Sleep initiation and maintenance disorders: Difference between revisions
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==Treatment== | ==Treatment== | ||
Treatment options for [[geriatrics|geriatric]] patients have been reviewed.<ref name="pmid19484833">{{cite journal| author=Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH et al.| title=Evidence-based recommendations for the assessment and management of sleep disorders in older persons. | journal=J Am Geriatr Soc | year= 2009 | volume= 57 | issue= 5 | pages= 761-89 | pmid=19484833 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19484833 | pmc=PMC2748127 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
===Non-drug treatment=== | ===Non-drug treatment=== | ||
No-drug treatments such as light therapy, exercise, and sleep-hygiene modification have been reviewed.<ref name="pmid19256583">{{cite journal| author=Shub D, Darvishi R, Kunik ME| title=Non-pharmacologic treatment of insomnia in persons with dementia. | journal=Geriatrics | year= 2009 | volume= 64 | issue= 2 | pages= 22-6 | pmid=19256583 | No-drug treatments such as light therapy, exercise, and sleep-hygiene modification have been reviewed.<ref name="pmid19256583">{{cite journal| author=Shub D, Darvishi R, Kunik ME| title=Non-pharmacologic treatment of insomnia in persons with dementia. | journal=Geriatrics | year= 2009 | volume= 64 | issue= 2 | pages= 22-6 | pmid=19256583 | ||
Revision as of 21:36, 8 December 2009
In medicine, sleep initiation and maintenance disorders, including insomnia, are "disorders characterized by impairment of the ability to initiate or maintain sleep. This may occur as a primary disorder or in association with another medical or psychiatric condition."[1][2]
Treatment
Treatment options for geriatric patients have been reviewed.[3]
Non-drug treatment
No-drug treatments such as light therapy, exercise, and sleep-hygiene modification have been reviewed.[4]
Indirect evidence suggests a warm bath may help.[5]
Exercise, perhaps by raising body temperature, may help.[5]
Medications
GABA agonists
These medications are agonists of the GABA-A receptors.
BZ1 selective agonists
In treating persistent insomnia in adults, 6 weeks of zolpidem 10 mg nightly along with weekly sessions of cognitive behavioral therapy followed by 6 months of monthly sessions and no medications yielded the most remission of insomnia in a randomized controlled trial.[6]
In geriatrics, the benefits of zolpidem for insomnia to not clearly exceed the drug toxicity.[7][8]
Melatonin agonists
Ramelteon is one available agonist.
Tasimelteon can help transient insomnia due to shift changes related to employment..[9]
References
- ↑ Anonymous (2024), Sleep initiation and maintenance disorders (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Kupfer DJ, Reynolds CF (1997). "Management of insomnia.". N Engl J Med 336 (5): 341-6. PMID 9011788.
- ↑ Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH et al. (2009). "Evidence-based recommendations for the assessment and management of sleep disorders in older persons.". J Am Geriatr Soc 57 (5): 761-89. PMID 19484833. PMC PMC2748127.
- ↑ Shub D, Darvishi R, Kunik ME (2009). "Non-pharmacologic treatment of insomnia in persons with dementia.". Geriatrics 64 (2): 22-6. PMID 19256583.
- ↑ 5.0 5.1 Horne JA, Moore VJ (1985). "Sleep EEG effects of exercise with and without additional body cooling.". Electroencephalogr Clin Neurophysiol 60 (1): 33-8. PMID 2578352.
- ↑ Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al. (2009). "Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial.". JAMA 301 (19): 2005-15. DOI:10.1001/jama.2009.682. PMID 19454639. Research Blogging.
- ↑ Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE (2005). "Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits.". BMJ 331 (7526): 1169. DOI:10.1136/bmj.38623.768588.47. PMID 16284208. PMC PMC1285093. Research Blogging. Review in: ACP J Club. 2006 Jul-Aug;145(1):14 Review in: Evid Based Med. 2006 Aug;11(4):110 Review in: Evid Based Nurs. 2006 Jul;9(3):87
- ↑ Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF, Kupfer DJ (1997 Dec 24-31). "Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy.". JAMA 278 (24): 2170-7. PMID 9417012.
- ↑ Rajaratnam SM, Polymeropoulos MH, Fisher DM, Roth T, Scott C, Birznieks G et al. (2009). "Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials.". Lancet 373 (9662): 482-91. DOI:10.1016/S0140-6736(08)61812-7. PMID 19054552. Research Blogging.