Does modafinil safely and effectively treat shift-work sleep disorder?
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Adolescent↗
Biomedical subjects
David N Neubauer
Publications and source records attributed to David N Neubauer.
Insomnia.
Insomnia is a common problem that is chronic for many individuals. Multiple processes, including psychologic, physiologic, and environmental factors, can influence insomnia, and their effects can shift over time. Accordingly, the evaluation of patients who have insomnia should be broad in scope. Insomnia represents a clinical problem with significant daytime consequences, associations, and comorbidities. Several nosologies categorize insomnia into specific diagnoses. Useful minimal criteria for an insomnia disorder include persistent nighttime symptoms with daytime distress or impairment. Specific treatments, addressing particular underlying causes,and general pharmacologic and nonpharmacologic strategies may play valuable roles in the management of insomnia patients. The effective treatment of insomnia can have further benefits in decreasing the likelihood of future psychiatric symptoms.
Chronic Disease↗
Indiplon: the development of a new hypnotic.
Indiplon is a short-acting hypnotic that is currently being developed as a treatment for insomnia by Neurocrine Biosciences and Pfizer, and is expected to be marketed in mid-2006. It is a high-affinity allosteric potentiator of GABAA responses that demonstrates preference for alpha1 subunit-containing GABAA receptors. Indiplon will be an addition to the general category of newer-generation hypnotics that now includes zaleplon, zolpidem, zopiclone and eszopiclone. Clinical trials were carried out with an immediate-release capsule and a modified-release tablet and demonstrate very positive efficacy and safety profiles. The major challenge will be developing a commercial success in the crowded insomnia treatment marketplace.
Animals↗
Chronic insomnia: current issues.
Insomnia is a common problem in the general population and has a higher prevalence in persons with medical and psychiatric disorders. Although insomnia is most often transient, occurring as a result of identifiable stressors, a substantial portion of insomnia cases involve persistent sleep difficulty. This chronic form of insomnia may be associated with a wide range of adverse consequences. An understanding of the characteristics and causes of this disorder and the available therapeutic strategies will promote more effective identification and treatment of patients with chronic insomnia.
Chronic Disease↗
Pharmacologic approaches for the treatment of chronic insomnia.
Insomnia is a common problem that for many sufferers persists chronically and may result from a wide range of causes. Specific treatments address particular underlying medical disorders. General therapeutic approaches, including pharmacologic and behavioral strategies, may have broad applicability to insomnia patients. Many different medications and substances have been used in an attempt to improve sleep. This article reviews the advantages and disadvantages of medications and other substances employed to promote improved sleep. Special emphasis is given to the use of the newer-generation benzodiazepine receptor agonist hypnotics.
Alcohol Drinking↗
Cognitive behavior therapy for chronic insomnia.
Approximately 20% of patients presenting in general medical settings have severe and persistent insomnia. Studies consistently find that trouble initiating and maintaining sleep are independent risk factors for medical and psychiatric morbidity, but insomnia is often underdetected and undertreated in primary care settings. Cognitive-behavioral treatment approaches for chronic insomnia and related sleep disorders have been shown to be effective in various patient populations. This article reviews the most common cognitive-behavioral interventions for insomnia, and discusses their efficacy and durability. Possible adaptations for the integration of these approaches into primary care settings and a description of the emerging field of behavioral sleep medicine as a resource for health care providers treating patients with chronic insomnia are also presented.
Chronic Disease↗
The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep.
BACKGROUND: Daytime sleepiness is common in patients with sleep-disordered breathing. Although respiratory events during sleep are associated with the occurrence of daytime sleepiness, the differential impact of these events during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep on daytime sleepiness has not been well characterized. STUDY OBJECTIVES: To determine the effect of respiratory events during REM sleep and NREM sleep on daytime sleepiness, as assessed by the multiple sleep latency test (MSLT). DESIGN: Cross-sectional study. SETTING: University-based sleep disorders laboratory. PARTICIPANTS: Patients referred for polysomnography and daytime MSLT (n=1,821). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The study sample was initially divided into quartiles based on the level of the apnea-hypopnea index (AHI) during NREM sleep. Within the first NREM-AHI quartile (NREM-AHI < 8.3 events/hr), the association between REM-related respiratory events and daytime sleepiness was examined using the method of Kaplan-Meier analysis and Cox proportional hazards regression. After adjusting for age, gender, body mass index, and the duration of NREM and REM sleep, REM-AHI was not associated with daytime sleepiness (Relative Risk: 1.01; 95%CI: 0.94-1.10). Similarly, no significant association was observed between REM-AHI and the MSLT in patients within the second through fourth NREM-AHI quartiles. In contrast, increasing severity of disordered breathing during NREM sleep was associated with daytime sleepiness. For a 10-point increase in NREM-AHI, the adjusted relative risks for daytime sleepiness in the second through fourth NREM-AHI quartile were 1.21 (95%CI: 1.01-1.46), 1.20 (95%CI: 1.05-1.37), and 1.10 (95%CI: 1.04-1.16), respectively. CONCLUSION: Sleep-disordered breathing during NREM sleep, but not REM sleep, is associated with increased risk of daytime sleepiness.
Adult↗