Sleep initiation and maintenance disorders: Difference between revisions
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imported>Robert Badgett |
imported>Robert Badgett (→Treatment: Started Non-drug treatment) |
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==Treatment== | ==Treatment== | ||
===GABA agonists=== | ===Non-drug treatment=== | ||
Indirect evidence suggests a warm bath may help.<ref name="pmid2578352">{{cite journal| author=Horne JA, Moore VJ| title=Sleep EEG effects of exercise with and without additional body cooling. | journal=Electroencephalogr Clin Neurophysiol | year= 1985 | volume= 60 | issue= 1 | pages= 33-8 | pmid=2578352 | |||
| 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=2578352 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
Exercise, perhaps by raising body temperature, may help.<ref name="pmid2578352">{{cite journal| author=Horne JA, Moore VJ| title=Sleep EEG effects of exercise with and without additional body cooling. | journal=Electroencephalogr Clin Neurophysiol | year= 1985 | volume= 60 | issue= 1 | pages= 33-8 | pmid=2578352 | |||
| 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=2578352 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
===Medications=== | |||
====GABA agonists==== | |||
These medications are agonists of the [[GABA-A receptor]]s. | These medications are agonists of the [[GABA-A receptor]]s. | ||
====BZ<sub>1</sub> selective agonists ==== | =====BZ<sub>1</sub> 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]].<ref name="pmid19454639">{{cite journal| author=Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al.| title=Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 19 | pages= 2005-15 | pmid=19454639 | 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]].<ref name="pmid19454639">{{cite journal| author=Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al.| title=Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 19 | pages= 2005-15 | pmid=19454639 | ||
| 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=19454639 | doi=10.1001/jama.2009.682 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | 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=19454639 | doi=10.1001/jama.2009.682 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
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| 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=9417012 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | | 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=9417012 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | ||
===Melatonin agonists=== | ====Melatonin agonists==== | ||
Ramelteon is one available agonist. | Ramelteon is one available agonist. | ||
Revision as of 20:24, 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
Non-drug treatment
Indirect evidence suggests a warm bath may help.[3]
Exercise, perhaps by raising body temperature, may help.[3]
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.[4]
In geriatrics, the benefits of zolpidem for insomnia to not clearly exceed the drug toxicity.[5][6]
Melatonin agonists
Ramelteon is one available agonist.
Tasimelteon can help transient insomnia due to shift changes related to employment..[7]
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.
- ↑ 3.0 3.1 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.