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

Advances in knowledge of brain regulation of sleep and wakefulness have led to greater understanding of the effects of such diseases as narcolepsy and sleeping sickness on brain function. Treatment of the two most common sleep disorders, insomnia and obstructive sleep apnea syndrome (OSAS), is often but not always effective; promising new approaches are under investigation.
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PMID:Sleep disorders. 162 51

Insomnias lead the list of sleep disorders in the elderly. The differential diagnosis includes poor sleep habits, medical and psychiatric disorders, and drug interactions. Effective treatment includes sleep hygiene education and avoidance of substances known to interfere with sleep. In general, anticholinergic agents, antihistamines and long-half-life benzodiazepines should be avoided as hypnotic agents in the elderly. Safer therapeutic options include relaxation therapy and the short-half-life benzodiazepines without active metabolites.
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PMID:Insomnia in the elderly. 173 33

There are few data about the prevalence and characteristics of reported sleep disorders in chronic dialysis patients and, although insomnia is often used as a marker of uremia, there are few data relating complaints of sleep to adequacy of dialysis. We therefore surveyed 48 hemodialysis (HD) patients, 22 continuous peritoneal dialysis (PD) patients, and 41 healthy control subjects about disordered sleep. The questionnaire included demographic data, questions characterizing the reported sleep problems, and linear analogue scales quantitating the severity of the sleep disturbance and feelings of anxiety, worry, and sadness. Kt/V determinations were also made for each dialysis patient. Fifty-two percent of the HD, 50% of the PD, and 12% of the control subjects reported problems sleeping (P less than 0.001, all dialysis patients v controls). No differences between HD and PD in characteristics of sleep problems were seen. Sleep severity scale results confirmed sleep disorders (7.2 in those with v 0.95 in those without sleep disorders, where 0 = sleep a little problem and 10 = a big problem, P less than 0.001). Caffeine intake (P less than 0.05) and worry (P less than 0.004) were the only factors associated with reported sleep disturbances. Kt/V values (1.4 +/- 0.3) did not predict reported sleep problems. Mean reported hours of sleep per night (5.5 +/- 2 v 5.8 +/- 1.4) and desired hours of sleep per night (8.3 +/- 2 v 7.6 +/- 1.3) were similar among dialysis patients and controls reporting sleep problems. Dialysis patients and controls without self-reported sleep disorders slept a mean of 7.1 +/- 2.4 and 7 +/- 1.1 h/night, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of reported sleep disorders in patients on chronic hemodialysis and continuous peritoneal dialysis. 173 98

Forty-eight chronic hemodialysis (HD) patients (pts) completed questionnaires that used linear analogue scales (LAS), yes/no responses, and demographic data collection to characterize sleep disorders. Twenty-five pts (52%) reported problems sleeping. These pts graded sleep problems significantly higher than those without sleep problems (6.5 +/- 3 vs. 1.8 +/- 2, p less than 0.001 by LAS). Those with sleep disorders were more likely to smoke cigarettes (13/25 vs. 6/23, p less than 0.05) and have bone pain (14/25 vs. 6/23, p less than 0.05). No differences among pts with and without sleep problems were seen in age, gender, time on dialysis, caffeine intake, pruritus, feelings of sadness, worry, or anxiety, or Kt/V values (1.5 +/- 0.2 vs. 1.4 +/- 0.2, p less than 0.13). Restless legs (84%), onset insomnia (76%), and nighttime (76%) and early A.M. waking (72%) characterized the sleep disorders; symptoms suggesting nocturnal myoclonus were less common (20%). We conclude that sleep disorders are common in HD pts and may be exacerbated by tobacco use, bone pain, and restless legs. Kt/V does not correlate with sleep disorders. Further examination of this problem, including formal sleep studies, is needed.
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PMID:Characterizing sleep disorders in chronic hemodialysis patients. 175 Dec 35

In the Upper Bavarian Field Study a total of 1,536 persons (15 yr of age and older) were interviewed by research psychiatrists. The prevalence of insomnia (last 7 days) identified with the aid of the Clinical Interview Schedule (CIS) was 28.5% (mild: 15.0%; moderate/severe: 13.5%). For both sexes sleep disorders increased with age. The female preponderance of insomnia was mainly associated with the middle and older age groups. In contrast to other psychiatric disorders, sleep disturbances were not associated with social class. Moderate/severe insomnia was strongly related to psychiatric diagnoses, the use of psychiatric in- and outpatient services and general hospitals. It also constituted a significant burden for the primary-care physicians, whereby the average annual consultation rate among mild (10.61) and moderate/severe insomniacs (12.87) was significantly higher compared to that for those without sleep disorders (5.25). A total of 33.7% of the insomniacs were treated with hypnotic and/or other psychotropic drugs during the week prior to the interview, whereby the drug consumption among moderate/severe insomniacs (48.5%) was significantly higher than that of mild insomniacs (20.4%).
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PMID:Prevalence and treatment of insomnia in the community: results from the Upper Bavarian Field Study. 175 91

Insomnia is one of the most common complaints encountered by the primary care physician. Yet, in many cases, physicians treat the symptom of insomnia rather than evaluating and treating the underlying causes of insomnia. Because the subjective complaint of insomnia does not always correlate with evidence of objective sleep disruption, a careful history and evaluation are required. Assessment of the duration of insomnia and quantification of the impact of nocturnal sleep disruption on daytime functioning provide the most reliable indices of severity. Primary insomnia may be due to a number of different causes, such as poor sleep hygiene or circadian rhythm disruption. Insomnia may also be the presenting symptom of other primary sleep disorders, such as sleep apnea syndrome or nocturnal myoclonus, or of a variety of medical or psychiatric illnesses. The treatment of the patient with insomnia should address the underlying cause, when identifiable. When the cause cannot be identified, treatment should be conservative; nonpharmacologic therapies should be used whenever possible. When pharmacologic approaches are indicated, short-acting benzodiazepines should be administered in concordance with strict prescribing guidelines. Frequent follow-up is necessary to ensure continued therapeutic efficacy of the prescribed therapy.
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PMID:Detection and assessment of insomnia. 179 May 41

A total of 100 new patients was investigated who consulted the Department of Psychiatry of Tosei General Hospital concerning insomnia as a chief complaint. The average age of the subjects was 52, with an age range of 13-88, and a male female ratio of 1:22. According to the DSM-III-R classification, primary sleep disorder was most frequent (39%), followed by affective disorders (34%), organic mental disorders (9%), anxiety disorders (6%), psychoactive substance use disorders (4%), psychotic disorders not elsewhere classified (4%), and others. Various psychosocial stressors were observed in 40% of the subjects, and concurrent major physical disorders in 44% of the subjects. Based on the results, the role of consultation-liaison psychiatry in treatment of sleep disorders and primary care was discussed.
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PMID:Clinical study of insomnia, a common disorder in primary care: from a viewpoint of consultation-liaison psychiatry. 181 73

Sleep disorders are common in our society. It is estimated that there are 50 million people in the United States who suffer to varying degrees from sleep problems. A great deal has been learned about sleep during the past 40 years. Much of this knowledge has been obtained by the use of PSG, which consists of the simultaneous recording of several physiologic parameters from a patient just prior to and during sleep. Much of the technology utilized in PSG are based on individual tests developed many years ago. Current published data permit the conclusion that PSG is useful for the diagnostic evaluation of patients with sleep-related breathing disorders, may be helpful in the evaluation of suspected cases of narcolepsy wherein other findings are inconclusive or contradictory, and may be helpful in cases of parasomnias and/or suspected epilepsy wherein the distinction between seizure activity and other forms of sleep disturbance is uncertain. Current data do not permit a firm conclusion as to the clinical effectiveness of PSG in other symptoms of sleep disturbance such as insomnia. Current, ongoing clinical trials are expected to provide information addressing this point, and several agencies (NINDS, ADAMHA, and NIA) have expressed their intent to encourage the organization of prospective trials to determine the ultimate clinical utility of SDC and PSG techniques. A physician need not be present during PSG in an SDC.
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PMID:Polysomnography and sleep disorder centers. 182 78

Sleep disturbances are common in cancer patients, but there are few specific data on their prevalence. Among other things, sleep problems may be a symptom of the cancer itself, part of a stress reaction to having cancer, a sequela to some other cancer symptom such as pain, or a side effect of cancer treatment. Insomnia is the more common sleep problem, although hypersomnia also occurs. Most insomnias are related either to pain or to psychophysiologic factors. Treatment should start with identification of a specific cause of sleeplessness; after that, behavioral interventions, medication, or psychotherapy may be helpful. When using medications, keep in mind possible complications, such as daytime sedation, tolerance, and rebound insomnia.
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PMID:Management of sleep problems in cancer patients. 183 74

This chapter will focus on the office management of psychiatric patients with sleep disorders. Psychiatric aspects of insomnia, the parasomnias, circadian rhythm disorder and disorders of excessive sleepiness will be reviewed. The antidepressants, electroconvulsive therapy, amino acids and bright lights.
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PMID:Psychiatric management of sleep disorders. 185 64


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