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

Sixty volunteers with insomnia participated in a randomized, double-blind, controlled clinical trial. After an initial six nights of placebo, 30 subjects (the abrupt-withdrawal group) received 0.5 mg of triazolam nightly for 7 to 10 nights, after which they received placebo. The other 30 subjects (the tapered-dosage group) received the same initial placebo treatment, then triazolam at 0.5 mg for seven nights, at 0.25 mg for two nights, and at 0.125 mg for two nights, and then placebo. As compared with the initial placebo period, the triazolam period significantly reduced the interval before the onset of sleep (sleep latency), and it prolonged sleep duration, reduced the number of awakenings, and improved the self-rated soundness of sleep in all cohorts. In the abrupt-withdrawal group, plasma levels of triazolam were undetectable the morning after the first night of placebo substitution, and subjects reported prolongation of sleep latency (57 minutes longer than base line), reduction in sleep duration (1.4 hours less than base line), and increased awakenings (1.2 per night above base line). The symptoms of rebound sleep disorder lasted one or possibly two nights, and there was a reversion toward base line on subsequent placebo nights. In the tapered-dosage group, however, plasma triazolam levels fell gradually to zero, and rebound symptoms were decreased or eliminated. Thus, rebound sleep disorder following abrupt discontinuation of triazolam can be attenuated by a regimen of tapering.
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PMID:Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. 330 80

Insomnia complaints are common in the general population and are seen with even greater frequency among psychiatric patients. In any patient, the development of insomnia complaints may reflect the combined influences of various psychological, psychophysiologic, pharmacologic, and other medical factors. The capacity to describe and define specific sleep disorders is an important component in the development of a workable plan for the treatment of these disturbances. Knowledge of specific behavioral and pharmacologic modalities is also necessary for the choice of safe and effective treatment approaches.
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PMID:Insomnia. 333 16

Although the initial sleep disorders classifications provided a framework for categorizing diagnoses, these early instruments had a number of limitations. Among their shortcomings were a lack of specific diagnostic criteria, limited clinical validation, and an overreliance on sleep laboratory findings. As a result, many of the diagnoses were not only poorly substantiated, but they lacked clinical relevance. Also, because of a fusing of diagnoses, a causal relationship was implied that may have been nonexistent and could misdirect the treatment focus. The ICD-10 represents a clinically based diagnostic classification. Furthermore, this classification system includes diagnostic criteria and encourages multiple diagnoses for a more complete description of the patient's clinical presentation. In addition, the ICD-10 allows for differentiation of psychogenic, developmental, and organic factors. Finally, it can be fully applied in the office setting, which allows physicians to maximize their interviewing and assessment skills to complete the diagnoses and subsequent treatment plans. Thus, this classification system strongly reinforces the doctor-patient relationship. It also facilitates consideration of the entire scope of the patient's problems in a truly biopsychosocial perspective. The prevalence of insomnia ranges across studies from 20 to 30% of the adult population. Before adulthood, its prevalence is below 2%. About 5% of adults complain of excessive daytime sleepiness. Among the conditions of excessive daytime sleepiness, narcolepsy has a prevalence of 0.1% and sleep apnea not more than 1% in the general adult population. Nightmares have a prevalence of about 5% in adulthood and 20% in childhood. Sleepwalking and night terrors have a prevalence of less than 1% in adulthood and 15 and 5%, respectively, in childhood.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nosology and prevalence of sleep disorders. 333 58

Within the context of the comprehensive treatment of sleep disorders, which includes medical, neurologic, psychiatric, and social interventions, use of medication is often indicated. Among the three benzodiazepine hypnotics that are available in the United States for the treatment of insomnia, flurazepam is effective for both sleep induction and maintenance, and it retains most of its efficacy over a 4-week period of nightly administration; temazepam is effective only for sleep maintenance, and triazolam improves both sleep induction and maintenance with initial but not with continued administration. Rebound phenomena are more frequent and intense with the more rapidly eliminated drug, triazolam, and to a lesser degree with temazepam. Also, with triazolam, certain behavioral side effects, such as amnesia and psychotic-like symptoms, have been reported. With flurazepam, which is a slowly eliminated benzodiazepine, daytime sedation is more frequent than with the other two drugs. When insomnia is secondary to major depression, antidepressant medication should be administered. Methylphenidate, amphetamines, or other stimulant medications are used for the symptomatic treatment of the sleepiness and sleep attacks of narcolepsy and hypersomnia. For cataplexy and the other two auxiliary symptoms of narcolepsy, imipramine or other tricyclics are the drugs of choice. Protriptyline and medroxyprogesterone have been used in treating mild cases of obstructive sleep apnea, but their efficacy is limited. Similarly, for the treatment of central sleep apnea, medroxyprogesterone and acetazolamide have shown only limited effects. Medication for patients with sleepwalking, night terrors, or nightmares should be prescribed judiciously, and primarily when treatment of an underlying psychiatric condition is desired. The neuropharmacology of sleep should also consider drugs that may cause sleep disorders. Medications with sleep disturbing effects include various antihypertensives, bronchodilators, and the energizing antidepressants. Withdrawal of REM-suppressant drugs, such as the barbiturates, may cause nightmares in association with a REM rebound. Occasionally, a drug or a combination of drugs may produce somnambulistic-like activity in some patients.
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PMID:Clinical neuropharmacology of sleep disorders. 333 64

Nocturnal motor activity of 67 poor sleepers referred to the Rehabilitation Research Centre (RRC) and of 16 healthy subjects were recorded to distinguish poor sleepers without affective disorders from those with affective disorders. All subjects slept on the static charge sensitive bed (SCSB) in a single room of the patient dormitory. All subjects filled out a sleep questionnaire about their subjective sleep quality. After comprehensive rehabilitation consultations the poor sleepers were divided into two subgroups: those with and those without affective disorders. Complaints about insomnia and sleep disorders distinguished poor sleepers from healthy controls but the subgroups of poor sleepers did not differ in the estimation of the quality of sleep. However, when the distribution of body movements through the night was considered, the dynamic of nocturnal motor activity typified poor sleepers with affective symptoms.
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PMID:Sleep movements and poor sleep in patients with non-specific somatic complaints--II. Affective disorders and sleep quality. 343 Apr 26

Chlormethiazole has sedative, hypnotic and anticonvulsant properties, and is used in the treatment of sleep disorders and confusion in the elderly. In this study we examined the effects of chlormethiazole on EEG recorded sleep in six normal volunteers aged 67-74 years. After baseline registration, chlormethiazole (base), 384 mg p.o. (i.e. 2 capsules), was administered during 5 nights followed by one withdrawal registration. Sleep latency decreased from 52 to 27 min during the treatment period (P less than 0.01) and increased to 57 min during withdrawal. Wakeful periods during sleep decreased from 106 to 62 min during the treatment period and increased during withdrawal to 104 min (P less than 0.001). The sleep efficiency improved slightly during chlormethiazole treatment. The distribution of the sleep stages was essentially unaffected by chlormethiazole. According to subjective assessment the subjects rated their ability to fall asleep and their sleep quality as significantly better during the drug period. Based on sleep recordings and subjective ratings, there was no evidence of rebound insomnia on withdrawal. Psychoperformance tests revealed no evidence of hangover effects.
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PMID:The effects of chlormethiazole in EEG recorded sleep in normal elderly volunteers. 346 56

All five sleep disorders reviewed in this article can be adequately evaluated in the physician's office by taking a sleep history and conducting a careful general medical and psychiatric assessment. Insomnia, the commonest sleep disorder, is more prevalent among women and elderly and psychosocially disadvantaged persons. Personality factors such as a tendency toward the internalization of emotions and the occurrence of stressful life events also play a major role in the development of chronic insomnia. A multidimensional approach is indicated for the treatment of chronic insomnia; hypnotic drugs should be used only as an adjunct to this treatment. In children, sleepwalking and night terrors (two manifestations of the same pathophysiologic substrate), nightmares, and enuresis are commonly related to developmental factors; counseling and reassurance of the parents is indicated. Psychopathologic disorders are usually present in secondary enuresis, as well as in sleepwalking, night terrors, and nightmares that occur in adulthood. Psychotherapy and the occasional use of psychotropic drugs may be necessary in the treatment given adults with these disorders.
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PMID:Sleep disorders: insomnia, sleepwalking, night terrors, nightmares, and enuresis. 354 25

The treatment of sleep disorders in depressives depends basically on the nature of the underlying affective disorder (endogenous, organic, psychogenic or constitutional depression). Therapeutic approaches may be categorized in: psychological, somatic and pharmacological ones. The former include psychotherapies and behavioral treatments which are useful in psychogenic and constitutional depressions with sleep-onset insomnia but may also be supportive in endogenous depressions. The basic therapeutic factor common to all is anxiety reduction. Somatic therapies, such as ECT, total, partial and REM-sleep deprivation, sleep schedule shifts and bright light (EL) are utilized mostly in endogenous depressions. Sleep laboratory findings and different hypotheses concerning the mode of action of these alternative treatment methods are reviewed. Somnopolygraphic, psychometric, and neuroendocrinological data of our comparative trial with BL and partial sleep deprivation in normals and patients are discussed. The similarity of changes after BL, antidepressants and lithium points to a chronobiological factor in the pathogenesis and treatment of affective disorders. Electrosleep is still controversial, hydro-, ergo- and physical therapy are supportive therapies and as such indicated in all depressions. Exercise, fatigue and nutritional factors may influence sleep. Psychopharmacological treatment has to be regarded as the most important therapeutic approach for sleep disorders in depressives. Antidepressants are the drugs of choice for most patients. Based on their effects on sleep-induction, -maintenance, and -architecture and REM measures, one may differentiate at least two subtypes: sedative antidepressants of the amitriptyline type and nonsedative antidepressants of the desipramine type. Bedtime infusions of antidepressants may have sleep promoting properties, which was objectivated by an EEG spectral analysis during infusion and subsequently by all night sleep studies. Measures indicative of therapeutic outcome are still controversial. Tranquilizers, hypnotics, neuroleptics and serotonin precursors are utilized if the antidepressants alone do not ameliorate insomnia. However, as evidence of a shared diathesis of origin of depressive and anxiety disorders is building up, benzodiazepines are increasingly prescribed as monotherapy too. Finally, sleep laboratory data concerning the hypnotic properties of a pharmacological 80 mg doses of melatonin are demonstrated.
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PMID:Therapy for sleep disorders in depressives. 355 6

A dose response curve for the phase shifting effect of triazolam, a short-acting benzodiazepine commonly prescribed for the treatment of insomnia, on the circadian rhythm of locomotor activity was measured for the golden hamster. A single intraperitoneal injection of triazolam six hours before the onset of wheel-running activity induced a dose-dependent phase advance in the rhythm. A maximum phase advance, which averaged about 100 minutes, was observed in animals injected with 0.5 to 5.0 mg of triazolam. The use of drugs which promote sleep, and induce phase shifts in a central circadian clock, could be important in the treatment of sleep disorders associated with disrupted schedules and of mental and physical disorders associated with abnormal circadian rhythmicity.
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PMID:Dose response curve for the phase-shifting effect of triazolam on the mammalian circadian clock. 382 71

The hypnotic effect of suanzaorentang, an ancient Chinese remedy for insomnia, was studied in 60 patients with sleep disorders. After receiving placebo for one week, patients ingested capsules containing 1 gm of suanzaorentang each night, 30 minutes before bedtime, for two weeks. Treatment was followed by another week of placebo administration. Each morning during the study, patients completed questionnaires relating to their sleep the night before and to their ability to function during the previous day. Analysis of the responses showed statistically significant improvements (P less than 0.001) in all ratings of sleep quality and well-being during active treatment compared with both placebo periods. Laboratory tests performed before and after treatment with suanzaorentang showed no alterations in any test value. No side effects were noted. We conclude from these results that the compound merits further extensive investigation.
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PMID:Clinical trial of suanzaorentang in the treatment of insomnia. 388 94


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