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

Quality of sleep influences the level of daytime functioning, including stress levels, psychosomatic complaints, general health, and overall well-being. As people age, they complain more about disturbed sleep, insomnia, increased time in bed, and sleep fragmentation. These complaints can be related to circadian rhythm desynchronization, hypnotic or other medication use, chronic bedrest, napping, dementia, or to sleep apnea, a disorder of respiratory cessation which is quite prevalent in the elderly. We review here the results of 12 years of research on sleep in the elderly. In studies of three populations of elderly, it was found that between 24% and 42% had five or more apneas per hour of sleep and 4%-14% had 20 or more apneas per hour of sleep. Since apnea is related to dementia and even to mortality, this high prevalence of apnea is of extreme importance.
Biofeedback Self Regul 1991 Dec
PMID:Prevalent sleep problems in the aged. 176 Apr 57

Although Halcion has received a great deal of attention and scrutiny, Halcion and the other benzodiazepines have a place in the pharmacotherapy of anxiety, panic, and sleep disturbances. Obviously, any physician's prescribing practices are going to be influenced by a variety of factors, including the popular press, to some extent. However, by paying careful attention to prudent and appropriate prescribing practices, following indications and guidelines for safety, efficacy, and patient acceptance, and by prescribing Halcion with the same cautions one would prescribe any other short-acting benzodiazepine or other hypnotic, this medication can be safe, efficacious, and a useful adjunct to the treatment of insomnia. Side effects--even such rare ones as musical hallucinations--will occur, to a greater or lesser extent, as with any medication, but these can be managed by the prudent physician, taking into account the risk/benefit considerations of Halcion, or any benzodiazepine, as a physician would in prescribing any medication for any reason.
N J Med 1991 Dec
PMID:What about Halcion? 176 3

This study assessed consistency, duration of use, and individual difference in rebound insomnia. Eleven healthy men, 20-30 years old, with normal sleep by both subjective and polysomnographic criteria, received each of four treatments in a double-blind Latin Square design (triazolam 0.50 mg for 1, 6, and 12 nights and placebo for 12 nights), followed by two placebo discontinuation nights. Triazolam increased sleep compared with placebo without differences in effects between the first and last nights of treatment. On discontinuation following active drug, sleep efficiency was reduced compared with placebo, but duration of administration did not alter the likelihood or intensity of rebound insomnia. Those subjects (5) showing poorer sleep on discontinuation from the 12-night treatment also had poorer sleep in the 1- and 6-night treatment. Subjects with rebound insomnia had poorer baseline sleep and a greater drug effect than did subjects without.
J Clin Psychopharmacol 1991 Dec
PMID:Rebound insomnia: duration of use and individual differences. 177 Jan 56

Insomnia is an important nursing problem in hospitals. Although sleep medication is often criticized, it is one of the commonest interventions with regard to sleep problems. In this study, the prescription and provision of sleep medication in three Dutch general hospitals is investigated. Results show that on a random day 47% of all patients (n = 1076) of the surgical and medical wards were prescribed medication. Thirty-four per cent actually received sleep medication that evening or night. The prescription and provision of sleep medication was higher on medical than on surgical wards. Furthermore, hospitals were shown to differ regarding the prescription and provision of as-needed sleep medication. The study also explores whether attitudes of nurses are related to the provision of as-needed sleep medication. Although their influence does not seem to be great, it is concluded that more attention has to be paid to possible effective nursing interventions in educational programmes.
J Adv Nurs 1991 Dec
PMID:Sleep medication in Dutch hospitals. 179 Dec 52

Epidemiological studies and studies of clinical populations suggest that there are primarily two opposite patterns of seasonally recurring depressions: summer depression and winter depression. In addition, there is preliminary evidence that the two seasonal types of depression may have opposite types of vegetative symptoms. In the present study, we prospectively monitored symptoms of depression in 30 patients with recurrent summer depression and 30 sex-matched patients with recurrent winter depression and compared the symptom profiles of the two groups. Consistent with predictions based on the earlier reports, we found that winter depressives were more likely to have atypical vegetative symptoms, with increased appetite, carbohydrate craving, weight gain and hypersomnia, and that summer depressives were more likely to have endogenous vegetative symptoms, with decreased appetite and insomnia. A cluster analysis performed on the patients' symptom profiles without reference to season of occurrence of their episodes separated 78% of the summer depressives and winter depressives from each other on the basis of their symptoms (chi 2 = 19.29, P less than 0.001).
J Affect Disord 1991 Dec
PMID:Contrasts between symptoms of summer depression and winter depression. 179 Dec 62

We used a chronobiological inferential statistical method to investigate circadian rhythms of hypophyseal hormones, cortisol, melatonin and catecholamines in two females of the same family affected by fatal familial insomnia. Case 1 (confirmed at autopsy) presented an absent or progressive loss of circadian rhythms of all hormones. In case 2 there was a loss of GH circadian rhythm and a less significant rhythm for melatonin, catecholamines and gonadotropins. These results confirm the role of the thalamus in regulating hormonal circadian rhythm.
Acta Neurol (Napoli) 1991 Dec
PMID:Circadian hormonal rhythms in two new cases of fatal familial insomnia. 180 56

Three 6-8 week comparative studies have shown sertraline to be an effective, safe and well-tolerated treatment for acute depressive illness. The first, a double-blind fixed-dose study, demonstrated the efficacy of sertraline over placebo; the second, a forced upward titration, active- and placebo-controlled, double-blind study, showed that sertraline was of equal efficacy to amitriptyline. The third was a double-blind comparison of sertraline and amitriptyline in elderly depressives, with the dose being increased as necessary and as tolerated. The overall results showed sertraline to be consistently superior to placebo and equivalent in therapeutic effect to amitriptyline on a number of measures including depression, anxiety, insomnia and suicidal ideation. Efficacy was found in both moderately and severely depressed patients whose primary psychiatric diagnoses included single-episode and recurrent major depression, with and without melancholia. Sertraline was also found to be effective in patients with a high baseline anxiety score on the Hamilton Rating Scale for Depression.
Int Clin Psychopharmacol 1991 Dec
PMID:Controlling acute episodes of depression. 180 27

Depression is highly prevalent in the elderly and there are difficulties with definition and diagnosis. The signs and symptoms of depression may differ from those in younger patients since the elderly are frequently preoccupied with physical ailments and may have more agitation, insomnia and hypochondriasis. The aetiology and cause of depression and its association with psychosocial and other risk factors are discussed, with particular reference to masked depression, depressive delusional illness and 'pseudo dementia'. A range of treatments have been used in depressive patients, including psychotherapy, cognitive therapy, ECT and various drug treatments. In the elderly drugs may cause more problems than in younger patients. These can be divided into those associated with: pharmacokinetics, polypharmacy, side effects, dosage and lethality. Trials of antidepressants in the elderly are discussed and include trials with tricyclic antidepressants, monoamine oxidase inhibitors and SSRIs. Particular reference is made to a trial of fluvoxamine versus mianserin in the elderly, which demonstrated that fluvoxamine is as effective as mianserin in treating depression, and has fewer side effects.
Int Clin Psychopharmacol 1991 Dec
PMID:The elderly depressed and treatment with fluvoxamine. 180 33

In order to assess the predictive value of somatic and biological factors in antidepressant trials, non specific parameters, i.e. natural course of illness, life events, placebo effect ... have to be controlled by means of studies vs placebo. Among somatic factors, retardation seems to predict a positive response to antidepressants. The predictive value of other endogenous signs--like insomnia or weight loss--is still questioned. Few biochemical parameters appear relevant when metabolites of central monoamines, their precursors and the enzymatic processes involved are considered. The serotoninergic system is the focus of many studies. Among the neuroendocrine indices, the DST proved too poorly specific of depression. Among the physiological parameters, some characteristics of sleep EEG, like a shortening of REM latency, seem promising. Pharmacological challenges, for instance response to stimulant drugs, gave inconsistent results and should be discussed on ethical grounds. Many studies have been undertaken but presently no routine reliable biological index is available to predict a response to antidepressants.
Encephale 1991 Dec
PMID:[Somatic and biological factors predicting a response to antidepressive agents]. 180 63

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.
Jpn J Psychiatry Neurol 1991 Dec
PMID:Clinical study of insomnia, a common disorder in primary care: from a viewpoint of consultation-liaison psychiatry. 181 73


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