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PubMed1982

Relationship of psychopathology to insomnia in the elderly.

Three groups of 18 volunteers each (nine men and nine women) were selected on the basis of age and the response to a sleep status questionnaire. Younger subjects (mean age, 43.8 years) who complained of difficulty in falling asleep or in staying asleep or of awakening too early were compared for evidence of psychopathologic signs with older subjects (mean age, 68.5 years) who had sleep-related complaints and with older subjects (mean age, 71.3 years) who did not have sleep-related complaints. Older subjects with insomnia complained more frequently of having trouble staying asleep and of awakening too early (P less than 0.05), whereas the younger subjects with insomnia complained primarily about difficulty in falling asleep (P less than 0.005). On a short form of the Minnesota Multiphasic Personality Inventory (MMPI-168), the number of elevated scores indicating pathologic disturbances (T score less than 70) was higher (p less than 0.05) for the younger subjects with insomnia (2.5 high scores) than for older subjects with insomnia (0.7 high scores) or for older normal sleepers (0.4 high scores). These results imply that although in younger persons psychopathologic disorders are associated with insomnia, psychopathic disorders usually are not the cause of insomnia in the elderly.

Age Factors↗
PubMed2005

Headache characteristics in obstructive sleep apnea syndrome and insomnia.

OBJECTIVES: To determine headache characteristics in the obstructive sleep apnea syndrome (OSAS) and in insomnia. PATIENTS AND METHODS: Fifty-six OSAS patients and 50 insomnia patients were assessed in the same time period. Patients in both groups underwent an accurate interview to investigate headache occurrence and its characteristics. Results - Headache was reported by 49% of OSAS patients and 48% of insomnia patients. In OSAS patients headache had most frequently a tension-type pattern. Headache occurred on awakening in 74% of OSAS patients, more frequently than in insomnia patients (40%) (chi(2); P < 0.04). The occurrence of morning headache appears to be significantly correlated with nocturnal oxygen desaturation and OSAS severity. CONCLUSION: Headache is a common finding in both OSAS and insomnia patients. Because morning headache seems to be more specific for OSAS than insomnia, and in OSAS its occurrence seems to be associated with disease severity, we hypothesize the involvement of certain pathogenic mechanisms associated with OSAS.

Adult↗
PubMed1995

Mental comorbidity of chronic insomnia in general practice attenders using DSM-III-R.

The major aim of this study was to investigate links between chronic insomnia and mental and personality disorders using the DSM-III-R classification. Of a sample of 2512 general practice attenders, 105 with a chronic insomnia complaint over a 4-month period were evaluated for mental and personality disorders. In addition, the significance of other factors such as personality traits, social functioning and the patient's own estimation of sleep quality was studied. Sixty-six patients got a diagnosis of a current insomnia using a structured interview for DSM-III-R. Fifty percent of them had at least one additional current Axis I or II diagnosis. Affective disorders were most common as principal psychiatric diagnosis followed by substance use disorders. The general practitioners were poor in recognizing their patients' chronic insomnia complaints and the high percentage of substance abusers among them. The important role of psychopathology in chronic insomnia sufferers was indicated by the high number of patients who displayed prominent personality traits. The predominant personality pattern was characterized by a pattern of internalization of problems combined with an anxious-depressive reaction style. In summary, strong associations between chronic insomnia, mental disorders and psychopathology were confirmed by this investigation.

Adolescent↗
PubMed1985

Causes and treatment of insomnia among adolescents.

Though the preponderance of research on insomnia suggests that this malady occurs primarily among the adult population, recent research has revealed that as many as 13% of the adolescent population may suffer from chronic insomnia. Having one in 10 of the school population afflicted by this seldom considered ailment holds serious implications for learning. Adolescent insomnia can impair the victim's daily existence and affect personal life, school performance, and school attendance. Furthermore, if not dealt with initially, adolescent insomnia may lead to adult insomnia and dependence on alcohol and other drugs. The prevalence of adolescent insomnia, its cause, diagnosis, and treatment are examined.

Adolescent↗
PubMed2005

Can social factors explain sex differences in insomnia? Findings from a national survey in Taiwan.

STUDY OBJECTIVE: To examine sociological explanations for the higher level of insomnia in women, including social roles and socioeconomic status (SES). DESIGN: Cross sectional survey research SETTING: Taiwanese 2001 "social trend survey" PARTICIPANTS: A nationally representative sample of 39,588 citizens aged 15 years or older living in Taiwan. MAIN RESULTS: On average, women scored 1.25 points higher than men on the insomnia inventory (p<0.001) but after controlling for social roles, the sex discrepancy in insomnia decreased slightly. SES did not, however, explain women's higher levels of insomnia. Subscale analysis showed an association between the role of homemaker and increased night time sleep disturbance and decreased daytime sequelae of poor sleep while higher educational attainment was related only to more severe daytime sequelae. CONCLUSION: The sex discrepancy in insomnia narrowed slightly after taking social role factors into consideration but was not explained by SES. The persistent sex gap in insomnia warrants further investigation.

Adolescent↗
PubMed2006

Insomnia in Parkinson's disease: frequency and progression over time.

OBJECTIVES: To examine the development of nocturnal sleeping problems in patients with Parkinson's disease (PD) over an 8-year period and to study the clinical and demographic correlates of insomnia. METHODS: 231 patients were included in a population-based prevalence study in 1993, and re-examined in 1997 and 2001. At all study visits, we applied semi-structured interviews to obtain information on clinical and demographic data, as well as on nocturnal sleeping problems. Standardised rating scales of parkinsonism, depression and cognitive impairment were used. The relationship between insomnia and demographic and clinical variables was analysed using population-averaged logistic regression models for correlated data. 231 patients were included at baseline, 142 were available for re-evaluation in 1997 and 89 patients in 2001. RESULTS: Most nocturnal sleeping problems varied little in prevalence over time, whereas problems related to turning in bed and vivid dreaming or nightmares increased. Insomnia was present in 54-60% of the patients at each of the three study visits and varied considerably in individual patients over time. The presence of insomnia was closely related to disease duration, higher Montgomery-Asberg Depression Rating Scale scores and female sex. CONCLUSION: Insomnia is a highly frequent complaint in patients with PD. It fluctuates over time in individual patients, and its origin seems to be multifactorial. Physicians should be aware of the high prevalence of insomnia in patients with PD and should examine their patients for a possible coexisting depression.

Aged↗
PubMed2004

Intradermal acupuncture on shen-men and nei-kuan acupoints in patients with insomnia after stroke.

This is the first study that focuses on the effects of intradermal acupuncture on insomnia after stroke. We enrolled hospitalized stroke patients with insomnia and assigned them into a real intradermal acupuncture group (RA group) or a sham acupuncture group (SA group) by randomization. The RA group received intradermal acupuncture on shen-men (He-7) and nei-kuan (EH-6) for 2 days, and the SA group received sham acupuncture on the same points. The effectiveness was measured by the Morning Questionnaire (MQ), Insomnia Severity Index (ISI), and Athens Insomnia Scale (AIS). These scales were examined by an independent, blinded neurologist before, and 1 and 2 days after treatment, repeatedly. Thirty subjects (15 in the RA group and 15 in the SA group) were included in the final analysis. The RA group showed more improvement on insomnia than the SA group. Repeated measures analysis detected that there were significant between-subjects effects in the MQ, the ISI and the AIS. In conclusion, we suggest that intradermal acupuncture on shen-men and nei-kuan is a useful treatment for post stroke-onset insomnia.

Acupuncture↗
PubMed1993

Daytime alertness in patients with primary insomnia.

OBJECTIVE: In the absence of clear distinctions in alertness between patients with primary insomnia and normal subjects, the goal of this study was to identify psychometric and electrophysiological measures that would distinguish these two groups. METHOD: The daytime alertness of 20 primary insomnia patients and 20 normal subjects was investigated through their scores on a 26-item hyperarousal scale and measurement of auditory evoked potentials and alpha and nonalpha band EEG activity. Statistical analysis of the data included correlation of the hyperarousal scores and the electrophysiological measures. RESULTS: The hyperarousal scores showed clearly higher daytime alertness in the insomnia patients compared with the normal subjects. In addition, during wakefulness, the insomnia patients showed greater amplitudes of P1N1, a durable, intrinsic, late (cortical) component of the auditory evoked potential, as well as greater EEG activity across the frequency spectrum. The hyperarousal scores correlated positively with the amplitude of P1N1 at each of three sound intensities. CONCLUSIONS: To the authors' knowledge, this is the first study to offer evidence that patients with primary insomnia have objectively definable features during wakefulness that clearly distinguish them from normal subjects. The measurement of hyperarousal might be used to refine descriptions of insomnia populations in experimental studies.

Adult↗
PubMed1994

Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy.

OBJECTIVE: Because of the role of psychological factors in insomnia, the shortcomings of hypnotic medications, and patients' greater acceptance of nonpharmacological treatments for insomnia, the authors conducted a meta-analysis to examine the efficacy and durability of psychological treatments for the clinical management of chronic insomnia. METHOD: A total of 59 treatment outcome studies, involving 2,102 patients, were selected for review on the basis of the following criteria: 1) the primary target problem was sleep-onset, maintenance, or mixed insomnia, 2) the treatment was nonpharmacological, 3) the study used a group design, and 4) the outcome measures included sleep-onset latency, time awake after sleep onset, number of nighttime awakenings, or total sleep time. RESULTS: Psychological interventions, averaging 5.0 hours of therapy time, produced reliable changes in two of the four sleep measures examined. The average effect sizes (i.e., z scores) were 0.88 for sleep latency and 0.65 for time awake after sleep onset. These results indicate that patients with insomnia were better off after treatment than 81% and 74% of untreated control subjects in terms of sleep induction and sleep maintenance, respectively. Stimulus control and sleep restriction were the most effective single therapy procedures, whereas sleep hygiene education was not effective when used alone. Clinical improvements seen at treatment completion were well maintained at follow-ups averaging 6 months in duration. CONCLUSIONS: The findings indicate that nonpharmacological interventions produce reliable and durable changes in the sleep patterns of patients with chronic insomnia.

Adult↗
PubMed2006

Hypnosis for treatment of insomnia in school-age children: a retrospective chart review.

BACKGROUND: The purposes of this study are to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition. METHODS: A retrospective chart review was performed for 84 children and adolescents with insomnia, excluding those with central or obstructive sleep apnea. All patients were offered and accepted instruction in self-hypnosis for treatment of insomnia, and for other symptoms if it was felt that these were amenable to therapy with hypnosis. Seventy-five patients returned for follow-up after the first hypnosis session. Their mean age was 12 years (range, 7-17). When insomnia did not resolve after the first instruction session, patients were offered the opportunity to use hypnosis to gain insight into the cause. RESULTS: Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis. CONCLUSION: Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children.

Adolescent↗
PubMed2004

Agreement among subjective, objective, and collateral measures of insomnia in postwithdrawal recovering alcoholics.

The level of agreement among objective, subjective, and collateral assessments of insomnia was examined in 56 recovering alcoholics. Participants underwent a multimodal sleep assessment protocol consisting of sleep logs, actigraph recordings, questionnaires, and collateral reports of insomnia severity. All sleep measures confirmed moderate to severe insomnia in the study sample. Over 1 week of simultaneous sleep log and actigraph recording, the average disagreement between methods ranged from 16 min for sleep onset latency to 1 hr for wake time after sleep onset. Interrater agreement for the severity of insomnia symptoms using the Sleep Impairment Index was poor for subject-clinician, subject-collateral, and collateral-clinician rating pairs (intraclass correlation coefficients < .35). In general, recovering alcoholics' self-reported sleep reflected a greater severity of insomnia symptoms than did the actigraph and collateral measures. Given that such high levels of disagreement can occur in individual participants, researchers are advised to use a combination of sleep measures to assess insomnia in this population.

Adult↗
PubMed2005

Time estimation ability and distorted perception of sleep in insomnia.

Although it is an established finding that people with insomnia characteristically overestimate the time they have taken to get to sleep and underestimate the total amount of time they have slept, little is known about the mechanisms that underpin this phenomenon. Accordingly, this study sought to investigate whether the tendency to misperceive sleep among patients with insomnia is accounted for by (a) a general deficit in time estimation ability or (b) the context in which the time estimates are made. Twenty individuals with insomnia and 20 individuals who did not have insomnia were asked to perform two time estimation tasks; one in the laboratory during the day and one in the participant's own bedroom during the night. The two groups were compared with respect to the accuracy of their performance in estimating unfilled temporal intervals of various lengths. The results indicated that the performance of the insomnia group was no different from that of the noninsomnia group, regardless of the context in which the time estimates were made. Time overestimation correlated positively with cognitive and physiological arousal experienced during the time estimation tasks. These findings argue against the hypothesis that individuals with insomnia misperceive their sleep simply because they are poor estimators of time. Future research is required to test the hypothesis that increased cognitive arousal (worry) and physiological arousal are candidate mechanisms that underpin sleep misperception.

Adult↗
PubMed2006

Clinical management of insomnia using cognitive therapy.

Cognitive therapy has been shown effective in the treatment of several psychological and health-related disorders. It is also increasingly used in the management of insomnia. This article outlines some principles and applications of this therapeutic approach as adapted to the treatment of insomnia. Based on Beck's model, this psychotherapeutic approach seeks to modify sleep-related dysfunctional beliefs and thoughts and maladaptive cognitive processes involved in the exacerbation and perpetuation of insomnia. This is accomplished through the use of several cognitive restructuring procedures. After outlining a conceptual model of insomnia, which emphasizes the mediating role of dysfunctional cognitions in the development and maintenance of chronic insomnia, the rationale and general principles of cognitive therapy for insomnia are presented, followed by a description of the treatment procedures, clinical case illustrations, and practical implementation issues. Future directions include the need to refine cognitive interventions and to examine the unique contribution of this therapeutic component to the overall efficacy of multifaceted cognitive-behavioral therapy.

Adult↗
PubMed2001

Treatment of insomnia in hospitalized patients.

OBJECTIVE: To provide recommendations for the short-term management of insomnia in hospitalized patients and review patient assessment, nonpharmacologic treatment modalities, and selection of hypnotic medications. DATA SOURCES: Review articles and primary literature representative of current knowledge regarding the treatment of insomnia were identified by MEDLINE search (1966-January 2001). Search terms included insomnia (sleep initiation and maintenance disorders), benzodiazepines, zaleplon, zolpidem, and trazodone. DATA SYNTHESIS: Literature regarding the management of insomnia in hospitalized patients is limited; therefore, data pertinent to the treatment of ambulatory patients must be extrapolated to the inpatient setting. When evaluating insomnia in hospitalized patients, it seems reasonable to obtain a thorough history and physical examination to identify potential underlying etiologies. Treatment of these underlying etiologies should be considered. When the use of a sedative-hypnotic agent is necessary, medication and dose selection should be based on the pharmacokinetic and adverse effect profiles of each agent. Patent-specific characteristics should also be considered to provide effective treatment while minimizing adverse effects. CONCLUSIONS: Nonpharmacologic approaches to the treatment of insomnia should be considered for hospitalized patients. When sedative-hypnotic medications must be administered, the pharmacokinetic profile of intermediate-acting benzodiazepines (e.g., lorazepam, temazepam) makes them good first-line agents. Zaleplon and zolpidem are also attractive hypnotic agents; however, they are typically reserved for second-line therapy due to cost. Trazodone may be an alternative for patients unable to take benzodiazepines.

Hospitalization↗
PubMed2003

An exploration of pre-sleep cognitive activity in insomnia: imagery and verbal thought.

OVERVIEW: Patients with insomnia commonly report that unpleasant intrusive thoughts and images prevent them falling asleep. Previous research has documented the topics people with insomnia think about during the pre-sleep period, but has not yet distinguished between different types of cognitive activity. Given that research relating to the anxiety disorders suggests that different types of cognitive activity, in particular images and verbal worry, are functionally independent, the present study aimed to provide a detailed phenomenological investigation of imagery and verbal thought in insomnia. DESIGN AND METHOD: A semi-structured interview, designed to assess the content and management of pre-sleep images and verbal thought, was administered to individuals with sleep-onset insomnia (N = 34) and good sleepers (N = 38) immediately following an afternoon nap. During the nap, heart rate and sleep-onset latency were measured objectively. RESULTS: The insomnia group was more likely than the good sleeper group to report negative images than positive images. The start, direction and stopping of pre-sleep images was rated as less controllable than pre-sleep verbal thoughts. CONCLUSION: Participants disengaged more from images compared with verbal thoughts, and the insomnia patients reported feeling less calm and relaxed at the end of the salient verbal thought compared with the good sleepers.

Adolescent↗
PubMed2005

Benefit-risk assessment of zaleplon in the treatment of insomnia.

Insomnia is a heterogeneous, highly prevalent condition that is associated with a high level of psychiatric, physical, social and economic morbidity. The treatment of insomnia involves pharmacological and non-pharmacological interventions. The mainstay of pharmacological treatment of insomnia has been the benzodiazepines, the introduction of which represented a significant improvement over the barbiturates and chloral hydrate. Although benzodiazepines have been shown to be efficacious in treating insomnia, they have also been associated with a number of adverse effects including tolerance, dependence, withdrawal and abuse potential, impairment in daytime cognitive and psychomotor performance (including an increased risk of accidents and falls), adverse effects on respiration and the disruption of normal sleep architecture with reduction in both slow wave sleep and rapid eye movement. In the last decade, the treatment of insomnia has been supplemented by the introduction of a number of non-benzodiazepine hypnotics including zolpidem, zopiclone and, most recently, zaleplon. Zaleplon possesses a unique pharmacological profile, with an ultra-short half-life of about 1 hour, and selective binding to the BZ1(omega1) receptor subtypes of the GABA(A) receptor. This unique pharmacological profile predicts a number of pharmacodynamic properties that account for a unique benefit-risk profile. Consistent with these predictions, zaleplon has been shown in a number of studies to be efficacious in promoting sleep initiation, but less so in promoting sleep maintenance. The adverse effects associated with zaleplon have been shown to be more rapidly resolved and/or lesser in magnitude than those associated with benzodiazepines (including triazolam) and the longer acting non-benzodiazepine hypnotics (zolpidem and zopiclone). This improved risk profile includes: the effects of zaleplon on psychomotor and cognitive performance; tolerance, withdrawal and rebound; respiratory depression; sleep architecture; and other treatment-emergent adverse effects. The unique benefit-risk profile of this agent may be particularly suitable for certain patients with insomnia and provides yet another option in the management of this impairing condition.

Acetamides↗
PubMed2000

Zolpidem: an update of its pharmacology, therapeutic efficacy and tolerability in the treatment of insomnia.

UNLABELLED: Zolpidem is an imidazopyridine agent that is indicated for the short term (< or = 4 weeks) treatment of insomnia (recommended dosage 10 mg/day in adults and 5 or 10 mg/day in the elderly or patients with hepatic impairment). Data have shown that the hypnotic efficacy of zolpidem is generally comparable to that of the benzodiazepines flunitrazepam, flurazepam, nitrazepam, temazepam and triazolam as well as nonbenzodiazepine hypnotic agents such as zopiclone and trazodone in the treatment of elderly and adult patients with insomnia. The comparative efficacy of a recently available nonbenzodiazepine hypnotic zaleplon and zolpidem has yet to be established. There was no evidence of tolerance developing to the hypnotic effects of zolpidem in a number of studies of up to 6 months' duration. However, tolerance has been described in a few patients taking the drug at high dosages for periods of up to several years. Zolpidem is well tolerated in patients with insomnia and the most common adverse events are generally nausea, dizziness and drowsiness. Although zolpidem produced some psychomotor and memory impairment over the first few hours after administration, it had few next-day effects (including effects on daytime well-being and morning coordination). In this respect, it was comparable or superior to flunitrazepam and flurazepam and comparable to other benzodiazepines in patients with insomnia. Zolpidem appears to have a low potential for abuse. CONCLUSIONS: Zolpidem is effective and well tolerated in patients with insomnia, including the elderly. Studies have shown that zolpidem generally has similar efficacy to other hypnotics including benzodiazepines and zopiclone. Zolpidem appears to have minimal next-day effects on cognition and psychomotor performance when administered at bedtime. In addition, there is little evidence of tolerance to the hypnotic effects of zolpidem, or rebound insomnia or withdrawal symptoms after discontinuation of the drug when it is given as recommended (10 mg/day for < 1 month) or over longer periods.

Animals↗
PubMed1996

Impact of insomnia on health-related quality of life.

With the increased interest in sleep disorders, the definition of insomnia has been refined and extended so that the aetiology of these disorders is considered in addition to their operational characteristics. The International Classification of Sleep Disorders is the most advanced nosology available. It encompasses, although it does not define, the concept that sleep may be disturbed either through disruption of the mechanisms that control sleep and wakefulness, or by factors external to those mechanisms. Formal measures of quality of life invariably include assessment of sleep or the consequences of disturbed sleep, such as fatigue. Generally, when these assessments are used, sleep has been disturbed by external factors, rather than by disruption of the mechanisms that control sleep. Occasional insomnia does not necessarily need medical treatment, but it may nevertheless cost national economies significant sums through absenteeism and sleep-related accidents. Profound, longer term insomnias may arise either because of failure of the mechanisms central to sleep (i.e. as sleep disorders) or as a consequence of medical disorders (i.e. as disordered sleep). These insomnias should be treated, because the former may lead to the development of costlier and more intransigent psychiatric disorders, whereas the latter should be treated for compassionate reasons, within the framework of palliative medicine. Insomnia as a sleep disorder can require either psychological or pharmacological treatment, depending on the diagnosis, whereas insomnia as a symptom may require treatment with newer hypnotics, e.g. zopiclone.

Age Factors↗