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

We report on nine patients between the ages of 21 and 39 years who were admitted to an inpatient substance abuse treatment unit for cocaine treatment. The patients' sleep was studied in the laboratory for 4 nights during the first week, and 2 nights during the second and third weeks of their hospitalization. Daily mood ratings, cocaine craving scores and sleep logs were also recorded on each patient. During the first week of withdrawal, these patients had a markedly shortened REM latency, an increased REM sleep percentage, a very high REM density and a long total sleep period time. During the third week, REM latencies were very short and total percentage of REM sleep was increased. By week three of withdrawal the sleep continuity pattern was similar to that found in chronic insomnia, with a long sleep latency, an abnormally increased total time awake after sleep onset and a poor sleep efficiency. The subjects' ratings of cocaine craving, total POMS scores and depression fell precipitously after the first week of withdrawal and were at sub-clinical levels by week three of withdrawal.
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PMID:Electroencephalographic sleep and mood during cocaine withdrawal. 148 92

We studied Swedish survey responders who reported regular treatment with hypnotic drugs, to find associations to perceived health problems, inpatient psychiatric diagnoses, and subsequent suicide. Among 32,679 sampled Swedes, 26,952 (83%) participated, 500 of which (2%) reported regular hypnotic drug treatment. The rate of treatment was higher in women, and increased by age in both sexes. The major findings were high odds of concurrent psychoactive drug treatments, nervous symptoms and insomnia, as well as high rates of circulatory and musculoskeletal conditions in both sexes, with indicators of disability and sleep-disturbing symptoms. During a 15-year period, 35% of the men and 21% of the women who reported regular hypnotic drug treatment had also been admitted to inpatient psychiatric care. Substance abuse was diagnosed in 20% of the men and 4.3% of the women reporting hypnotic drug treatment. In multiple logistic regression models, the highest odds for regular hypnotic drug treatment were incurred by recent/current insomnia, nervous symptoms, and other psychoactive drug treatment. We conclude that therapy was principally given according to some current peer guidelines. Yet, further research is needed into the risk/benefit ratio of sustained hypnotic drug therapy in patients with qualifying somatic and psychiatric disorders to obtain a more uniformly based consensus.
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PMID:Regular hypnotic drug treatment in a sample of 32,679 Swedes: associations with somatic and mental health, inpatient psychiatric diagnoses and suicide, derived with automated record-linkage. 201 45

This work discusses the papers of the third symposium on psychiatry held in Basle. Herzka interprets substance abuse from a historical and cultural point of view as an escape from external tensions into an internal fight with the drug. The increase of tolerance of the many controversies and discrepancies in our culture could help to prevent drug abuse. The doctor is also in a clash between different cultures and social systems, where most values have become relative. In this situation the doctor will be tempted to only take some of the aspects of the bio-psychosociological model of psychiatric illnesses into account and to become highly specialized as to evade the conflict himself. The development of new benzodiazepines is progressing and the isolation of partial effect components, such as pure antianxiety and antiaggressive effects, is an important goal which has been partly reached. Benzodiazepines today belong to the most important medication for insomnia, restlessness, tension, anxiety present in different functional disorders, which not only concern psychiatry but medicine in general. A lot of patients need longterm treatment with benzodiazepines. This fact is contrary to the common recommendation to avoid benzodiazepine dependence. The one year prevalence of dependence is estimated to be, according to Ladewig, 0.1% of the population, which is, with regard to frequency and toxicity, compared to other substances, socially and medically relatively low. The therapeutic benefit is worth the risk of dependence. The prophylaxis for the reduction of drug dependence in the population is effective.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Perspectives of the 3d Basel Psychiatry Rounds]. 257 Apr 55

Traumatized combat veterans frequently attempt to escape the chronic anxiety, insomnia and nightmares characteristic of post-traumatic stress disorder by self-medicating with alcohol and drugs. The elimination of alcohol and drugs through chemical-dependency treatment, therefore, might be expected to precipitate an exacerbation of stress symptoms and predispose veterans to new cycles of abuse. The relationship between combat and post-treatment substance abuse has not been subjected to empirical study. This paper examines treatment-completion and post-treatment abstinence rates (treatment efficacy) as a function of level of combat when combat veterans are provided trauma-oriented therapy concurrently with treatment for chemical dependency. The experimental results suggest that, under these conditions, treatment efficacy does not vary with level of combat. The absence of combat-level effects is explained in terms of the interactive dynamics of chemical-dependency and post-traumatic stress disorder.
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PMID:Efficacy of chemical dependency treatment as a function of combat in Vietnam. 380 32

The use of electrical currents for the treatment of disease has been considered since antiquity but it has only been in recent years that suitable devices have been available to scientific investigators to provide stimulation currents for clinical use. These devices have been used extensively for the relief of intractable pain and are an accepted treatment modality today. Other investigators have turned to the investigation of the effects of tiny currents, less than one milliampere, applied to the head. Recent investigations have been successful in the alleviation of such symptoms as insomnia, depression, and tremor. Other investigations have shown similar currents to be effective in relieving stress that accompanies withdrawal from substance abuse. In spite of these successes, resulting from scientific investigation of the effects of cranial electrical stimulation, there is still a general reluctance to use this new modality. It is the purpose of this paper to review pertinent aspects of this treatment so the health care practitioner may make judgements with respect to the safety and efficacy of cranial electrical stimulation.
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PMID:Electrical stimulation and substance abuse treatment. 388 83

Zopiclone is a cyclopyrrolone which is chemically unrelated to the benzodiazepines and is thought to act on the GABAA receptor complex at a site distinct from, but closely related to, the benzodiazepine binding site. The hypnotic efficacy of zopiclone administered as single oral doses has been demonstrated in patients undergoing next-day surgery and in patients with insomnia, and these studies have established an optimal dose of 7.5mg for elderly patients. Using this dose, clinical studies have shown that zopiclone improved sleep in elderly patients to a similar extent as triazolam 0.125 to 0.5mg, flurazepam 15mg, and nitrazepam 5mg. Studies that also included younger patients have shown that zopiclone 7.5mg is at least as effective as triazolam 0.25 or 0.5mg, and on most sleep parameters is comparable to temazepam 20mg, nitrazepam 5mg, flunitrazepam 2mg, and flurazepam 20mg. Zopiclone causes minimal impairment to psychomotor performance and mental alertness the morning after night-time administration. The drug is generally well tolerated by patients of all ages; the most frequently reported adverse effects being bitter taste and dry mouth. Treatment withdrawal due to adverse effects is seldom required and reports of rebound insomnia after zopiclone withdrawal are rare. While symptoms of physical dependence have not been observed in clinical studies, there have been isolated reports of physical dependence in patients with a history of substance abuse. Although the latter finding should be kept in mind, it appears that zopiclone has a low dependence liability. Thus, with its short duration of action and good tolerability profile, zopiclone is a well established alternative to the benzodiazepine hypnotics and may be particularly beneficial in those patients unable or unwilling to tolerate the residual effects associated with many other hypnotic agents.
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PMID:Zopiclone. A review of its pharmacological properties and therapeutic efficacy as an hypnotic. 824 8

Insomnia may result from a variety of causes, including pathophysiology of the cardiorespiratory system, medical or psychiatric disorders, medications, substance abuse, and circadian rhythm disturbances. When these many causes are excluded, there remains an interesting group of patients whose disorder is characterized either by learned sleep-preventing associations or by a dissociation between physiologic measures and the subjective experience of sleep. One approach to understanding the latter group is to examine the patient's perception of the experience of being awake or asleep as well as the effects of hypnotic medication on this process.
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PMID:Insomnia and related sleep disorders. 830 15

The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have causal relations, or may be associated in the same patient with mutual reinforcements. We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated. The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache. For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemicrania were not modified by polysomnography. The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication. Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction. In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.
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PMID:The relationship between headaches and sleep disturbances. 855 Mar 59

Insomnia may be periodic and transient, as caused by situational stress, or persistent, as caused by a chronic sleep disorder. Physicians can gain much information concerning the type, probable cause, onset, and duration of insomnia through history taking. A sleep diary may reveal helpful information, and input from the patient's sleeping partner can also be valuable. Complicating disorders, such as heart failure, prostatism, or depression, should be sought and specific treatment prescribed. Chemical dependency, too, requires appropriate treatment. These measures, institution of good sleep-hygiene practices, and behavior modification may resolve sleeplessness. The primary indication for use of hypnotic agents is transient sleep disruption caused by acute stress. When an agent is chosen, onset of action, metabolism, and side effects should be considered, especially in elderly patients. Addictive agents should not be given to patients with substance abuse problems. If insomnia persists, evaluation at a sleep-disorder center is recommended to facilitate design of an appropriate therapeutic regimen.
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PMID:Treatment of insomnia. Getting to the root of sleeping problems. 891 33

Psychological and psychotherapeutic techniques are an essential part of the treatment of insomnia. Mainly two facts stress the importance of psychological/psychotherapeutical strategies for insomnia: (1) Concepts for non-drug treatment aim at improvement of the symptoms and the underlying cause of the disease and (2) disadvantages of hypnotic therapy such as substance abuse or addiction are avoided. Effective treatment techniques such as patients education and counseling, sleep hygiene, stimulus control and relaxation techniques should be known to every therapist, especially general practitioners who treat the majority of patients haring difficulties in initiating or maintaining sleep. Several other effective behavioural techniques, e.g. sleep restriction, or cognitive therapy, and psychotherapy should be used only by skilled and trained experts. Insomniacs with chronic and severe complaints should be treated by therapists with experience in sleep medicine. Multimodal treatment strategies are provided for by sleep disorder centres and combine effective treatment elements in structured therapeutic concepts. There is absolute consensus of opinion that every hypnotic treatment of an insomniac patient should be combined with basal elements of non-drug treatment strategies.
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PMID:[Psychological, psychotherapeutic and other non-pharmacologic forms of therapy in treatment of insomnia. Position of the "Insomnia" Study Group of the German Society of Sleep Research and Sleep Medicine]. 917 35


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