the treatment must be chosen accordingly. Of the drugs marketed, benzodiazepines are the drugs of choice, but other types of drugs are often useful in selected patients. The pharmacological profiles of the various types of benzodiazepines differ markedly from one another. The rate of distribution of the drug determines the duration of effects after a single dose whereas the elimination half-life is the determining factor during continuous intake. A treatment programme based on the individual patient and the type of sleep disturbance is usually necessary. An understanding of the quality and occurrence of such phenomena as carry-over, withdrawal and rebound effects as well as dependence problems reduces treatment complications and unnecessary use of sleeping pills. A good patient/doctor relationship is also needed to minimize the potential risks as well as the unnecessary use of hypnotic drugs.
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PMID:Drug treatment of insomnia: indications and complications. 390 22


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