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

Despite the fact that the prevalence rate for insomnia in the United States is high (35.2%), the number of patients with this condition do not represent a large percentage of patients evaluated and treated in sleep disorders clinics. On the other hand, the great majority of patients with insomnia do not seek treatment for their condition from their physicians. Several hypotheses have been created to explain this phenomenon: (1) lack of training for physicians in the area of sleep disorders, (2) pessimism in relation to treatment outcome shared by patients and physicians, and (3) time constraints and other reasons on the part of the physicians. Insomniacs, however, deserve accurate diagnosis and effective treatments for their condition. Insomnia is often the result of multiple factors converging rather than one single cause. For academic purposes, however, different disorders in difficulties with initiation and maintenance of sleep are discussed. Among them, adjustment sleep disorder, obstructive sleep apnea, periodic limb movements in sleep, circadian abnormalities, and psychiatric disturbances. Emphasis is placed on the treatment of each, along with the treatment of the other factors that are commonly found in patients with insomnia: poor sleep hygiene, use of medications that disrupt sleep, performance anxiety, deficient exposure to entrainers of circadian rhythms, diet, and exercise. A comprehensive treatment that includes a multifactorial approach is the ideal way to treat patients with insomnia. Research that will enhance our knowledge of the biological substrate of insomnia will provide clinicians with additional tools to improve the outcome of their treatments of patients with insomnia.
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PMID:Diagnosis and treatment of insomnia and risks associated with lack of treatment. 148 80

To assess the use of actigraphy in evaluating insomnia, 36 patients with a serious complaint of insomnia slept 3 nights each in the laboratory, where the usual polysomnograms (PSGs) were obtained as well as actigraphic assessments of their sleep. Patients also wore actigraphs for 7 days at home, were extensively interviewed and filled out psychometric tests. Based on all this information, the patients were then diagnosed according to the International Classification of Sleep Disorders. Averaged over the 3 nights for each insomniac, the mean discrepancy between actigram and PSG was 49 minutes per night. In three-fourths of the cases, actigram and PSG agreed to within 1 hour on the total amount of sleep per night. Discrepancies, however, were not random: In patients with psychophysiologic insomnia and in insomnia associated with psychiatric disease, the actigram typically overestimated sleep when compared with the PSG. In patients with sleep-state misperception, the actigram was either quite accurate or it underestimated sleep when compared with the PSG. Comparing laboratory with home sleep, one-third of all insomniacs slept better in the laboratory and two-thirds slept better at home. In addition, night-by-night variability was higher at home than in the laboratory. Based on our study, we now recommend actigraphy as an additional tool in the clinical evaluation of insomnia, but we believe that in complex cases it should be combined with 1 PSG night in the sleep disorders center.
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PMID:Wrist actigraphy in insomnia. 788 Feb 49

The safety and efficacy of 10 or 20 mg/day zolpidem, a new hypnotic belonging to the imidazopyridine class, were studied over a 180-day period in 96 patients with sleep disorders. The treatment was continued for a further 180 days by 49 of these patients. Follow-up information from 21 patients who discontinued treatment after 180 days showed no rebound insomnia or withdrawal signs. Efficacy of treatment with respect to reduction of sleep onset latency and number of nocturnal wakenings, and improvement in duration of sleep, quality of sleep and morning wakenings was found in nearly 90% of patients and was maintained in those patients who continued treatment for 360 days. This efficacy was achieved with a stable percentage of patients receiving 10 mg/day and 20 mg/day zolpidem from day 30 to the final visit. Zolpidem, therefore, has been shown to be an effective and safe hypnotic, and to be devoid of rebound and withdrawal effects.
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PMID:The safety and efficacy of zolpidem in insomniac patients: a long-term open study in general practice. 152 72

Insomnia and daytime sleepiness in an elderly patient may be a normal consequence of aging, the result of a primary sleep disorder, or an adverse effect of medication or medical illness. Effective management requires a differential diagnosis. Adjustment sleep disorder, primary snoring, inadequate sleep hygiene, and mood disorders are common in the aged. The physician needs to review the patient history, including stressful events, medications, medical illness, and the possible presence of a psychiatric disorder. Treatment often involves behavioral changes and conservative use of medications, including antidepressants or benzodiazepines.
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PMID:Common sleep disorders in the elderly: diagnosis and treatment. 154 86

Sleep state misperception (SSM) is the diagnostic term proposed in the International Classification of Sleep Disorders to describe those insomniacs who mislabel their sleep as wakefulness. Although sleep misperception has long been recognized among insomnia patients, it is debatable whether this clinical finding warrants a distinctive diagnosis or simply represents an extreme variation of other, more common forms of insomnia. We present two cases to explore the clinical meaningfulness of SSM. It is concluded that SSM represents a distinctive, albeit rare, sleep disorder. However, refinements in existing diagnostic criteria may be needed to improve the meaningfulness of the SSM diagnosis.
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PMID:Subjective total insomnia: an example of sleep state misperception. 155 96

An inquiry about sleep habits and sleep disturbances revealed a significantly higher prevalence of insomnia in a solvent-exposed group than in a comparable group that had no occupational exposure to organic solvents. In the solvent-exposed group was also registered an increased consumption of hypnotics, and a significant increase occurred in the number of individuals who had consulted physicians because of sleep disorders. The results indicate that solvent exposure could induce sleep disturbance.
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PMID:Sleep disturbances and exposure to organic solvents. 156 32

The elderly have more organic sleep problems disturbing sleep and contributing to insomnia than younger individuals. The most common disorders afflicting the elderly are obstructive sleep apnea, restless legs syndrome, and nocturnal myoclonus. Poor sleep habits often aggravate or contribute to the ongoing difficulty with sleeping. In the depressed elderly, characteristic EEG changes occur that may help distinguish major depression from pseudodementia; however, it should be considered that pseudodementia may be a harbinger of primary dementia. A careful sleep history and often evaluation by polysomnography are central to the management of sleep problems in the elderly. In conjunction with treatment of any underlying organic sleep disorders, brief administration of short-acting benzodiazepine sedatives for sleep onset insomnia or rapid-acting intermediate half-life benzodiazepines for sleep maintenance insomnia can be quite helpful in the elderly, especially if behavioral techniques also are employed. Elimination of medications, alcohol, and caffeine, which disturb sleep, is also an important part of the treatment approach.
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PMID:Sleep disorders in geriatric patients. 160 Apr 90

For a period of six months (april to october 1990) 361 manic-depressive in-patients or out-patients were examined and treated. 178 patients (119 females and 69 males) were suffering from depression at examination time. Among them, 34 women and 11 men had mixed mood disorders with a symptomatology near that of typical depression (major depression, according to the DSM III-R criteria) but not of mixed bipolar disorder. The main symptoms were: dysphoric mood with irritability; internal tension, psychic and sometimes physical agitation; emotional lability; head crowded with thoughouts or thoughts that vanish too quickly; sleep disorders with initial insomnia or with frequent night awakenings; suicidal thoughts or attempted suicide with impulsiveness. These patients sustained severe suffering. They were in no way slow-minded but rather talkative and expressive. Antidepressant drugs increased agitation and insomnia, and in some cases, suicidal impulses. BZDs had limited efficacy but neuroleptics given in small doses, anticonvulsants and lithium gave very effective results. A limited number of electroshocks provided rapid improvement. In many respects, depression with delirium seems a more severe form of the above-described combined depressive syndrome and responds to the same treatments. We think that this mood disorder includes excitement as an important component, although this was not clearly evident. However, it is not easy to conceive this syndrome as a mixture of depressive and manic symptoms; it should rather be regarded as another specific mood condition, either permanent or transient, situated between the two other conditions.
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PMID:[Mixed depressive syndrome]. 160 Aug 99

Wakefulness and sleep are antagonistic states competing for the domain of brain activity. Non-REM sleep and REM sleep are different states of being, sustained by activity in brainstem nuclei, hypothalamus, basal forebrain, and thalamus. Such complex phenomenology is subject to many alterations grouped in the new International Classification of Sleep Disorders. The insomnias are the result of interacting psychosocial, psychophysiologic, neurodevelopmental, and medical factors. Proper perspective of each factor provides the clinical strategies to approach medically the symptom-complex of insomnia. The most common cause of daytime hypersomnia is chronic sleep deprivation. Obstructive sleep apnea responds to nasal CPAP, but the failure rate approaches 30%. In intolerant patients BiPAP and surgical remedies should be considered. Motor and behavioral abnormalities of sleep may be linked to REM sleep as in the REM sleep behavior disorder. Paroxysmal nocturnal dystonia and nocturnal wanderings may be associated with epilepsy. Intrusions of one state of being (wakefulness, non-REM sleep, and REM sleep) into another result in mixed, poorly defined, or only partially developed states. Dissociation of states may be responsible for confusional arousals, hallucinations, and cateplexy. Senile degeneration of the suprachiasmatic nuclei may underlie the circadian rhythm changes in old age and the "sundown" syndrome in demented patients. Misalignment of the hypothalamic pacemaker causes dysregulation of sleep-related physiologic and behavioral variables. Exposure to bright light retrains the pacemaker in night-shift workers, transmeridian travelers, and in patients with seasonal affective syndrome. Benzodiazepine compounds are very effective hypnotics, but should be used sparingly in the elderly to avoid falls, memory lapses, and aggravation of a preexisting sleep apnea syndrome. Sleep laboratory evaluations are indicated in patients with hypersomnia, suspected sleep apnea syndrome, motor-behavioral disorders of sleep, and in many individuals complaining of insomnia.
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PMID:Update on disorders of sleep and the sleep--wake cycle. 160 36

Although the definitions of insomnia have changed over the last decade to include the perceptions of patients and the effects of disturbed sleep on daytime function, no clear measure exists for isolating the scope of the problem within the general population. A 1979 Gallup poll survey showed that 95% of the adult population had experienced insomnia. The current literature maintains consistently that approximately one third of all people have sleep problems in any given year. Of those, only half consider the problem serious enough to seek medical advice. Sleep disorders appear to effect women more often than men, and the complaints increase with age. Younger people tend to have trouble falling asleep, while older people have difficulty maintaining sleep. The many varieties of sleep disorders and the diverse etiologies underlying them make it crucial that the individual sleep problem be understood clearly. An accurate diagnosis should drive treatment.
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PMID:The epidemiology and occurrence of insomnia. 161 19


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