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

Sleep disturbance and excessive daytime sleepiness have been reported in patients with hepatic cirrhosis. The objective of this study was to evaluate daytime somnolence and sleep complaints in a group of 178 patients with cirrhosis compared to a control group. Sleep features and excessive daytime sleepiness were evaluated by the Basic Nordic Sleep Questionnaire (BNSQ) and the Epworth Sleepiness Scale (ESS). We collected clinical and laboratory data, neurological assessment and EEG recordings in cirrhotic patients. Patients with cirrhosis complained of more daytime sleepiness (p<0.005), sleeping badly at least three times a week (p<0.005), difficulties falling asleep (p<0.01) and frequent nocturnal awakening (p<0.005) than controls. We found a poor correlation between sleep disorders and clinical or laboratory parameters. Our results confirm previous literature reports suggesting a high prevalence of sleep disturbance in patients with cirrhosis. Insomnia and daytime sleepiness are the main complaints. Sleep disorders are probably a multifactorial phenomenon.
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PMID:Sleep disturbance and daytime sleepiness in patients with cirrhosis: a case control study. 1881 May 97

Insomnia is common in older people and can be associated with significant daytime dysfunction. Sleep problems, and the medications used to treat them, may contribute to the risk of falls and fractures in this population; however, the independent effects of disturbed sleep or the risk of hypnotic use are not well understood. Data arising from the Study of Osteoporotic Fractures (SOF) cohort of elderly women have confirmed the link between sleep problems (measured subjectively or objectively) and an increased risk of falls after taking into account the use of insomnia medications (benzodiazepines) in a community-dwelling population of older women. The data also suggest that benzodiazepine use is associated with increased risk of falls, although this association is less clear-cut when insomnia/sleep problems are taken into consideration. The risk of falls should be considered when prescribing benzodiazepines in this population. So far no data exist concerning whether the effective treatment of insomnia in the elderly may help prevent falls. Furthermore, studies are warranted to evaluate the efficacy and safety of the non-benzodiazepine BZRAs (benzodiazepine receptor agonists) in relation to risk of falls. In addition, there is a need to include fall risk factors such as postural sway and reaction time as outcomes for trials of new insomnia treatments.
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PMID:Sleep, insomnia and falls in elderly patients. 1892 14

The prevalence of insomnia is high in the population of western industrial countries (up to 35 %). Sleep disturbance may consequently lead to an impairment of cognitive functions, mood disturbance and metabolic alterations. Therefore, the confirmation of insomnia and its diagnostic characterization is of great importance. Treatment of insomnia is based on its aetiology and intensity. For secondary insomnia treatment of the basic disorder is mandatory. Before the initiation of a symptomatic pharmacological treatment the application of non-pharmacological interventions should be considered. Efficacious pharmacological interventions are non-benzodiazepine hypnotics for a limited time span. If a longer treatment of insomnia is necessary, hypnotic antidepressants and hypnotic neuroleptics (without anti-cholinergic action) can be applied taking the specific side effects into account. Classical benzodiazepines and substances with anti-cholinergic properties should be avoided in particular in long-term treatment and in elderly subjects due to its side effect profile.
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PMID:[Treatment of insomnia]. 1949 40

Antidepressants have long been recognized as a contributory factor to falls and many studies show an association between antidepressants and falls. There are extensive data for tricyclic antidepressants (TCAs) and related drugs, and for selective serotonin reuptake inhibitors (SSRIs), but few data for other classes of antidepressants. Sedation, insomnia and impaired sleep, nocturia, impaired postural reflexes and increased reaction times, orthostatic hypotension, cardiac rhythm and conduction disorders, and movement disorders have all been postulated as contributing factors to falls in patients taking antidepressants. Sleep disturbance is a cardinal feature of depression, and all antidepressants have effects on sleep. TCAs and related drugs cause marked sedation with daytime drowsiness. SSRIs and related drugs have an alerting effect, impairing sleep duration and quality and causing insomnia, which may result in nocturia and daytime drowsiness. Daytime drowsiness is a significant risk factor for falls, both in untreated depression and in depression treated with antidepressants. Clinically significant orthostatic hypotension is common with TCAs and related drugs, the older monoamine oxidase inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs). It occurs less commonly with SSRIs, and rarely with moclobemide and bupropion, and is not reported as a significant adverse effect of hypericum (St John's wort). Cardiac rhythm and conduction disturbances are well recognized with TCAs, tetracyclics and SNRIs, but have also been reported with SSRIs. The contribution of antidepressant-induced conduction and rhythm disturbances to falls cannot be assessed with current data. There are insufficient data to exonerate any individual antidepressant or class of antidepressants as a potential cause of falls. The magnitude of the increased risk of falling with an antidepressant is about the same as the excess risk found in patients with untreated depression.
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PMID:Antidepressants and falls in the elderly. 1955 90

Sleep disturbance commonly co-occurs with a range of psychiatric disorders. This is of concern given the accruing evidence that sleep is critically important for mood regulation, physical health, cognitive functioning, and quality of life. There is strong evidence that insomnia, even if it is comorbid with another psychiatric disorder, is treatable with cognitive behavioral therapy. There is a need to develop cognitive behavioral approaches to the other types of sleep disturbance often experienced by patients with psychiatric disorders, such as hypersomnia, reduced sleep need, delayed phase, nocturnal panic attacks, and nightmares. The possibility of developing a transdiagnostic treatment that comprehensively treats sleep disturbance for use across psychiatric disorders is discussed because (a) there are many disorders in which multiple types of sleep disturbance can be characteristic at one time or over the life-course of the disorder and (b) there are considerable challenges inherent to disseminating any new treatments but particularly many "disorder-specific" treatments.
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PMID:A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. 1969 79

Previous studies of the prevalence of sleep problems in adults with intellectual disabilities (ID) are affected by small, potentially biased samples and other limitations. This study aims to determine the prevalence and associations of sleep problems in the adult population with ID. The 4-week period prevalence of sleep problems was determined in a cross-sectional study of all adults with ID in a defined geographical area. Sleep problems were identified using the Psychiatric Assessment Scale for Adults with Developmental Disabilities (PAS-ADD) checklist and categorized as initial insomnia, early morning wakening and broken sleep. A fourth, composite, variable of significant sleep problem was also derived. Of the 1023 adults with ID who participated, 9.2% had experienced a significant sleep problem, during the 1-month period. Individuals with a significant sleep problem are more likely to have mental ill-health [odds ratio (OR) = 5.53, 95% confidence interval (CI) 3.52-8.69], problem behaviours (OR = 2.06, 95% CI: 1.25-3.41) and respiratory disease (OR = 2.03, 95% CI: 1.27-3.26). There is a positive association between visual impairment and initial insomnia (OR = 1.91, 95% CI: 1.21-3.04). Although a diagnosis of epilepsy is not associated with sleep problems, the finding that individuals taking antiepileptic medication are more likely to experience broken sleep (OR = 1.73, 95% CI: 1.13-2.66) suggests that medication side effects may impact on sleep of individuals with ID. The results suggest that there is a need to further examine the relationship between sleep problems and co-morbid health problems, which would inform the development of interventions, and trials of their efficacy.
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PMID:A cohort study of the prevalence of sleep problems in adults with intellectual disabilities. 1991 12

Sleep problems are associated with mood and function disturbances in caregivers of persons with Alzheimer's disease (AD). However, the factors associated with the onset and maintenance of sleep disturbances in caregivers of persons with dementia are unknown, and little attention has been paid to treatments to improve sleep in caregivers. Here we review some of the evidence for the association between caregiver sleep problems, and caregiver and care-recipient demographic, health, and psychosocial variables. We present data from a longitudinal study that examined factors associated with self-reported sleep problems in dementia caregivers and care-recipients over a 5-year follow-up period, and describe the existing caregiver insomnia treatment literature. We conclude with recommendations for future research.
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PMID:Insomnia In Caregivers Of Persons With Dementia: Who Is At Risk And What Can Be Done About It? 2004 6

Sleep disturbance among methadone-maintained patients is highly prevalent. A full understanding of sleep disturbance requires polysomnographic measures along with subjective sleep quality measures. The goal of this study was to describe the authors' experiences in performing at-home unattended polysomnography in this population. Participants had a Pittsburgh Sleep Quality Index score of six or higher, which indicates clinically significant insomnia, and 65% of eligible individuals agreed to enroll. Among 88 participants (53% female, 82% white, and a mean methadone dose of 105 mg/day), each undergoing two nights of home polysomnography, we initiated 165 of a maximum of 176 recordings. Overall, 81.7% of participants provided at least one night of "acceptable" polysomnographic data of at least 4 hours duration. Urine toxicology on polysomnographic nights demonstrated that benzodiazepine use was common. The authors conclude that unattended polysomnography is feasible in a population of individuals receiving methadone maintenance treatment. Polysomnography signal quality and overall study success rates were similar to those in non-substance using populations.
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PMID:Insomnia among methadone-maintained individuals: the feasibility of collecting home polysomnographic recordings. 2015 90

Insomnia is the predominant sleep concern in children with autistic spectrum disorder (ASD), and its nature is most likely multifactorial, with neurochemical (abnormalities in serotonergic transmission or melatonin levels), psychiatric (anxiety), and behavioral (poor sleep habits) etiological factors involved. Children with ASD experience sleep problems similar to those of typically developing children, although the prevalence is markedly higher, occurring in 44-83% of school-aged children with ASD. Caregivers usually report that insomnia is the most frequent sleep disorder, described as disorders of initiating and maintaining sleep, restless sleep, bedtime resistance, co-sleeping, alterations of sleep hygiene, and early awakenings in the morning. Many actigraphic studies have added information on sleep disorders, confirming the questionnaire findings in the majority of cases. There are relatively few polysomnographic data for ASD, compared with questionnaire studies, and most of these studies reported a reduction in total sleep time and more undifferentiated sleep in the youngest patients. These findings were associated with several sleep microstructure alterations during rapid eye movement (REM) sleep, and with non-REM (NREM) sleep microstructure changes that appeared to be related to cognitive impairment rather than to the autistic core. Moreover, few data about other less frequent sleep disorders, such as periodic limb movements disorder and obstructive sleep apnea syndrome, bruxism, and the influence of epilepsy and EEG abnormalities, are available. Both pharmacologic and behavioral interventions have been suggested for the treatment of sleep problems in autistic children. The most common types of behavioral interventions are complete extinction (removing reinforcement to reduce a behavior) and various forms of graduated extinction. Melatonin has shown promising results in the treatment of insomnia in children with ASD. Although controlled studies are limited, there are more data demonstrating the safety and effectiveness of melatonin in ASD than for other sedative/hypnotic drugs. Finally, a dual treatment for insomnia in ASDs with melatonin and behavioral techniques has been suggested. A recent study using a combination of genetic and functional experimental techniques reported evidence that low melatonin concentration caused by a primary deficit in acetylserotonin methyltransferase activity is a risk factor for ASD. Sleep problems usually start at the same age as developmental regression, suggesting a higher vulnerability at this period of life. Further studies, beginning at younger ages, are necessary to better investigate these aspects and the role of melatonin in insomnia in children with ASD.
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PMID:Epidemiology and management of insomnia in children with autistic spectrum disorders. 2021 44

Children and adolescents with autistic spectrum disorders (ASD) suffer from sleep problems, particularly insomnia, at a higher rate than typically developing children, ranging from 40% to 80%. Sleep problems in ASD might occur as a result of complex interactions between biological, psychological, social/environmental, and family factors, including child rearing practices that are not conducive to good sleep. Interestingly, children with a history of developmental regression have a more disturbed sleep pattern than children without regression. Even though regulation of sleep in children with ASD is still poorly understood, circadian abnormalities in autism might be the result of genetic abnormalities related to melatonin synthesis and melatonin's role in modulating synaptic transmission. Recently a bifurcation of the sleep/wake cycle with increased sensitivity to external noise and short sleep duration causing irregular sleep onset and wake up times has been suggested. Identifying and treating sleep disorders may result not only in improved sleep, but also impact favorably on daytime behavior and family functioning. Several studies have also demonstrated effectiveness of behavioral interventions for sleep onset and maintenance problems in these populations. When behavioral interventions are not effective or lead only to a partial response, pharmacological treatment options should be considered. Studies of melatonin use in children with ASD provide evidence for its effectiveness and safety in the long run. The clinician assessing a child with an ASD should screen carefully for sleep disorders and make referrals as indicated.
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PMID:Sleep in children with autistic spectrum disorder. 2060 10


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