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

Sleep disturbances of insomnia type belong to the most common health problems of the modern society. Chronic insomnia, one that worsens daytime functioning and lasts over one month, occurs in 9 to 15% of the general population of developed countries. Further 15-20% of the population suffers from short term insomnia. When approaching a patient with insomnia, the physician should firstly regard sleep disturbances as a symptom related to other medical conditions. The most common causes of chronic insomnia include psychiatric disorders, addictions, somatic disorders and poor sleep habits. For successful treatment of insomnia it is most important to diagnose the cause of sleep problems properly. Such management of sleep disturbances allows treating insomnia causally. The symptomatic treatment of insomnia includes sleep hygiene and intermittent administration of sleep promoting drugs such as benzodiazepines, non-benzodiazepine hypnotics of second generation, antidepressants, antipsychotics, antihistaminics or herbal and over the counter agents. This article reviews the sleep promoting drugs and substances that can be used for treatment of chronic insomnia.
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PMID:[Pharmacological treatment of insomnia]. 1703 20

Chronic insomnia is a common disorder that is under recognized, under diagnosed and under treated. Initial assessment should focus on identifying and treating, if present, any secondary causes of insomnia. Primary insomnia can be treated with behavioral and/or pharmacological therapy. A thorough sleep history can identify the type of insomnia present, its severity, and can consequently guide therapy. Behavioral therapy has been shown to be equivalent to or superior to pharmacologic therapy, at least in some patients. It is a reasonable initial approach, although there are barriers to its use. There are several pharmacologic agents available, some of which are more effective at reducing time to fall asleep and others for maintaining sleep. There is some evidence to indicate that combining the approaches may impair outcomes. There is little data on the long-term use of pharmacologic agents.
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PMID:Pharmacologic management of chronic insomnia. 1723 94

Chronic insomnia affects approximately one quarter of cancer patients. Non-pharmacologic interventions are the treatment of choice for chronic insomnia, yet they are rarely offered to people with cancer. The study question was how to make these interventions available to cancer patients. Twenty-six cancer patients who had sleep difficulty participated in focus groups or one-to-one interviews. The key questions included: What would be the best way for you to find out about a service for insomnia treatment? What would make it easy/difficult for you to participate? Transcripts were examined independently by three readers who identified participants' answers to the questions, as well as themes that emerged from participants' reflections on their experience with cancer and sleep difficulty. The readers then worked together to reach consensus on a final classification system for describing the content of patients' responses. Participants provided many practical answers to our specific questions. In addition, the following themes emerged: sleep difficulty needs greater recognition by health professionals; patients wish to receive more information about sleep and sleep difficulty; and that although patients perceive sleep as being important, they are reluctant to report sleep problems to doctors. Furthermore, participants recommended that the assessment and treatment of sleep difficulty be integrated into the health care system while considering the cancer-treatment status and energy level of patients.
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PMID:How to provide insomnia interventions to people with cancer: insights from patients. 1735 6

Insomnia is a subjective complaint relating to approximately 30% of the adult population in France, described by the patient as a difficulty of initiating and/or maintaining sleep. Its prevalence increases with age and sex: women are more affected than men (24% vs 14%). Insomnia is either occasional (20%), or chronic (10%). Chronic insomnia has an important impact on patients' everyday life e.g. fatigue, perturbed diurnal waking state, impaired quality-of-life... which results in lower work productivity and drowsiness as well as relational difficulties, absenteeism. About 80% of patients consult their general practitioner first. The aim of a hypnotic agent is to obtain sleep as physiological as possible. Benzodiazepines and benzodiazepines-like agents (zopiclone, zolpidem, zaleplon) are the most widely used hypnotics. However, their indications must be limited to occasional insomnia with a limited duration: less than four weeks. There is no advantage with using a combination of hypnotic agents, a practice which should be prohibited. Adverse effects can be serious, e.g. diurnal somnolence associated with risks of road accidents and, in the elderly, the risk of falls. After chronic use, hypnotics can be addictive, as their effects wear off in three to four weeks. After withdrawal, insomnia rebound is frequent. Use of hypnotics in association with alcohol is a well-known drug-addiction behavior. According to the French health insurance fund, 9% of the general population use hypnotics and about half of them regularly. Insurance refunds for hypnotics and sedatives reach more than 110 million euros annually. The efficiency of hypnotics wears off, quickly for benzodiazepines (three - four weeks), or less quickly for zopiclone and zolpidem (a few months). Insomnia is a major public health issue, each year 10% of the incident cases of insomnia treated by hypnotics joint the group of subjects with chronic insomnia. This failure to treat insomnia properly can be explained, at least in part, by several insufficiencies: physicians and pharmacists training, medical profession awareness, research, public information on the rules of good sleep (public health campaigns, booklets, role of physicians and the pharmacists).
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PMID:[Sleep disorders and hypnotic agents: medical, social and economical impact]. 1765 91

Insufficient sleep is an under-recognized public health problem that is projected to increase in the next decade as the US population ages. Chronic insomnia alone impacts 10% to 15% of adults. Epidemiologic data indicate that pain, fatigue, and mood disturbance are common correlates of persistent insomnia. Rates of most sleep disorders are substantially elevated in rheumatologic diseases, with chronic insomnia impacting at least 50% of patients. Clinicians treating patients with rheumatologic disorders should screen for sleep disorders and possess a basic knowledge of sleep physiology and empirically based intervention approaches. Sleep disturbances occurring within the context of chronic medical illnesses, including rheumatologic diseases, do not typically respond to primary disease and/or pain management interventions. Identification of co-occurring sleep disorders followed by aggressive treatment is recommended and has the potential to improve quality of life, ameliorate pain, and improve psychosocial adaptation to the primary illness. In this report, we briefly highlight that sleep disturbance increases risk for both comorbidities and symptoms associated with rheumatologic diseases, we identify specific sleep disorders commonly encountered in rheumatologic populations, and we discuss pharmacologic and behavioral treatment approaches for the most common sleep disorder observed in rheumatologic conditions, chronic insomnia.
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PMID:Sleep in rheumatic diseases and other painful conditions. 1771 96

Chronic insomnia and cognitive impairment are both common complaints among older adults. This study explores the association between chronic insomnia and changes in cognitive functioning among older adults. The study population comprised two groups: 64 older adults without insomnia and 35 older adult insomniacs. The cognitive capacity of each participant was tested at the participant's home using the computerized "MindFit" test (CogniFit, Inc.). In five categories of cognitive functioning, older adult insomniacs displayed impaired performance compared to older adult good sleepers. Specifically, significant differences were found between insomniacs and good sleepers on memory span, allocating attention to a target, time estimation, executive functioning, and integration of two dimensions (visual and semantic) tests. The findings imply that insomnia may have detrimental effects on some cognitive functions in healthy older adults.
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PMID:Chronic insomnia and cognitive functioning among older adults. 1841 36

Chronic insomnia is highly prevalent in our society, with an incidence of 10 to 30 percent. It is a major cost to society in terms of health care expenditure and reduced productivity. Nonpharmacologic interventions have been studied and shown to produce reliable and sustained improvements in sleep patterns of patients with insomnia. Cognitive behavior therapy for insomnia has multiple components, including cognitive psychotherapy, sleep hygiene, stimulus control, sleep restriction, paradoxical intention, and relaxation therapy. Cognitive psychotherapy involves identifying a patient's dysfunctional beliefs about sleep, challenging their validity, and replacing them with more adaptive substitutes. Sleep hygiene education teaches patients about good sleep habits. Stimulus control therapy helps patients to associate the bedroom with sleep and sex only, and not other wakeful activities. Sleep restriction therapy consists of limiting time in bed to maximize sleep efficiency. Paradoxical intention seeks to remove the fear of sleep by advising the patient to remain awake. Relaxation therapies are techniques taught to patients to reduce high levels of arousal that interfere with sleep. Cognitive behavior therapy involves four to eight weekly sessions of 60 to 90 minutes each, and should be used more frequently as initial therapy for chronic insomnia.
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PMID:Nonpharmacologic management of chronic insomnia. 1917 64

Chronic insomnia and cognitive impairment are both common complaints among older adults. Even so, only a few studies have examined the effects of chronic insomnia on cognitive functioning among the elderly, and the results of these studies are contradictory. The authors therefore examined whether insomnia is associated with changes in cognitive functioning among elderly people. The study population comprised two groups: 64 older adult subjects without sleep disorders, and 48 older adult insomniacs. All subjects were living independently in the community and were in good clinical condition. The cognitive capacity of each subject was tested at the subject's home using the computerized "MindFit" test (CogniFit, Inc.). The results demonstrate that chronic insomnia in older adults is associated with impairment in cognitive functioning. Specifically, we found that older people suffering from late-life insomnia exhibit significantly reduced performance in memory span, allocating attention to a target, time estimation, working memory and integration of two dimensions. The present findings suggest that late-life insomnia may be one of the factors contributing to the decline in cognitive functioning seen among older people. Thus, it is particularly important for health care practitioners to screen for, evaluate and treat insomnia symptoms in the elderly. The findings of this study offer hope that treatment of insomnia in older adults can have beneficial effects in improving cognitive functioning in these patients. Therefore, attention to and effective treatment of chronic insomnia in older persons may not only improve the quality of their nighttime sleep, but conceivabLy, may also maintain cognitive function, thus improving their overall quality of life.
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PMID:[Sleep in older adults: association between chronic insomnia and cognitive functioning]. 1963 Mar 61

Chronic insomnia is highly common in adults, and certain population groups are particularly prone to sleep disturbances, including the elderly, women in menopausal transition, persons with chronic pain, and those with depression. Diagnosis and treatment of insomnia in such patients may be problematic because of (1) the presence of one or more comorbid medical illnesses, as in the elderly or patients with a chronic pain syndrome, (2) the presence of depressive symptoms, or (3) the patient's underlying physiologic status (eg, hormone fluctuations due to perimenopause). Effective management of sleep disturbances in these special populations requires an integrative approach to evaluation in the context of the underlying condition and to concurrent treatment of the sleep disturbance and any coexisting medical condition or associated symptom. The contributors to this article discuss insomnia as it is experienced by each of these populations and present representative case examples and proposed treatment plans for each.
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PMID:Insomnia in special populations: effects of aging, menopause, chronic pain, and depression. 1966 89

Chronic insomnia afflicts millions of people in the United States. It is associated with decreased quality of life, accidents, several comorbid conditions, increased morbidity, and substantial direct and indirect costs. Chronic insomnia is a multifactorial and individualized disorder. Its etiology may be cognitive or physiologic in nature (or both), and is more often than not associated with a comorbid condition, complicating its recognition, evaluation, and treatment. Effective nonpharmacotherapeutic (cognitive-behavioral therapy for insomnia) and pharmacotherapeutic (hypnotic medications) treatment modalities are available. Treatment of chronic insomnia can make a significant improvement in quality of life, and may also be associated with an improvement in comorbid conditions.
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PMID:Chronic insomnia. 1974 10


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