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

Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep. Conversely, medications may be used therapeutically for specific sleep disorders. For example, restless legs syndrome and periodic limb movement disorder may be treated with dopamine agonists. An understanding of the disorders of sleep and the effects of medications is required for the appropriate use of medications affecting sleep.
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PMID:Medications for the Treatment of Sleep Disorders: An Overview. 1501 9

Insomnia is characterized by difficulty falling asleep (sleep onset disturbance), difficulty staying asleep (sleep maintenance disturbance), or poor quality (nonrestorative) sleep, leading to impairment of next-day functioning, including psychological distress. Published prevalence estimates of insomnia vary considerably, very likely due to differences in definitions, study setting, and data collection methods. However, estimates based on large population-based surveys provide a rather constant prevalence rate for chronic insomnia in the United States of about 10% (approximately 25 million people). Chronic insomnia is associated with numerous physical and psychiatric conditions and is more common in women and the elderly. Although it is often perceived as a symptom of depression, insomnia is also a precursor of depression and is associated with a substantial increase in the relative risk of major depression. Chronic insomnia is correlated with impaired mood, subjective functioning, and quality of life and, in some cases, with increased daytime sleepiness and accident risk. Those reporting insomnia have higher rates of absenteeism and health care utilization. Direct costs of insomnia have been estimated to be $13.9 billion annually, with a large majority of costs attributable to nursing home care. Chronic insomnia is a common problem, often associated with negative waking mood or function. As such, heightened clinical attention and clinical research appear warranted.
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PMID:Clinical and socioeconomic correlates of insomnia. 1515 63

Insomnia, defined by difficulty falling asleep or remaining asleep, early morning awakening and/or non-restorative sleep, and daytime consequences, is an important public health issue with a significant negative impact on individuals' physical and social performance, ability to work and quality of life, as well as on society as a whole. Chronic insomnia warrants treatment in the majority of cases, but it is often under-treated. Primary insomnia occurs independently of other factors, and is possibly related to a general psychophysiologic hyperarousal. Other types of insomnia occur in association with various conditions such as psychiatric disorders, medical disorders (e.g., chronic pain, dysfunction and movement disorders), circadian rhythm disorders and medication or substance use. These types of insomnia are diagnosed more frequently in the clinic. As a result, insomnia is traditionally viewed and treated as a symptom rather than a disease, with the majority of therapies aimed at resolving underlying medical factors. However, it is important to clearly establish whether co-morbidities are causative for or simply co-exist with insomnia, in order to recommend the most appropriate treatment and optimize treatment outcomes. Difficulties still arise when categorizing insomnia subtypes. Here, we highlight some of the major challenges for future research in classifying both primary insomnia and insomnia related to or associated with various conditions, and their relevance to primary care.
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PMID:Is insomnia best categorized as a symptom or a disease? 1530 96

Recent studies by Cloninger suggest that the temperament dimension of harm avoidance might be related to serotonergic activity. Since serotonergic mechanisms equally play a major role in sleep regulation, we decided to use Cloninger's psychobiological model of temperament and character to assess whether there is a link between psychophysiologic insomnia and specific personality traits. Chronic insomnia is a common complaint in modern society, and it is still controversial whether insomniacs share specific personality traits. Thirty-two chronic insomniacs (< 50 years) were studied. They underwent polysomnography for two consecutive nights and filled out the 226-item self-questionnaire of Temperament and Character Inventory as well as the Hospital Anxiety and Depression scale. (1) Harm avoidance for all subscores was significantly higher in insomniac patients when compared with controls; (2) self-directedness scores were lower in insomniacs; (3) sleep latency was positively correlated to harm avoidance; (4) HA1 (anticipatory worry) was negatively correlated to REM latency. Temperament and Character Inventory is a useful tool in the investigation of chronic insomnia. Serotonergic mechanisms might explain the high incidence of harm avoidance as personality trait in psychophysiologic insomniac patients. Further studies are needed to see whether harm avoidance could be a psychological vulnerability marker for primary insomnia and be used as predictor of SSRI treatment responders.
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PMID:Temperament and character in primary insomnia. 1579 6

Insomnia is a common sleep complaint even in young adults and has important daytime consequences. Several subjective and objective tools are recommended to assess the magnitude of the problem and to try to find a cause. Chronic insomnia is often caused by precipitating factors, such as acute stress, work conditions, illness, and travel, and perpetuating factors, such as poor sleep hygiene, anxiety, and medications. Insomnia may have implications in athletic performance resulting from physical and cognitive effects. Several pharmacologic and nonpharmacologic approaches are employed in the management of insomnia that have proven effective for short-term treatment. The pharmacologic approaches include the use of zolpidem and specific GABA agonists, benzodiazepines for specific indications, antidepressants, and melatonin. The nonpharmacologic approaches include stimulus control, sleep restriction, relaxation strategies, and cognitive behavioral therapy.
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PMID:Insomnia and sleep disruption: relevance for athletic performance. 1589 23

Chronic insomnia impacts 1 in 10 adults and is linked to accidents, decreased quality of life, diminished work productivity, and increased long-term risk for medical and psychiatric diseases such as diabetes and depression. Recent National Institutes of Health consensus statements and the American Academy of Sleep Medicine's Practice Parameters recommend that cognitive-behavioral therapy for insomnia (CBT-I) be considered the 1st line treatment for chronic primary insomnia. Growing research also supports the extension of CBT-I for patients with persistent insomnia occurring within the context of medical and psychiatric comorbidity. In the emerging field of behavioral sleep medicine, there has yet to be a consensus point of view about who is an appropriate candidate for CBT-I and how this determination is made. This report briefly summarizes these issues, including a discussion of potential contraindications, and provides a schematic decision-to-treat algorithm.
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PMID:Who is a candidate for cognitive-behavioral therapy for insomnia? 1644 93

Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through 1995-1997. The outcome was subsequent award of a disability pension (18-48 months after the health screening) as registered by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted odds ratio=3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had little confounding effect (adjusted odds ratio=3.69, 95% confidence interval: 3.00, 4.53), and this association remained significant after adjustment for psychiatric and physical morbidity and for health-related behaviors (adjusted odds ratio=1.75, 95% confidence interval: 1.40, 2.20). This study suggests that insomnia should receive increased attention as a robust predictor of subsequent work disability.
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PMID:The long-term effect of insomnia on work disability: the HUNT-2 historical cohort study. 1661 65

Chronic insomnia may coexist with chronic physical and psychiatric conditions, and its prevalence is often higher among patients with these conditions than in the general population. Evidence suggests that insomnia as a feature of chronic disease tends to be more severe and persistent than insomnia that does not occur in the context of chronic illness. Furthermore, comorbid insomnia can have a profound negative impact on patients' quality of life and overall functioning, and may be associated with greater healthcare resource utilization. In some cases, treatment of the underlying disorder may improve sleep, whereas in other cases, treatment of the sleep symptoms may actually improve the underlying disorder. In addition, chronic insomnia may be a precursor to certain psychiatric comorbidities. Further research is needed not only to clarify the efficacy and safety of specific therapeutic approaches but also to further investigate the possibility that successful treatment of sleep disturbances may improve objective and subjective parameters of the disorders themselves. This article reviews the specific associations between chronic insomnia and a wide range of chronic physical and psychiatric disorders.
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PMID:The impact and prevalence of chronic insomnia and other sleep disturbances associated with chronic illness. 1668 92

Sleep is an active state that is critical for our physical, mental, and emotional well-being. Sleep is also important for optimal cognitive functioning, and sleep disruption results in functional impairment. Insomnia is the most common sleep disorder in psychiatry. At any given time, 50% of adults are affected with 1 or more sleep problems such as difficulty in falling or staying asleep, in staying awake, or in adhering to a consistent sleep/wake schedule. Narcolepsy affects as many individuals as does multiple sclerosis or Parkinson disease. Sleep problems are especially prevalent in schizophrenia, depression, and other mental illnesses, and every year, sleep disorders, sleep deprivation, and sleepiness add billions to the national health care bill in industrialized countries. Although psychiatrists often treat patients with insomnia secondary to depression, most patients discuss their insomnia with general care physicians, making it important to provide this group with clear guidelines for the diagnosis and management of insomnia. Once the specific medical, behavioral, or psychiatric causes of the sleep problem have been identified, appropriate treatment can be undertaken. Chronic insomnia has multiple causes arising from medical disorders, psychiatric disorders, primary sleep disorders, circadian rhythm disorders, social or therapeutic use of drugs, or maladaptive behaviors. The emerging concepts of sleep neurophysiology are consistent with the cholinergic-aminergic imbalance hypothesis of mood disorders, which proposes that depression is associated with an increased ratio of central cholinergic to aminergic neurotransmission. The characteristic sleep abnormalities of depression may reflect a relative predominance of cholinergic activity. Antidepressant medications presumably reduce rapid eye movement (REM) sleep either by their anticholinergic properties or by enhancing aminergic neurotransmission. Intense and prolonged dreams often accompany abrupt withdrawal from antidepressant drugs, a reflection of an REM rebound after drug-induced REM deprivation. The postulated link between sleep and psychiatric disorders has been reinforced by the findings of modern neurobiology.
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PMID:Sleep disorders in psychiatry. 1697 26

Sleep is a vital part of normal health and wellness for everyone. It is also an important factor in recovering from the physiological and emotional stress of any hospitalization or illness. Insomnia--the lack of adequate period of sleep--has a profound impact on society and public health in many ways. Chronic insomnia contributes to injury and illness and may have adverse effects on cognitive functioning, interpersonal relationships, concentration, the ability to handle stress, and productivity. Nurses who are knowledgeable about the possible causes of insomnia, the different types of insomnia, and various therapeutic interventions will be able to identify those who have insomnia or are at risk of insomnia and will be able to counsel these patients about healthy sleep habits and the safe use of pharmacotherapeutic therapies used to treat insomnia.
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PMID:Managing insomnia. 1703 22


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