1
|
Khoshnevis S, Smolensky MH, Haghayegh S, Castriotta RJ, Hermida RC, Diller KR. Recommended timing of medications that impact sleep and wakefulness: A review of the American Prescribers' Digital Reference. Sleep Med Rev 2023; 67:101714. [PMID: 36509029 DOI: 10.1016/j.smrv.2022.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
An appreciable number of medicines have a recommended unique single time-of-day or asymmetrical or unequal-interval multiple-daily administration schedule. Many prescription and over-the-counter (OTC) products, according to administration time, can exert positive or negative impact on nighttime sleep and daytime wakefulness. Intuitively, medicines used to manage nighttime sleep and daytime wake disorders should be taken, respectively, at night before bedtime and morning after arising. However, some utilized for other medical conditions, if improperly timed, may compromise nocturnal sleep and diurnal attentiveness. We conducted a comprehensive review of the American Prescribers' Digital Reference, internet version of the Physician's Desk Reference, for the recommended scheduling of medications and OTC remedies that can impact sleep and wakefulness. The search revealed several hundred therapies of various classes -- α2-receptor agonists, antidepressants, barbiturates, central nervous system stimulants, benzodiazepines, dopamine agonists, dopamine norepinephrine reuptake inhibitors, selective norepinephrine reuptake inhibitors, eugeroics, γ-aminobutyric acid modulators, H1 and H3-receptor antagonists, melatonin analogues, OTC melatonin-containing products, non-benzodiazepine benzodiazepine-receptor agonists, dual orexin-receptor antagonists, and serotonin modulators -- that have a recommended unique dosing schedule. The tables and text of this article are intended to guide the proper scheduling of these medicines to optimize desired and/or minimize undesired effects.
Collapse
Affiliation(s)
- Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA.
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, Division of Cardiology, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
2
|
Pérez-Valdecantos D, Caballero-García A, Bello HJ, Noriega-González D, Palomar-Ciria N, Roche A, Roche E, Córdova-Martínez A. Professional Quality of Life of Healthcare Workers in Hospital Emergency Departments. Behav Sci (Basel) 2022; 12:188. [PMID: 35735398 PMCID: PMC9220185 DOI: 10.3390/bs12060188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
In previous publications, we have reported that professionals in emergency departments undergo high levels of stress according to the amounts of salivary biomarkers (α-amylase and cortisol). The stress seems to be counteracted by increased levels of dehydroepiandrosterone. This hypothesis is confirmed in the answers to different tests indicating no working stress, no anxiety, optimal self-efficacy, and good sleeping quality. Altogether, these previous results suggest an optimal adaptation of these workers to the demanding situations that occur in emergency departments. To complete this research, we decided to evaluate the quality of life of health professionals working in the emergency departments of two Spanish hospitals. A descriptive cross-sectional study was carried out during the pre-pandemic months of July and August 2019. We determined the professional quality of life through the QPL-35 questionnaire in 97 participants, including nurses (n = 59) and medical doctors (n = 38). Answers to the test indicate that the studied participants working in emergency departments have a good perception of professional quality of life. This is reflected in the three dimensions of the questionnaire: managerial support, workloads, and intrinsic motivation. Based on the results of all answered tests, emergency healthcare staff seem to have adequate professional management, with levels of stress, sleep, and quality of life in line with a controlled lifestyle. Altogether, this would allow a correct adaptation to the demanding situations experienced in emergency departments. The relevance to clinical practice is that the COVID-19 pandemic has disrupted this controlled professional management.
Collapse
Affiliation(s)
- Daniel Pérez-Valdecantos
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR “Physical Exercise and Aging”, University of Valladolid, Campus “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.R.)
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR “Physical Exercise and Aging”, University of Valladolid, Campus “Los Pajaritos”, 42004 Soria, Spain;
| | - Hugo J. Bello
- Department of Mathematics, School of Forestry, Agronomy and Bioenergy Engineering, GIR “Physical Exercise and Aging”, University of Valladolid, Campus “Los Pajaritos”, 42004 Soria, Spain;
| | - David Noriega-González
- Department of Surgery, Ophthalmology, Otolaryngology and Physiotherapy, Faculty of Medicine, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | | | - Alba Roche
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR “Physical Exercise and Aging”, University of Valladolid, Campus “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.R.)
| | - Enrique Roche
- Instituto de Bioingeniería y Departamento de Biología Aplicada-Nutrición, Universidad Miguel-Hernández, 03202 Elche, Spain;
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Alfredo Córdova-Martínez
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR “Physical Exercise and Aging”, University of Valladolid, Campus “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.R.)
| |
Collapse
|
3
|
Advancement in the contemporary clinical diagnosis and treatment strategies of insomnia disorder. Sleep Med 2022; 91:124-140. [DOI: 10.1016/j.sleep.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/27/2022] [Accepted: 02/19/2022] [Indexed: 11/22/2022]
|
4
|
Pérez-Valdecantos D, Caballero-García A, del Castillo-Sanz T, Bello HJ, Roche E, Roche A, Córdova A. Variations in Salivary Stress Biomarkers and Their Relationship with Anxiety, Self-Efficacy and Sleeping Quality in Emergency Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9277. [PMID: 34501877 PMCID: PMC8431039 DOI: 10.3390/ijerph18179277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022]
Abstract
Hospital healthcare workers of emergency departments (EDs) face a variety of occupational stressors on a daily basis. We have recently published that emergency professionals display increased salivary levels of α-amylase and dehydroepiandrosterone during the working day. The pattern of these markers may suggest a counteracting mechanism of dehydroepiandrosterone against the stress reflected by amylase increases. In order to verify this hypothesis, we have analysed different psychological aspects in the same group of healthcare professionals through different tests related to behaviours resulting from stress. These include the state-trait anxiety inventory, the self-efficacy test and the sleeping quality questionnaire. The tests were provided at the beginning of the working day and collected at the end. STAI scores (trait and state) were indicative of no anxiety. Self-efficacy scores were considered optimal, as well as those from the sleeping quality questionnaire. This is supported by the modest correlation between STAI scores and salivary levels of α-amylase and dehydroepiandrosterone. In conclusion, the emergency professionals of the studied hospitals seem to have adequate work management. Altogether it means that the stress generated during work performance is controlled, allowing a correct adaptation to the demanding situations undergone in emergency departments.
Collapse
Affiliation(s)
- Daniel Pérez-Valdecantos
- Departamento de Bioquímica, Campus Universitario “Los Pajaritos”, Biología Molecular y Fisiología, Facultad de Ciencias de la Salud, GIR de “Ejercicio Físico y Envejecimiento”, Universidad de Valladolid, 42004 Soria, Spain;
| | - Alberto Caballero-García
- Departamento de Anatomía y Radiología, Facultad de Ciencias de la Salud, GIR de “Ejercicio Físico y Envejecimiento”, Campus Universitario “Los Pajaritos”, Universidad Valladolid, 42004 Soria, Spain;
| | - Teodosia del Castillo-Sanz
- Gerencia de Emergencias Sanitarias de Castilla y León, UME Soria, Hospital Virgen del Mirón, 42005 Soria, Spain;
| | - Hugo J. Bello
- Departamento de Matemáticas, Escuela de Ingeniería de la Industria Forestal, Agronómica y de la Bioenergía, GIR de “Ejercicio Físico y Envejecimiento”, Campus Universitario “Los Pajaritos”, Universidad de Valladolid, 42004 Soria, Spain;
| | - Enrique Roche
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain; (E.R.); (A.R.)
- Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), 03010 Alicante, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alba Roche
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain; (E.R.); (A.R.)
| | - Alfredo Córdova
- Departamento de Bioquímica, Campus Universitario “Los Pajaritos”, Biología Molecular y Fisiología, Facultad de Ciencias de la Salud, GIR de “Ejercicio Físico y Envejecimiento”, Universidad de Valladolid, 42004 Soria, Spain;
| |
Collapse
|
5
|
Tucker RP, Cramer RJ, Langhinrichsen-Rohling J, Rodriguez-Cue R, Rasmussen S, Oakey-Frost N, Franks CM, Cunningham CCA. Insomnia and suicide risk: a multi-study replication and extension among military and high-risk college student samples. Sleep Med 2021; 85:94-104. [PMID: 34298228 DOI: 10.1016/j.sleep.2021.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/BACKGROUND A clear link between insomnia concerns and suicidal ideation has been shown in a variety of populations. These investigations failed to use a theoretical lens in understanding this relationship. Research within the veteran population has demonstrated that feelings of thwarted belongingness (TB), but not perceived burdensomeness (PB), mediate the insomnia and suicidal ideation relationship. Using two high risk samples, the present investigation replicated and extended this line of inquiry to include interpersonal hopelessness about TB, a key component of the Interpersonal Psychological Theory of Suicide. METHODS/RESULTS/CONCLUSIONS Using medical record review and survey data, study 1 replicated the finding that TB is a stronger explanatory factor of the insomnia to suicidal ideation/suicide risk relationship in a sample of N = 200 treatment-seeking active-duty personnel. Study 2 found that insomnia symptoms had an indirect effect on suicidal ideation through TB and PB but not interpersonal hopelessness in a sample of N = 151 college students with a history of suicidal thoughts and/or behaviors. TB was the only mediator of the insomnia-suicide attempt likelihood link and insomnia to clinically significant suicide risk screening status. Limitations include cross-sectional design of both studies and the lack of formal diagnoses of insomnia. Implications and future research directions are discussed.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Capt Michael Franks
- US Public Health Service, Naval Medical Center Psychology Training Programs, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA, 23708, USA
| | - Capt Craig A Cunningham
- Nursing Research and Consultation Services, Navy Medicine Readiness and Training Command Portsmouth, Portsmouth, VA, 23708, USA
| |
Collapse
|
6
|
Flaxer JM, Heyer A, Francois D. Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly. Am J Geriatr Psychiatry 2021; 29:585-603. [PMID: 33218915 DOI: 10.1016/j.jagp.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Insomnia in the elderly is a prevalent condition that poses treatment challenges to practitioners across medical fields. There are many behavioral and other nonpharmacological therapies, 18 Food and Drug Administration-approved pharmacotherapies, and numerous off-label, over the counter and alternative treatments. Most reviews on this subject focus either on pharmacological treatments or behavioral treatments. The authors provide a combined review of available pharmacological and nonpharmacological treatments. The authors narratively reviewed each treatment from our literature search, tabled results with the highest level of available evidence on 5 major sleep outcomes and evaluated these results for clinical significance. The authors also evaluated the safety of pharmacotherapies within the context of the 2019 Beers Criteria for Potentially Inappropriate Medications in the Elderly. The authors found the most rigorous evidence supporting Cognitive Behavioral Therapy for Insomnia as a first-line treatment option, with longer lasting therapeutic effects than treatment with pharmacologic agents alone. The authors also found evidence of similar outcomes from other behavioral interventions, such as Brief Behavioral Therapy for Insomnia and relaxation training. The authors found 4 studies, 2 on relaxation training, 1 on sleep restriction, and 1 on stimulus control limited to the elderly with clinically significant results. The authors found no pharmacological studies limited to the elderly on treatments not contraindicated by Beers criteria with clinically significant results. The authors discussed the challenges of determining clinical significance in sleep studies, the lack of studies restricted to the elderly, and the role of placebo effect.
Collapse
Affiliation(s)
- Joseph M Flaxer
- Zucker School of Medicine at Hostra/Northwell (JMF), Glen Oaks, NY
| | - Arianna Heyer
- Sidney Kimmel Medical College (AH), Thomas Jefferson University, Philadelphia, PA
| | - Dimitry Francois
- Weill Cornell Medicine (DF), New York Presbyterian/Westchester, White Plains, NY.
| |
Collapse
|
7
|
Dosman JA, Karunanayake CP, Fenton M, Ramsden VR, Skomro R, Kirychuk S, Rennie DC, Seeseequasis J, Bird C, McMullin K, Russell BP, Koehncke N, Smith-Windsor T, King M, Abonyi S, Pahwa P. Prevalence of Insomnia in Two Saskatchewan First Nation Communities. Clocks Sleep 2021; 3:98-114. [PMID: 33525338 PMCID: PMC7931024 DOI: 10.3390/clockssleep3010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
Insomnia is a common problem in Canada and has been associated with increased use of health care services and economic burden. This paper examines the prevalence and risk factors for insomnia in two Cree First Nation communities in Saskatchewan, Canada. Five hundred and eighty-eight adults participated in a baseline survey conducted as part of the First Nations Sleep Health Collaborative Project. The prevalence of insomnia was 19.2% among participants with an Insomnia Severity Index score of ≥15. Following the definition of nighttime insomnia symptoms, however, the prevalence of insomnia was much higher, at 32.6%. Multivariate logistic regression modeling revealed that age, physical health, depression diagnosis, chronic pain, prescription medication use for any health condition, and waking up during the night due to terrifying dreams, nightmares, or flashbacks related to traumatic events were risk factors for insomnia among participants from two Saskatchewan Cree First Nation communities.
Collapse
Affiliation(s)
- James A Dosman
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
- Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada; (M.F.); (R.S.)
| | - Chandima P Karunanayake
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
| | - Mark Fenton
- Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada; (M.F.); (R.S.)
| | - Vivian R Ramsden
- West Winds Primary Health Centre, Department of Academic Family Medicine, University of Saskatchewan, 3311 Fairlight Drive, Saskatoon, SK S7M 3Y5, Canada;
| | - Robert Skomro
- Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada; (M.F.); (R.S.)
| | - Shelley Kirychuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
- Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada; (M.F.); (R.S.)
| | - Donna C Rennie
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada;
| | | | - Clifford Bird
- Community B, PO Box 250, Montreal Lake, SK S0J 1Y0, Canada;
| | - Kathleen McMullin
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
| | - Brooke P Russell
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
| | - Niels Koehncke
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
- Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada; (M.F.); (R.S.)
| | | | - Malcolm King
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (M.K.); (S.A.)
| | - Sylvia Abonyi
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (M.K.); (S.A.)
| | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (S.K.); (K.M.); (B.PR.); (N.K.); (P.P.)
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (M.K.); (S.A.)
| |
Collapse
|
8
|
Evaluation and management of insomnia in women with breast cancer. Breast Cancer Res Treat 2020; 181:269-277. [PMID: 32314110 DOI: 10.1007/s10549-020-05635-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Insomnia is a common issue among patients with breast cancer with a potentially devastating impact on quality of life. It can be caused or exacerbated by multiple disease and treatment-related factors. Despite the prevalence and impact of insomnia, it is rarely addressed systematically in the oncology clinic. We conducted a comprehensive review of insomnia to guide clinical care of patient's with breast cancer and insomnia. METHODS This manuscript reviews the prevalence, etiology, emerging science and both non-pharmacologic and pharmacologic options for treatment of insomnia among patients with breast cancer. RESULTS Multiple factors contribute to insomnia among patients with breast cancer including endocrine therapy and hotflashes, pain and discomfort from local therapy, and fear of recurrence. If we do identify insomnia, there are treatment options and strategies available to help patients. In particular, there is now a considerable body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBT-I), yoga, and mind-body programs. It is also important for oncology providers to be educated regarding available pharmacologic therapies and emerging data for cannabis-based therapy. CONCLUSION This manuscript provides an up-to-date and comprehensive review of the prevalence, etiology, and treatment approaches available for insomnia for clinicians treating patients with breast cancer. We also address strategies and goals for cancer care delivery and future research.
Collapse
|
9
|
Latif ZEH, Šaltytė Benth J, Solli KK, Opheim A, Kunoe N, Krajci P, Sharma-Haase K, Tanum L. Anxiety, Depression, and Insomnia Among Adults With Opioid Dependence Treated With Extended-Release Naltrexone vs Buprenorphine-Naloxone: A Randomized Clinical Trial and Follow-up Study. JAMA Psychiatry 2019; 76:127-134. [PMID: 30566177 PMCID: PMC6439739 DOI: 10.1001/jamapsychiatry.2018.3537] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Extended-release naltrexone (XR-NTX) is a promising alternative treatment of opioid addiction but has never been compared with opioid agonist treatment for effects on symptoms of anxiety, depression, and insomnia. OBJECTIVE To investigate whether XR-NTX unmasks or reinforces current comorbid symptoms of anxiety, depression, or insomnia compared with opioid agonist treatment. DESIGN, SETTING, AND PARTICIPANTS In this prospective randomized clinical trial, 159 men and women aged 18 to 60 years with opioid dependence were randomized to 12 weeks of treatment with either XR-NTX or combined buprenorphine-naloxone (BP-NLX) followed by a 9-month, open-label treatment study with participant choice of 1 of these 2 drugs. The study was conducted at outpatient addiction clinics in 5 urban hospitals in Norway, with the clinical trial performed from November 1, 2012, to October 23, 2015, and the follow-up study completed on July 23, 2016. All analyses were conducted using an intention-to-treat sample. INTERVENTIONS Extended-release naltrexone hydrochloride, 380 mg, administered as an injection every 4 weeks or flexible doses (4-24 mg; target dosage 16 mg/d) of daily oral combined BP-NLX. MAIN OUTCOMES AND MEASURES Every 4 weeks, symptoms of anxiety and depression were assessed using the 25-item Hopkins Symptom Checklist, and symptoms of insomnia were assessed using the Insomnia Severity Index. RESULTS In total, 159 participants were randomized to treatment with either XR-NTX (n = 80) or BP-NLX (n = 79), and 105 participants (66.0%) completed the trial. The treatment groups showed similar distributions of age (mean [SD], 36.4 [8.8] vs 35.7 [8.5] years), sex (61 [76.3%] women and 54 [68.4%] men), and duration of heroin use (mean [SD], 6.9 [5.8] vs 6.7 [5.2] years). For the clinical trial period, no overall differences were detected between treatment groups for anxiety (effect size [95% CI], -0.14 [-0.47 to 0.19]) or depression (effect size [95% CI], -0.12 [-0.45 to 0.21]) scores, but the insomnia score was significantly lower in the XR-NTX group (effect size [95% CI], -0.32 [-0.61 to -0.02]; P = .008). In the follow-up period, no overall differences could be detected in the effect size [95% CI] of scores for anxiety (0.04 [-0.34 to 0.42]), depression (-0.04 [-0.42 to 0.33]), or insomnia (0.04 [-0.33 to 0.42]) between participants continuing with and participants switching to XR-NTX. No significant sex differences between the 2 treatment groups were detected. CONCLUSIONS AND RELEVANCE Comorbid symptoms of anxiety, depression, or insomnia in abstinence-motivated persons with opioid dependence should not prevent switching from treatment with an opioid agonist to treatment with XR-NTX. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01717963.
Collapse
Affiliation(s)
- Zill-e-Huma Latif
- Department of Research and Development in Mental
Health, Akershus University Hospital, Lørenskog, Norway,Norwegian Center for Addiction Research, University of
Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus,
University of Oslo, Oslo, Norway,Health Services Research Unit, Akershus University
Hospital, Lørenskog, Norway
| | - Kristin Klemmetsby Solli
- Department of Research and Development in Mental
Health, Akershus University Hospital, Lørenskog, Norway,Norwegian Center for Addiction Research, University of
Oslo, Oslo, Norway
| | - Arild Opheim
- Department of Addiction Medicine, Haukeland University
Hospital, Bergen, Norway,Faculty of Medicine and Odonthology, The University of
Bergen, Bergen, Norway
| | - Nikolaj Kunoe
- Department of Research and Development in Mental
Health, Akershus University Hospital, Lørenskog, Norway
| | - Peter Krajci
- Department of Addiction Medicine, Oslo University
Hospital, Oslo, Norway,Vestfold Hospital Trust, Toensberg, Norway
| | - Kamni Sharma-Haase
- Norwegian Center for Addiction Research, University of
Oslo, Oslo, Norway
| | - Lars Tanum
- Department of Research and Development in Mental
Health, Akershus University Hospital, Lørenskog, Norway,Norwegian Center for Addiction Research, University of
Oslo, Oslo, Norway
| |
Collapse
|
10
|
Lee KY, Chen PP, Tse LA. Insomnia and Associated Factors among Anaesthetists in Hong Kong. Anaesth Intensive Care 2019; 41:750-8. [DOI: 10.1177/0310057x1304100610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- K. Y. Lee
- Department of Anaesthesia and Operating Services, North District Hospital, Hong Kong
| | - P. P. Chen
- Department of Anaesthesia and Operating Services, North District Hospital, Hong Kong
| | - L. A. Tse
- Department of Anaesthesia and Operating Services, North District Hospital, Hong Kong
- Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
| |
Collapse
|
11
|
Ho ECM, Siu AMH. Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence. Occup Ther Int 2018; 2018:8637498. [PMID: 30150906 PMCID: PMC6087566 DOI: 10.1155/2018/8637498] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/04/2018] [Accepted: 06/25/2018] [Indexed: 11/18/2022] Open
Abstract
The effectiveness of sleep intervention developed by occupational therapists was reviewed, and a conceptual framework for organizing the developing practice of sleep management in occupational therapy was proposed in this paper. Evidence-based articles on sleep management practice in occupational therapy from 2007 to 2017 were retrieved. Four types of effective sleep management intervention were identified from the literature, including the use of assistive devices/equipment, activities, cognitive behavioral therapy for insomnia, and lifestyle intervention, and the use of assistive device was the most popular intervention. Applying the Person-Environment-Occupation Performance (PEOP) framework, we developed a conceptual framework for organizing occupational therapy practice in sleep management. The future development of occupation-based sleep intervention could focus on strategies to (1) minimize the influence of bodily function on sleep, (2) promote environment conducive to sleep, and (3) restructure daytime activity with a focus on occupational balance.
Collapse
Affiliation(s)
- Eris C. M. Ho
- Occupational Therapy Department, Queen Elizabeth Hospital, Hospital Authority, Kowloon, Hong Kong
| | - Andrew M. H. Siu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
12
|
The Efficacy of Transcranial Current Stimulation Techniques to Modulate Resting-State EEG, to Affect Vigilance and to Promote Sleepiness. Brain Sci 2018; 8:brainsci8070137. [PMID: 30037023 PMCID: PMC6071002 DOI: 10.3390/brainsci8070137] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Transcranial Current Stimulations (tCSs) are non-invasive brain stimulation techniques which modulate cortical excitability and spontaneous brain activity by the application of weak electric currents through the scalp, in a safe, economic, and well-tolerated manner. The direction of the cortical effects mainly depend on the polarity and the waveform of the applied current. The aim of the present work is to provide a broad overview of recent studies in which tCS has been applied to modulate sleepiness, sleep, and vigilance, evaluating the efficacy of different stimulation techniques and protocols. In recent years, there has been renewed interest in these stimulations and their ability to affect arousal and sleep dynamics. Furthermore, we critically review works that, by means of stimulating sleep/vigilance patterns, in the sense of enhancing or disrupting them, intended to ameliorate several clinical conditions. The examined literature shows the efficacy of tCSs in modulating sleep and arousal pattern, likely acting on the top-down pathway of sleep regulation. Finally, we discuss the potential application in clinical settings of this neuromodulatory technique as a therapeutic tool for pathological conditions characterized by alterations in sleep and arousal domains and for sleep disorders per se.
Collapse
|
13
|
Li DJ, Chung KS, Wu HC, Hsu CY, Yen CF. Predictors of sleep disturbance in heroin users receiving methadone maintenance therapy: a naturalistic study in Taiwan. Neuropsychiatr Dis Treat 2018; 14:2853-2859. [PMID: 30464470 PMCID: PMC6208868 DOI: 10.2147/ndt.s177370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Sleep disturbance is a major health concern for heroin users receiving methadone maintenance treatment (MMT). The present study was aimed to investigate the predictors for new-onset clinically predominant sleep disturbance (CPSD) among heroin users receiving MMT. METHODS This 2-year retrospective study included 152 individuals (127 males and 25 females) with heroin use disorder who visited our MMT clinics for the first time. A univariate Cox proportional hazards regression model (Cox model) was used to estimate the potential factors of subsequent CPSD, followed by a multivariate Cox model to identify significant predictors of CPSD after adjusting for other covariates. RESULTS Twenty-nine (19.1%) participants developed CPSD during the 2-year period. After forward selection in the Cox model, earlier age at onset of heroin exposure (OR=0.95; P=0.044), lower attendance rate (OR =0.04; P=0.03), greater maximum dose of methadone (OR =1.01; P=0.022), and shorter time to maximum methadone dose (OR =0.98; P=0.007) were significantly associated with new-onset CPSD. CONCLUSION We identified predictors that were significantly associated with new-onset CPSD, and clinicians should be aware of sleep disturbance in heroin users receiving MMT with these risk factors. Future studies are necessary to verify our findings and extend the applicability.
Collapse
Affiliation(s)
- Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,
| | - Kuan-Shang Chung
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chih-Yao Hsu
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, .,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,
| |
Collapse
|
14
|
Abraham O, Schleiden LJ, Brothers AL, Albert SM. Managing sleep problems using non-prescription medications and the role of community pharmacists: older adults' perspectives. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 25:438-446. [PMID: 28261882 PMCID: PMC5724494 DOI: 10.1111/ijpp.12334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/21/2016] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To examine older adults' perspectives regarding managing sleep problems through selection and use of non-prescription sleep aids, and the role of pharmacists. METHODS Telephone interviews were conducted from May to June 2015 with 116 individuals aged ≥60 years in Pittsburgh, Pennsylvania. Participants reported in a previous survey to have used at least one non-prescription sleep aid in the past 30 days and were willing to participate in a follow-up interview. Interview guides were designed to elicit perspectives of sleep problems, selection and use of non-prescription sleep aids, and consultation with healthcare professionals. Interview transcripts underwent content analysis. KEY FINDINGS Four themes emerged as follows: experiences with sleep problems, selection of non-prescription sleep aids, non-prescription sleep aid use and interactions with healthcare professionals. Over half of participants reported using a non-prescription sleep aid for >1 year, were satisfied with its use and perceived it improved sleep quality. Participants commonly used an antihistamine-only sleep aid; 36% of participants self-recommended their sleep aid; and 16% of participants consulted healthcare professionals. Few participants read medication dosage labels (22%), side effects or warnings (19%), and many reported they disregarded directions. Participants did not typically consult pharmacists about sleep problems (65%) but perceived that they could assist with medication concerns. CONCLUSIONS Although most participants had favourable perceptions of non-prescription sleep aids, older adults may be inappropriately using non-prescription sleep aids to self-manage sleep problems by frequently disregarding medication labels and directions for safe use. Also, few older adults are discussing their sleep aid selection and use with pharmacists.
Collapse
Affiliation(s)
- Olufunmilola Abraham
- Department of Pharmacy and TherapeuticsSchool of PharmacyUniversity of PittsburghPittsburghPAUSA
| | - Loren J. Schleiden
- Department of Pharmacy and TherapeuticsSchool of PharmacyUniversity of PittsburghPittsburghPAUSA
| | - Amanda L. Brothers
- Department of Pharmacy and TherapeuticsSchool of PharmacyUniversity of PittsburghPittsburghPAUSA
| | - Steven M. Albert
- Department of Behavioral and Community Health SciencesGraduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
| |
Collapse
|
15
|
Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv 2017; 11:74-79. [PMID: 27495283 PMCID: PMC5865603 DOI: 10.1007/s11764-016-0564-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Insomnia is commonly experienced by cancer survivors. Chronic insomnia is associated with significant physical and psychosocial consequences if not properly treated. Both the National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care. To better understand current clinical practices, we conducted a survey of major cancer centers across the United States (US). METHODS Adult survivorship programs at the 25 US cancer centers that are both NCI-designated comprehensive cancer centers and NCCN member institutions were surveyed about the evaluation and treatment of insomnia in their hospital. RESULTS All institutions responded to the survey. Thirteen centers (56 %) reported screening <25 % of survivors for sleep disorders, and few clinicians providing survivorship care were well-prepared to conduct a proper sleep evaluation. Insomnia was most commonly treated with sleep hygiene, or pharmacotherapy, rather than cognitive-behavioral therapy. No program reported that >50 % of their survivors were receiving optimal insomnia-related care. A variety of methods to improve insomnia care were endorsed by respondents. CONCLUSIONS There is a clear need to improve the evaluation and treatment of insomnia for cancer survivors at institutions across the country. Cancer centers deemed a number of modalities relevant for improving provider confidence in addressing sleep challenges. IMPLICATIONS FOR CANCER SURVIVORS To improve the quality of insomnia care for survivors, systematic interventions to increase standardized screening for sleep disorders, providing additional sleep medicine training for survivorship clinicians, and optimizing the role of sleep medicine specialists in the oncology setting should be considered.
Collapse
Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - Alexis L Michaud
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| |
Collapse
|
16
|
Yu ZH, Xu XH, Wang SD, Song MF, Liu Y, Yin Y, Mao HJ, Tang GZ. Effect and safety of paroxetine combined with zolpidem in treatment of primary insomnia. Sleep Breath 2017; 21:191-195. [DOI: 10.1007/s11325-017-1462-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/18/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
|
17
|
Small GW. Detection and Prevention of Cognitive Decline. Am J Geriatr Psychiatry 2016; 24:1142-1150. [PMID: 27745823 DOI: 10.1016/j.jagp.2016.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 02/05/2023]
Abstract
Current diagnostic and treatment strategies for cognitive decline can help patients maintain cognitive ability and higher levels of function longer. Despite advances in detection and early treatment strategies, many patients do not receive proper assessments and available therapies. A systematic assessment strategy will increase the likelihood of an accurate diagnosis, which can facilitate pharmacologic and non-pharmacologic treatment plans that can have a meaningful impact on prognosis. Available data support the integration of healthy lifestyle strategies in the treatment plan to help to stabilize symptoms and potentially delay future cognitive decline. While investigators continue to pursue more effective detection, treatment, and prevention strategies, the scientific data support the use of symptomatic drug treatments and recommendations for healthy lifestyle behaviors to improve quality of life and potentially stave off future cognitive decline. Success of such healthy lifestyle programs involves educating participants on the connection between lifestyle and disease prevention, offering enjoyable exercises that target the patient's skill level, and providing feedback that motivates participants to continue their healthy behaviors so they become habits.
Collapse
Affiliation(s)
- Gary W Small
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, The UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
| |
Collapse
|
18
|
Li CT, Su TP, Wang Y, Lee B, Toh M, Ho T. Pharmacokinetics of a Novel Zolpidem Nasal Spray for Rapid Management of Insomnia: First Trial in Humans. J Clin Sleep Med 2016; 12:1453-1459. [PMID: 27568900 DOI: 10.5664/jcsm.6264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/30/2016] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES The present single-dose, parallel-group, randomized, double-blind, placebo-controlled study is to evaluate the pharmacokinetics, tolerability and safety of zolpidem tartrate nasal spray (ZNS) as compared to placebo in healthy subjects. METHODS Thirty-six healthy subjects participated in this study, with 19 male and 17 female subjects in 3 cohorts (12 subjects per cohort), who were randomly assigned to receive either an intranasal dose of ZNS 1.75 mg, 3.5 mg, 5.0 mg (n = 10 per dose), or an intranasal placebo (n = 2). Multiple venous blood samples were collected for pharmacokinetic analyses. RESULTS Plasma zolpidem concentrations rapidly increased after intranasal ZNS 1.75, 3.5, and 5.0 mg with mean Tmax of 0.42, 0.76 and 0.50 h, respectively, followed by rapid decreases at all three doses. Cmax, AUC0-t, and AUC0-∞ were found to increase in a dose-proportional manner. Female subjects had generally higher AUC0-t, AUC0-∞, and lower weight-normalized clearance rate (CL/F) than male subjects. In this study, ZNS was safe and well tolerated over the evaluated dose range. There were no serious adverse events. CONCLUSIONS Zolpidem was rapidly absorbed and eliminated after intranasal administration of ZNS. Dose proportionality was found at the doses ranged from 1.75 mg to 5.0 mg. Intranasal exposure of zolpidem was generally higher in female subjects than that in male subjects. It could be concluded that ZNS is safe and well tolerated over the evaluated range of intranasal doses.
Collapse
Affiliation(s)
- Cheng-Tai Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yanfeng Wang
- Renascence Therapeutics Limited, New Territories, Hong Kong
| | - Benjamin Lee
- Renascence Therapeutics Limited, New Territories, Hong Kong
| | - Melvin Toh
- Renascence Therapeutics Limited, New Territories, Hong Kong
| | - Tony Ho
- Renascence Therapeutics Limited, New Territories, Hong Kong
| |
Collapse
|
19
|
Bain KT, Weschules DJ, Knowlton CH, Gallagher R. Toward evidence-based prescribing at end of life: A comparative review of temazepam and zolpidem for the treatment of insomnia. Am J Hosp Palliat Care 2016; 20:382-8. [PMID: 14529041 DOI: 10.1177/104990910302000512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A comparative review of temazepam and zolpidem use in managing insomnia in the hospice patient was undertaken to determine whether treatment with temazepam is a more cost-effective approach for this patient population. A MEDLINE search was conducted to identify pertinent literature, including clinical trials and reviews that involved temazepam or zolpidem. Published data was used as background information and provided in the discussion. This retrospective analysis, conducted from June 2002 through November 2002, focused on the prescribing patterns of temazepam and zolpidem in our hospice practice setting. We examined the reasons for discontinuation of each agent, along with the frequency of therapeutic change from temazepam to zolpidem. The top 10 ICD-9 codes associated with each treatment modality were investigated to determine any prescribing patterns. A total of 4,752 participants were prescribed either temazepam or zolpidem during this six-month period. Of the 4,065 patients prescribed temazepam 9.9 percent had the agent discontinued, whereas, 13.0 percent of those taking zolpidem (n = 687) terminated therapy. Reasons for discontinuation included change in dose, incomplete efficacy, change in patient status, adverse drug reaction, cultural/social issues and “other.” Analyses of prescribing patterns and the reasons for termination of each drug therapy were completed and compared with results found in the primary literature. Due to the limited financial resources available for hospice care, our goal is to provide the most clinically appropriate and cost-effective agents for hospice patients. With the lack of data pertaining to the hospice patient, physicians often are faced with challenges in deciding the most appropriate therapy. They may prefer one agent over another based on current medical opinion rather than sound clinical evidence. After review of the primary literature and the prescribing patterns in our setting, there is currently no evidence in our patient population to support that zolpidem is superior to benzodiazepines for the treatment of insomnia.
Collapse
Affiliation(s)
- Kevin T Bain
- ExcelleRx, Inc., Philadelphia, Pennsylvania, USA
| | | | | | | |
Collapse
|
20
|
Abstract
Background Sleep problem is a common geriatric condition that can result in various outcomes, both physical and mental, that reduce quality of life. The studies regarding the prevalence and impact of insomnia on daily activities in Thailand in pre-elderly and elderly adults are few. Objectives The primary objective of this study was to determine the prevalence of insomnia among pre-elderly and elderly populations and the secondary objective was to study the impact of insomnia on their daily lives. Methods This study included the participants from the urban middle class in the pre-retirement age of 50 years or older adults who worked for Khon Kaen University (KKU), Khon Kaen, Thailand, and their elderly relatives. Information on baseline characteristics, sleep problems, and outcomes were collected. Descriptive analytical statistics were used to analyze baseline data. Multivariate analysis was used to analyze associated factors of the impact of insomnia. Results A total of 491 participants were recruited. The prevalence of insomnia was 60%. The significant consequences related to insomnia were feeling unrefreshed (adjusted odds ratio (AOD) 2.22, 95% confidence interval (CI) 1.44-3.04), daytime sleepiness (AOD 2.04, 95% CI 1.29-3.22), need for a sedative drug (AOD 4.23, 95% CI 2.09-8.55), depression (AOD 4.74, 95% CI 1.73-13), and impaired attention (AOD 2.29, 95% CI 1.52-3.45). Conclusions Insomnia was found in the majority of pre-elderly and elderly participants and resulted in several poor outcomes. Early detection of insomnia may prevent some inevitable outcomes.
Collapse
Affiliation(s)
- Manchumad Manjavong
- 1 Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Panita Limpawattana
- 1 Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.,2 Non-communicable Disease Research Group, Khon Kaen University, Thailand
| | - Pisaln Mairiang
- 3 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Sirirat Anutrakulchai
- 4 Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| |
Collapse
|
21
|
Block KI, Gyllenhaal C, Mead MN. Safety and Efficacy of Herbal Sedatives in Cancer Care. Integr Cancer Ther 2016; 3:128-48. [PMID: 15165499 DOI: 10.1177/1534735404265003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Insomnia and other sleep disturbances are common in cancer patients. Insomnia is a multifactorial health concern that currently affects at least 1 in 3 cancer patients, and yet most insomnia sufferers do not consult their physician regarding pharmaceutical options for relief. Use of hypnotic drugs (primarily benzodiazepines) is associated with increasing tolerance, dependence, and adverse effects on the central nervous system. While hypnotic drug use declined substantially in the past decade, the use of herbal sedatives appeared to increase. Mostly self-prescribed by lay people, herbal sedatives hold widespread appeal, presumably because of their lower cost and higher margin of safety when compared to pharmaceuticals. Studies of better-known herbal sedatives, notably valerian and kava, showed moderate evidence for both safety and efficacy for valerian while revealing disturbing toxicity concerns for kava. Milder sedatives or anxiolytics in need of clinical study include German chamomile, lavender, hops, lemon balm, and passionflower; St. John’s wort may have anxiolytic effects with relevance to sleep. Herb-drug interactions are a possibility for some of these species, including St. John’s wort. Although sufficient evidence exists to recommend some of these agents for short-term relief of mild insomnia, long-term trials and observational studies are needed to establish the safety of prolonged use as well as overall efficacy in the context of cancer treatment and management.
Collapse
Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Care, Evanston, Illinois 60201, USA
| | | | | |
Collapse
|
22
|
Ouellet MC, Savard J, Morin CM. Book Review: Insomnia following Traumatic Brain Injury: A Review. Neurorehabil Neural Repair 2016; 18:187-98. [DOI: 10.1177/1545968304271405] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances after a traumatic brain injury (TBI) have received very little scientific attention despite the fact that several studies indicate that they may occur in 30% to 70% of patients. For individuals with TBI, problems falling asleep or maintaining sleep can exacerbate other symptoms such as pain, cognitive deficits, fatigue, or irritability. Sleep disturbances can thus compromise the rehabilitation process and the ability to return to work. This article reviews the evidence on the epidemiology, etiology, and treatment of insomnia in the context of TBI and proposes areas for future research. Prevalence estimates of insomnia complaints in TBI patients are summarized. Potential etiological factors (i.e., lesions to the nervous system, anxiety) and possible consequences of insomnia (i.e., fatigue, cognitive problems) in the context of TBI are discussed. Finally, pharmacological and psychological treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for TBI patients. Increased knowledge about the high prevalence, diagnosis, and potential etiological factors of insomnia following TBI may promote a better identification, evaluation, and treatment of sleeping difficulties in this population.
Collapse
Affiliation(s)
- Marie-Christine Ouellet
- École de Psychologie, Centre d’Étude des Troubles du Sommeil, Université Laval, Québec, Canada,
| | - Josée Savard
- École de Psychologie, Centre d’Étude des Troubles du Sommeil, Université Laval, Québec, Canada
| | - Charles M. Morin
- École de Psychologie, Centre d’Étude des Troubles du Sommeil, Université Laval, Québec, Canada
| |
Collapse
|
23
|
Wang Y, Li M, Qian S, Zhang Q, Zhou L, Zuo Z, Lee B, Toh M, Ho T. Zolpidem Mucoadhesive Formulations for Intranasal Delivery: Characterization, In Vitro Permeability, Pharmacokinetics, and Nasal Ciliotoxicity in Rats. J Pharm Sci 2016; 105:2840-2847. [PMID: 27189774 DOI: 10.1016/j.xphs.2016.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/07/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
Zolpidem is a non-benzodiazepine hypnotic for the treatment of insomnia characterized by difficulties with sleep initiation. Our study aimed at developing a zolpidem mucoadhesive formulation with minimal local toxicity, prolonged nasal residence time, and enhanced absorption after intranasal delivery. In vitro permeability studies using artificial membrane and Calu-3 cell culture model indicated efficient permeability of zolpidem. Aqueous solubility of zolpidem was found to be significantly improved by hydroxypropyl-β-cyclodextrin. Various mucoadhesive formulations were then prepared comprising zolpidem, hydroxypropyl-β-cyclodextrin, and mucoadhesive polymers such as hydroxypropyl methylcellulose, sodium carboxymethylcellulose, and sodium alginate. Pharmacokinetic studies in rats demonstrated that intranasally administered zolpidem could achieve significantly faster absorption rate and higher plasma concentration than that from oral route. In comparison with solution formulation (ZLP-S03), the optimized mucoadhesive formulation (ZLP-B01) containing 0.25% hydroxypropyl methylcellulose was found to improve Cmax from 352.6 ± 86.0 to 555.7 ± 175.8 ng/mL, and AUC0-inf from 32,890 ± 7547 to 65,447 ± 36,996 ng·min/mL with mild nasal ciliotoxicity in rats.
Collapse
Affiliation(s)
- Yanfeng Wang
- Renascence Therapeutics Limited, 2 Dai Fu Street, Tai Po Industrial Estate, New Territories, Hong Kong
| | - Mi Li
- Renascence Therapeutics Limited, 2 Dai Fu Street, Tai Po Industrial Estate, New Territories, Hong Kong
| | - Shuai Qian
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Qizhi Zhang
- School of Pharmacy, Fudan University, Shanghai, China
| | - Limin Zhou
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Zhong Zuo
- School of Pharmacy, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Benjamin Lee
- Renascence Therapeutics Limited, 2 Dai Fu Street, Tai Po Industrial Estate, New Territories, Hong Kong
| | - Melvin Toh
- Renascence Therapeutics Limited, 2 Dai Fu Street, Tai Po Industrial Estate, New Territories, Hong Kong
| | - Tony Ho
- Renascence Therapeutics Limited, 2 Dai Fu Street, Tai Po Industrial Estate, New Territories, Hong Kong.
| |
Collapse
|
24
|
A prospective, longitudinal study of sleep disturbance and comorbidity in opiate dependence (the ANRS Methaville study). Psychopharmacology (Berl) 2016; 233:1203-13. [PMID: 26753792 DOI: 10.1007/s00213-016-4202-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023]
Abstract
RATIONALE/OBJECTIVES Sleep disturbance is frequent in opioid-dependent patients. To date, no data are available about the impact of methadone maintenance treatment on sleep disturbance. Using 1-year follow-up data from the Methaville trial, we investigated the impact of methadone initiation and other correlates on sleep disturbance in opioid-dependent patients. METHODS Sleep disturbance severity was evaluated using two items from different scales (Center for Epidemiological Studies Depression Scale for depression and Opiate Treatment Index). We assessed the effect of methadone and other correlates on sleep disturbance severity during follow-up (months 0, 6, and 12) using a mixed multinomial logistic regression model. RESULTS We included 173 patients who had 1-year follow-up data on sleep disturbance, corresponding to 445 visits. At enrolment, 60.5 % reported medium to severe sleep disturbance. This proportion remained stable during methadone treatment: 54.0 % at month 6 and 55.4 % at month 12. The final multivariate model indicated that younger patients (odds ratio (OR) [95 % CI] 0.95 [0.90-1.00]), patients with pain (OR [95 % CI] 2.45 [1.13-5.32]), patients with high or very high nicotine dependence (OR [95 % CI] 5.89 [2.41-14.39]), and patients at suicidal risk (2.50 [1.13-5.52]) had a higher risk of severe sleep disturbance. Because of collinearity between suicidal risk and attention deficit hyperactivity disorder (ADHD) symptoms, ADHD was not associated with sleep disturbance in the final model. Receiving methadone treatment had no significant effect on sleep disturbance. CONCLUSIONS Sleep disturbance is frequent among opioid-dependent patients. It can be regarded as an important signal of more complex psychiatric comorbidities such as suicidal risk and ADHD. However, sleep disturbance should not be considered an obstacle to methadone maintenance treatment (MMT) initiation or continuation.
Collapse
|
25
|
Magnée EHB, de Weert-van Oene GH, Wijdeveld TAGM, Coenen AML, de Jong CAJ. Sleep disturbances are associated with reduced health-related quality of life in patients with substance use disorders. Am J Addict 2015; 24:515-22. [PMID: 26073849 DOI: 10.1111/ajad.12243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep problems and substance use are strongly linked. Sleep problems play a role in the etiology of substance use, but also may be a result of it. After detoxification, sleep problems may worsen leading to relapse. Nowadays, most substance dependence treatment programs aim at recovery rather than total abstinence, and in that view health-related quality of life (HRQL) is a relevant construct. This article describes the association between self-perceived sleep problems and HRQL in a naturalistic population of polydrug-using inpatients. METHODS At the start of treatment, 388 polydrug-using inpatients completed questionnaires concerning their sleep quality and HRQL. Three categories were established based on reported sleep problems: patients without sleep problems (21.6%), those with clinically relevant sleep problems (34.5%), and patients with sleep disorders (43.8%). RESULTS Mean grades for quality of sleep were M = 7.3 (sd 1.7), M = 6.6 (sd 1.7) and M = 5.3 (sd 1.9) for the three categories, respectively. In addition, patients in the disorder category perceived a lower HRQL than those in the other categories. In the explanation of HRQL, both sleep problems and sleep disorders added significantly to the model when controlling for baseline characteristics. DISCUSSION AND CONCLUSIONS Our findings stress the need for clinicians to pay attention to the quality of sleep of recovering polydrug users, since this may play an important role in the recovery process. Monitoring sleep during treatment is advocated. This study adds to the knowledge about the way HRQL and sleep are related in a naturalistic sample of substance-dependent patients.
Collapse
Affiliation(s)
- Ellis H B Magnée
- Department of Addiction and Korsakov Care, Vincent van Gogh Institute, Oostrum, the Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| | - Gerdien H de Weert-van Oene
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands.,Victas, Addiction Treatment Center, Utrecht, the Netherlands
| | - Toon A G M Wijdeveld
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| | - Anton M L Coenen
- Donders Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Cor A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
26
|
Taylor HL, Rybarczyk BD, Nay W, Leszczyszyn D. Effectiveness of a CBT Intervention for Persistent Insomnia and Hypnotic Dependency in an Outpatient Psychiatry Clinic. J Clin Psychol 2015; 71:666-83. [DOI: 10.1002/jclp.22186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
27
|
Doghramji PP. Integrating Modern Concepts of Insomnia and its Contemporary Treatment into Primary Care. Postgrad Med 2015; 126:82-101. [PMID: 25295652 DOI: 10.3810/pgm.2014.09.2802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
28
|
Zorowitz RD, Smout RJ, Gassaway JA, Horn SD. Usage of Pain Medications During Stroke Rehabilitation: The Post-Stroke Rehabilitation Outcomes Project (PSROP). Top Stroke Rehabil 2015; 12:37-49. [PMID: 16698736 DOI: 10.1310/c7mf-vlr0-ckdl-3c44] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pain remains one of the most common, yet most challenging, medical problems in health care today, and it is one of the most common complications that occurs after a stroke. Pain can affect the course of stroke rehabilitation adversely, and it occasionally may be a cause for transfer back to an acute care hospital. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the incidence of pain by body location and trends in the use of different classifications of medications to treat pain. Of the 1,122 participants in the PSROP database, the most common locations of pain in stroke survivors were the head, leg, back, and shoulder. The most frequently prescribed classifications of pain medications were other analgesics (acetaminophen and tramadol), followed by narcotic analgesics, non-steroidal antiinflammatory drugs (NSAIDs), anticonvulsants, and tricyclic antidepressants. After acetaminophen, the most frequently prescribed medications in each classification, respectively, include hydrocodone APAP, cox-2 inhibitors, gabapentin, and amitriptyline. Other frequently prescribed pain medications included sumatriptan (migraine analgesic), cyclobenzaprine (muscle relaxant), and baclofen (antispasticity muscle relaxant). Medications should be chosen based upon the medical condition causing pain, the ability of the stroke survivor to comply with administration of the medication, and the cost of the medication. Appropriate and timely treatments of painful conditions result in maximum function and the ability to lead active lives and maintain an adequate quality of life.
Collapse
Affiliation(s)
- Richard D Zorowitz
- Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
29
|
Hoshino M, Ikarashi N, Hirobe R, Hayashi M, Hiraoka H, Yokobori K, Ochiai T, Kusunoki Y, Kon R, Tajima M, Ochiai W, Sugiyama K. Effects of Menthol on the Pharmacokinetics of Triazolam and Phenytoin. Biol Pharm Bull 2015; 38:454-60. [DOI: 10.1248/bpb.b14-00764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Ryuta Hirobe
- Department of Clinical Pharmacokinetics, Hoshi University
| | - Mami Hayashi
- Department of Clinical Pharmacokinetics, Hoshi University
| | | | | | - Takumi Ochiai
- Department of Clinical Pharmacokinetics, Hoshi University
| | | | - Risako Kon
- Department of Clinical Pharmacokinetics, Hoshi University
| | | | - Wataru Ochiai
- Department of Clinical Pharmacokinetics, Hoshi University
| | | |
Collapse
|
30
|
Shi Y, Dong J, Tang L, Kang R, Shi J, Zhang J. N6-(3-methoxyl-4-hydroxybenzyl) adenine riboside induces sedative and hypnotic effects via GAD enzyme activation in mice. Pharmacol Biochem Behav 2014; 126:146-51. [DOI: 10.1016/j.pbb.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/24/2014] [Accepted: 09/06/2014] [Indexed: 12/24/2022]
|
31
|
Durcan L, Wilson F, Cunnane G. The effect of exercise on sleep and fatigue in rheumatoid arthritis: a randomized controlled study. J Rheumatol 2014; 41:1966-73. [PMID: 25128510 DOI: 10.3899/jrheum.131282] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sleep disturbance and chronic fatigue are common in rheumatoid arthritis (RA) and contribute to disability, symptomatology, and healthcare use. It has long been recognized in other populations that exercise can improve sleep and diminish fatigue. The effect of exercise on sleep quality and fatigue in RA has not been evaluated. METHODS Ours is a randomized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue. These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale. Patients were randomized to either a 12-week, home-based exercise intervention or usual care. The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Questionnaire (HAQ) with cardiovascular work as per the guidelines. The intervention group was evaluated on a 3-week basis. Full evaluation was carried out at baseline and at 12 weeks. RESULTS Forty patients were randomized to the intervention with 38 controls. In the exercise intervention group, there was a statistically significant improvement in HAQ (p = 0.00), pain (p = 0.05), stiffness (p = 0.05), sleep quality (p = 0.04), and fatigue (p = 0.04). In our control group, there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise, but none of the other variables. CONCLUSION Our study demonstrates that an exercise program resulted in significant improvement in sleep quality and fatigue. This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population.
Collapse
Affiliation(s)
- Laura Durcan
- From the Department of Rheumatology, St. James's Hospital; the Department of Physiotherapy, Trinity College, Dublin, Ireland.L. Durcan, MD, MB, Bch, BAO, Specialist Registrar in Rheumatology, Department of Rheumatology, St. James's Hospital; F. Wilson, PhD, Assistant Professor and Chartered Physiotherapist, Department of Physiotherapy, Trinity College; G. Cunnane, PhD, Clinical Professor, Trinity College Dublin, Consultant Rheumatologist, St. James's Hospital.
| | - Fiona Wilson
- From the Department of Rheumatology, St. James's Hospital; the Department of Physiotherapy, Trinity College, Dublin, Ireland.L. Durcan, MD, MB, Bch, BAO, Specialist Registrar in Rheumatology, Department of Rheumatology, St. James's Hospital; F. Wilson, PhD, Assistant Professor and Chartered Physiotherapist, Department of Physiotherapy, Trinity College; G. Cunnane, PhD, Clinical Professor, Trinity College Dublin, Consultant Rheumatologist, St. James's Hospital
| | - Gaye Cunnane
- From the Department of Rheumatology, St. James's Hospital; the Department of Physiotherapy, Trinity College, Dublin, Ireland.L. Durcan, MD, MB, Bch, BAO, Specialist Registrar in Rheumatology, Department of Rheumatology, St. James's Hospital; F. Wilson, PhD, Assistant Professor and Chartered Physiotherapist, Department of Physiotherapy, Trinity College; G. Cunnane, PhD, Clinical Professor, Trinity College Dublin, Consultant Rheumatologist, St. James's Hospital
| |
Collapse
|
32
|
van de Glind EMM, Hooft L, Tulner LR, Tulen JHM, Kuper IMJA, Hamburger HL, de Rooij SE, van Munster BC. Acetaminophen for self-reported sleep problems in an elderly population (ASLEEP): study protocol of a randomized placebo-controlled double-blind trial. Trials 2014; 15:10. [PMID: 24398053 PMCID: PMC3895735 DOI: 10.1186/1745-6215-15-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of sleep disorders increases with age. Sleep disorders may have serious health implications and may be related to serious underlying diseases. Many older people use hypnotics, like benzodiazepines, although these medications have serious side effects and often lead to habituation. Acetaminophen is one of the most frequently used off-label drugs for sleep disorders, although little is known about its effects. Our objective is to investigate whether acetaminophen is effective in treating self-reported sleep disorders in older people. METHODS/DESIGN Participants, aged 65 years or older (n=150), who have sleep disorders will be randomized for treatment with either acetaminophen 1000 mg or placebo, once daily at bedtime in a double-blind design. Eligible patients should be able to give informed consent, should not be cognitively impaired (Minimal Mental State Examination (MMSE) score≥20), should not have pain, and should not use acetaminophen on a regular basis because of pain complaints. The study will take three weeks to complete. During these three weeks, the participants register their sleep behavior in a sleep diary. The participants will use the study medication during the second and third week. The primary endpoint will be the self-reported sleep disorders at the end of week three, as measured by means of the Insomnia Severity Index (ISI). To validate these subjective sleep parameters against objectively measured indices of the sleep-wake pattern, we will measure the periods of wakefulness and sleep in a subgroup of participants, using an actigraph worn on the wrist during the entire study period. DISCUSSION The proposed study will contribute to our knowledge about the treatment of sleep disorders in an older population. There is a need for treatments for sleep disorders without serious adverse effects. Acetaminophen might be a simple and inexpensive alternative for the regimes that are currently used with older people. TRIAL REGISTRATION The Netherlands National Trial Register NTR2747.
Collapse
Affiliation(s)
- Esther M M van de Glind
- Department of Internal Medicine, Geriatrics Section, Academic Medical Center, P,O, Box 22660, Amsterdam, 1100 DD, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Hussain A, Ibrahim MI, Malik M. Assessment of disease management of insomnia at community pharmacies through simulated visits in Pakistan. Pharm Pract (Granada) 2013; 11:179-84. [PMID: 24367456 PMCID: PMC3869632 DOI: 10.4321/s1886-36552013000400001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 11/27/2013] [Indexed: 11/14/2022] Open
Abstract
Objective The study aimed to document the state of insomnia management at community
pharmacies in Pakistan. Methods A cross-sectional study was conducted at randomly selected 371 pharmacies in
three cities of Pakistan. Simulated patient visits were performed to collect
information on case management of insomnia in terms of history taking and
patient counseling at community pharmacies. The data was coded, entered and
analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests
(p<0.05) were performed to find out differences. Results The patients were mainly handled by salesman 83.8% (n=311), by pharmacist
3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time
was 1.11 minutes (SD=5.61) with the range of 0.5 - 6 minutes. Of the 371
simulated patients who visited the pharmacies, 72.8% (n=270) subjects were
given medicines and 24.3% (n=90) subjects were referred to the doctor for
treatment of insomnia. 61.8% (n=193) of the subjects were given
benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at
community pharmacies in the three cities. The mean cost of treatment in case
of insomnia was PKR12.7 (SD=10.13, median=10). Conclusions The disease management of insomnia by community pharmacies in Pakistan is not
appropriate. The overall process of history taking, medication counselling
and referral practices at community pharmacies either located in rural or
urban setting and irrespective of the provider type and location of
pharmacies, in the three cities is limited.
Collapse
Affiliation(s)
- Azhar Hussain
- Pharmacy Department. Hamdard Institute of Pharmaceutical Sciences, Hamdard University . Islamabad ( Pakistan ).
| | | | - Madeeha Malik
- Pharmacy Department, Hamdard Institute of Pharmaceutical Sciences, Hamdard University . Islamabad ( Pakistan ).
| |
Collapse
|
34
|
|
35
|
Abstract
Research models show a strong interrelationship between sleep quality and immune function. The proinflammatory cytokines, interleukin-1, interleukin-6, and tumor necrosis factor α are classified as official sleep-regulatory substances. However, sleep-promoting properties are also possessed by several other immune and proinflammatory cellular classes. This article reviews the current physiologic evidence for the prominent somnogenic and sleep-regulatory properties inherent to these immune substances. Clinical examples of this relationship are discussed from the perspective of infectious and primarily immune-related conditions associated with significant sleep disruption and from the perspective of immune dysregulation associated with several primary sleep disorders.
Collapse
Affiliation(s)
- Charlene E Gamaldo
- Neurology, Pulmonary and Critical Care Medicine, Johns Hopkins Sleep Disorders Center, 600 North Wolfe Street, Meyer 6-119, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
36
|
Babson KA, Blonigen DM, Boden MT, Drescher KD, Bonn-Miller MO. Sleep quality among U.S. military veterans with PTSD: a factor analysis and structural model of symptoms. J Trauma Stress 2012; 25:665-74. [PMID: 23225033 DOI: 10.1002/jts.21757] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Poor sleep quality among individuals with posttraumatic stress disorder (PTSD) is associated with poorer prognosis and outcomes. The factor structure of the most commonly employed measure of self-reported sleep quality, the Pittsburgh Sleep Quality Index (PSQI), has yet to be evaluated among individuals with PTSD. The current study sought to fill this gap among a sample of 226 U.S. military veterans with PTSD (90% with co-occurring mood disorders, 73.5% with substance use disorders). We evaluated the factor structure of the PSQI by conducting an exploratory factor analysis (EFA) in approximately half of the sample (n = 111). We then conducted a second EFA in the other split half (n = 115). Lastly, we conducted a path analysis to investigate the relations between sleep factors and PTSD symptom severity, after accounting for the relation with depression. Results suggested sleep quality can best be conceptualized, among those with PTSD, as a multidimensional construct consisting of 2 factors, Perceived Sleep Quality and Efficiency/Duration. After accounting for the association between both factors and depression, only the Perceived Sleep Quality factor was associated with PTSD (β = .51). The results provide a recommended structure that improves precision in measuring sleep quality among veterans with PTSD.
Collapse
Affiliation(s)
- Kimberly A Babson
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California, USA.
| | | | | | | | | |
Collapse
|
37
|
Blanaru M, Bloch B, Vadas L, Arnon Z, Ziv N, Kremer I, Haimov I. The effects of music relaxation and muscle relaxation techniques on sleep quality and emotional measures among individuals with posttraumatic stress disorder. Ment Illn 2012; 4:e13. [PMID: 25478114 PMCID: PMC4253375 DOI: 10.4081/mi.2012.e13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 05/02/2012] [Accepted: 05/23/2012] [Indexed: 11/23/2022] Open
Abstract
Posttraumatic stress disorder (PTSD), an anxiety disorder with lifetime prevalence of 7.8%, is characterized by symptoms that develop following exposure to traumatic life events and that cause an immediate experience of intense fear, helplessness or horror. PTSD is marked by recurrent nightmares typified by the recall of intrusive experiences and by extended disturbance throughout sleep. Individuals with PTSD respond poorly to drug treatments for insomnia. The disadvantages of drug treatment for insomnia underline the importance of non-pharmacological alternatives. Thus, the present study had three aims: first, to compare the efficiency of two relaxation techniques (muscular relaxation and progressive music relaxation) in alleviating insomnia among individuals with PTSD using both objective and subjective measures of sleep quality; second, to examine whether these two techniques have different effects on psychological indicators of PTSD, such as depression and anxiety; and finally, to examine how initial PTSD symptom severity and baseline emotional measures are related to the efficiency of these two relaxation methods. Thirteen PTSD patients with no other major psychiatric or neurological disorders participated in the study. The study comprised one seven-day running-in, no-treatment period, followed by two seven-day experimental periods. The treatments constituted either music relaxation or muscle relaxation techniques at desired bedtime. These treatments were randomly assigned. During each of these three experimental periods, subjects' sleep was continuously monitored with a wrist actigraph (Ambulatory Monitoring, Inc.), and subjects were asked to fill out several questionnaires concerned with a wide spectrum of issues, such as sleep, depression, and anxiety. Analyses revealed a significant increase in objective and subjective sleep efficiency and a significant reduction in depression level following music relaxation. Moreover, following music relaxation, a highly significant negative correlation was found between improvement in objective sleep efficiency and reduction in depression scale. The study's findings provide evidence that music relaxation at bedtime can be used as treatment for insomnia among individuals with PTSD.
Collapse
Affiliation(s)
| | - Boaz Bloch
- Psychiatric Department, Haemek Medical Center, Afula
| | - Limor Vadas
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| | - Zahi Arnon
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| | - Naomi Ziv
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| | - Ilana Kremer
- Psychiatric Department, Haemek Medical Center, Afula
| | - Iris Haimov
- Department of Psychology and The Center for Psychobiological Research, The Max Stern Academic College of Emek Yezreel, Israel
| |
Collapse
|
38
|
Schoeneborn D, Blaschke S, Kaufmann IM. Recontextualizing Anthropomorphic Metaphors in Organization Studies. JOURNAL OF MANAGEMENT INQUIRY 2012. [DOI: 10.1177/1056492612448463] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this article, the authors discuss critically the use of “anthropomorphic” metaphors in organization studies (e.g., organizational knowledge, learning, and memory). They argue that, although these metaphors are potentially powerful, because of frequent usage they are at risk of becoming taken for granted and contextually disconnected from their source domain, the human mind. To unleash the heuristic potential of such metaphors, it is necessary to take into account the inherent dynamics and bidirectionality of metaphorical language use. Therefore, the authors propose a methodology for the context-sensitive use of metaphors in organization studies. They illustrate this approach by developing the new metaphor of organizational insomnia, which is informed by recent neuroscientific research on human sleep and its disruptions. The insomnia metaphor provides an alternative way of explaining deficits in organizational knowledge, learning, and memory, which originate in a state of permanent restlessness.
Collapse
|
39
|
Chan AS, Wong QY, Sze SL, Kwong PPK, Han YMY, Cheung MC. A Chinese chan-based mind-body intervention improves sleep on patients with depression: a randomized controlled trial. ScientificWorldJournal 2012; 2012:235206. [PMID: 22623888 PMCID: PMC3353275 DOI: 10.1100/2012/235206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/25/2011] [Indexed: 11/17/2022] Open
Abstract
Sleep disturbance is a common problem associated with depression, and cognitive-behavioral therapy (CBT) is a more common behavioral intervention for sleep problems. The present study compares the effect of a newly developed Chinese Chan-based intervention, namely Dejian mind-body intervention (DMBI), with the CBT on improving sleep problems of patients with depression. Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive 10 weekly sessions of CBT or DMBI, or placed on a waitlist. Measurements included ratings by psychiatrists who were blinded to the experimental design, and a standardized questionnaire on sleep quantity and quality was obtained before and after the 10-week intervention. Results indicated that both the CBT and DMBI groups demonstrated significantly reduced sleep onset latency and wake time after sleep onset (effect size range = 0.46-1.0, P ≤ 0.05) as compared to nonsignificant changes in the waitlist group (P > 0.1). Furthermore, the DMBI group, but not the CBT or waitlist groups, demonstrated significantly reduced psychiatrist ratings on overall sleep problems (effect size = 1.0, P = 0.00) and improved total sleep time (effect size = 0.8, P = 0.05) after treatment. The present findings suggest that a Chinese Chan-based mind-body intervention has positive effects on improving sleep in individuals with depression.
Collapse
Affiliation(s)
- Agnes S Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
INTRODUCTION The imidazopyridine derivative zolpidem , which acts as a benzodiazepine (BZ) receptor agonist, is the most widely prescribed hypnotic drug in the US. AREAS COVERED This review addresses the neuroreceptor properties of zolpidem; clinical pharmacokinetics, pharmacodynamics and drug interactions; efficacy as a hypnotic; adverse effects; tolerance, dependence and withdrawal; relation to motor vehicle accidents and complex sleep behaviors; and new dosage forms. EXPERT OPINION Approved doses of zolpidem (10 mg for adults, 5 mg for the elderly) are consistently effective in reducing sleep latency and consequently increasing sleep duration in patients with insomnia. However, favorable effects on sleep maintenance are observed less consistently. Residual daytime effects are unlikely with recommended doses, and provided that at least 8 h elapse prior to arising. Hypnotic efficacy is maintained with repeated nightly use, and the risk of rebound insomnia is low. Dependence and abuse of zolpidem are no more likely to occur than with typical benzodiazepines. Newly available novel dosage forms of zolpidem have increased therapeutic options for patients with insomnia variants such as sleep maintenance insomnia and middle-of-the-night awakening.
Collapse
Affiliation(s)
- David J Greenblatt
- Tufts University School of Medicine, Department of Molecular Physiology and Pharmacology, 136 Harrison Avenue, Boston, MA 02111, USA.
| | | |
Collapse
|
41
|
Abstract
Insomnia is a common condition that affects one's ability to sleep comfortably and consequently to work effectively. Its etiology is multifactorial and involves plethora of risk factors. Consequences can vary from mild sleepiness to more sever psychiatric disturbances and ischemic stroke. Despite several diagnostic criteria it is poorly diagnosed and less often treated. Benzodiazepines formed the mainline therapy for many years till the advent of newer nonbenzodiazepine group of drugs including zolpidem. Zolpidem is an imidazo-pyridine compound that enhances the GABA(A) receptor function by interaction with Omega-1 receptor subtype. Its pharmacokinetic profile allows the patients to use it later in the night when having trouble falling asleep without any residual cognitive impairment the next morning. It has rapid onset of action, improves total sleep duration, and reduces night-time awakenings. Its adverse effect profile is satisfactory as it appears to have low addiction potential. This review will focus on the current role of zolpidem in the management of insomnia.
Collapse
Affiliation(s)
- Amit Dang
- Department of Pharmacology, Goa Medical College, Goa, India.
| | | | | |
Collapse
|
42
|
Foral P, Knezevich J, Dewan N, Malesker M. Medication-Induced Sleep Disturbances. ACTA ACUST UNITED AC 2011; 26:414-25. [DOI: 10.4140/tcp.n.2011.414] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
43
|
Foral P, Dewan N, Malesker M. Insomnia: A Therapeutic Review for Pharmacists. ACTA ACUST UNITED AC 2011; 26:332-41. [DOI: 10.4140/tcp.n.2011.332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
44
|
Hollway JA, Aman MG. Pharmacological treatment of sleep disturbance in developmental disabilities: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:939-962. [PMID: 21296553 DOI: 10.1016/j.ridd.2010.12.035] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/23/2010] [Accepted: 12/27/2010] [Indexed: 05/30/2023]
Abstract
Sleep disturbance is a common problem in children with developmental disabilities. Effective pharmacologic interventions are needed to ameliorate sleep problems that persist when behavior therapy alone is insufficient. The aim of the present study was to provide an overview of the quantity and quality of pharmacologic research targeting sleep in children with developmental disabilities. Efficacy studies of medications most likely to be prescribed to children are reviewed in detail. Medline and PsychInfo searches were performed to identify relevant clinical trials and case reports, published between 1975 and 2009. Key search terms included sleep, children, antihistamines, alpha adrenergic agonists, antidepressants, antipsychotics, melatonin, ramelteon, benzodiazepines, and nonbenzodiazepines. The literature search identified 58 articles that met the inclusion criteria. Well-controlled studies employing both objective polysomnography and subjective sleep measures are needed to determine the efficacy and safety of currently prescribed pediatric sleep medicines. Melatonin appears to be the most widely assessed agent and safest choice for children with developmental disabilities. Trazodone, mirtazapine, and ramelteon hold promise but require further study.
Collapse
Affiliation(s)
- Jill A Hollway
- The Nisonger Center UCEDD, The Ohio State University, I/DD Psychology, 1581 Dodd Drive, Columbus, OH 43210, United States.
| | | |
Collapse
|
45
|
Kim HC, Kim BK, Min KB, Min JY, Hwang SH, Park SG. Association between job stress and insomnia in Korean workers. J Occup Health 2011; 53:164-74. [PMID: 21422721 DOI: 10.1539/joh.10-0032-oa] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We investigated the association between job stress and insomnia in a large nationwide samples of Korean workers. METHODS In this cross-sectional study, a total of 8,155 workers from a nationwide sample were recruited. We surveyed the subjects' socio-demographic and work-related characteristics and seven subscales of occupational stress using the Korean Occupational Stress Scale Short Form. Each subscales of job stress was dichotomized into higher or lower group by respective median scores. Insomnia was defined as having at least one of the three sleep symptoms. we performed multivariate logistic regression analysis to identify association between job stress and insomnia. RESULTS We found that individuals with relatively high job stress experienced insomnia significantly more frequently, and the significance was maintained even after adjustment for confounding variables(high job demand: OR: 1.30, 95% CI: 1.14-1.47; insufficient job control: OR: 1.13, 95% CI: 0.99-1.29; inadequate social support: OR: 1.30, 95% CI: 1.14-1.47; job insecurity: OR: 1.25, 95% CI: 1.11-1.44; organizational injustice: OR: 1.27, 95% CI: 1.12-1.44; lack of reward: OR: 1.18, 95% CI: 1.04-1.34; discomfort in occupational climate: OR: 1.38, 95% CI: 1.22-1.57; total job stress: OR: 1.45, 95% CI: 1.28-1.64). CONCLUSION This study suggested that job stress is possible risk factor for insomnia and that particularly discomfort in occupational climate and inadequate social support have more strong relation to insomnia in Korea.
Collapse
Affiliation(s)
- Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University Hospital
| | | | | | | | | | | |
Collapse
|
46
|
Insomnia: Neurophysiological and NeuropsychologicalApproaches. Neuropsychol Rev 2011; 21:22-40. [DOI: 10.1007/s11065-011-9160-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/06/2011] [Indexed: 01/08/2023]
|
47
|
Affiliation(s)
- M S Reddy
- Asha Hospital, Hyderabad, Andhra Pradesh, India. E-mail:
| | | |
Collapse
|
48
|
Saddichha S. Diagnosis and treatment of chronic insomnia. Ann Indian Acad Neurol 2010; 13:94-102. [PMID: 20814491 PMCID: PMC2924526 DOI: 10.4103/0972-2327.64628] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 03/30/2010] [Accepted: 05/17/2010] [Indexed: 11/05/2022] Open
Abstract
Insomnia is a disorder characterized by inability to sleep or a total lack of sleep, prevalence of which ranges from 10 to 15% among the general population with increased rates seen among older ages, female gender, White population and presence of medical or psychiatric illness. Yet this condition is still under-recognized, under-diagnosed, and under-treated. This article aims to review the operational definitions and management of chronic insomnia. A computerized search on PubMed carried from 1980 to January 2009 led to the summarization of the results. There are several strategies to manage chronic insomnia. To initiate treatment, it is necessary to define it and differentiate it from other co-morbid psychiatric disorders. Non-pharmacologic strategies such as stimulus control therapy and relaxation and cognitive therapies have the best effect sizes followed by sleep restriction, paradoxical intention and sleep hygiene education which have modest to less than modest effect sizes. Among pharmacotherapeutic agents, non-benzodiazepine hypnotics are the first line of management followed by benzodiazepines, amitryptiline and antihistaminics. However, adequate trials of combined behavior therapy and pharmacotherapy are the best course of management.
Collapse
Affiliation(s)
- Sahoo Saddichha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
| |
Collapse
|
49
|
Chen FP, Jong MS, Chen YC, Kung YY, Chen TJ, Chen FJ, Hwang SJ. Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during 2002. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:236341. [PMID: 19339485 PMCID: PMC3095483 DOI: 10.1093/ecam/nep018] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 02/12/2009] [Indexed: 12/18/2022]
Abstract
Chinese herbal medicine (CHM) has been commonly used for treating insomnia in Asian countries for centuries. The aim of this study was to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM use in treating insomnia. We obtained the traditional Chinese medicine (TCM) outpatient claims from the National Health Insurance in Taiwan for the year 2002. Patients with insomnia were identified from the diagnostic code of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM. Results showed that there were 16 134 subjects who visited TCM clinics for insomnia in Taiwan during 2002 and received a total of 29 801 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (25.3%). In addition, female subjects used CHMs for insomnia more frequently than male subjects (female : male = 1.94 : 1). There was an average of 4.8 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for insomnia. Shou-wu-teng (Polygonum multiflorum) was the most commonly prescribed single Chinese herb, while Suan-zao-ren-tang was the most commonly prescribed Chinese herbal formula. According to the association rule, the most commonly prescribed CHM drug combination was Suan-zao-ren-tang plus Long-dan-xie-gan-tang, while the most commonly prescribed triple drug combination was Suan-zao-ren-tang, Albizia julibrissin, and P. multiflorum. Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating insomnia.
Collapse
Affiliation(s)
- Fang-Pey Chen
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Maw-Shiou Jong
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Chun Chen
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yen-Ying Kung
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tzeng-Ji Chen
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Fun-Jou Chen
- Graduate Institute of Integration Chinese and Western Medicine, Chinese Medical University, Taichung, Taiwan
| | - Shinn-Jang Hwang
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| |
Collapse
|
50
|
Menza M, Dobkin RD, Marin H, Gara M, Bienfait K, Dicke A, Comella CL, Cantor C, Hyer L. Treatment of insomnia in Parkinson's disease: a controlled trial of eszopiclone and placebo. Mov Disord 2010; 25:1708-14. [PMID: 20589875 PMCID: PMC2928867 DOI: 10.1002/mds.23168] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease affecting up to 1 million individuals in the United States. Sleep disturbances, typically in sleep maintenance, are found in up to 88% of these individuals and are associated with a variety of poor outcomes. Despite being common and important, there are few data to guide clinical care. We conducted a 6-week, randomized, controlled trial of eszopiclone and placebo in 30 patients with PD and insomnia. Patients with other primary sleep disorders (PSG defined) were excluded. The primary outcome was total sleep time (TST), and secondary measures included wake after sleep onset (WASO), number of awakenings, and quality of sleep, among others. The groups did not significantly differ on TST, but significant differences, favoring eszopiclone, did emerge in number of awakenings (P = 0.035), quality of sleep (P = 0.018), and in physician-rated CGI improvement (P = 0.035). There was also a trend toward significance in WASO (P = 0.071). There were no significant differences between groups in measures of daytime functioning. The drug was well tolerated, with 33% of patients on eszopiclone and 27% of patients on placebo reporting adverse events. Although modest in size, this is the first controlled study of the treatment of insomnia in patients with PD. Eszopiclone did not increase TST significantly but was superior to placebo in improving quality of sleep and some measures of sleep maintenance, which is the most common sleep difficulty experienced by patients with PD. Definitive trials of the treatment of sleep disorders in this population are warranted.
Collapse
Affiliation(s)
- Matthew Menza
- Department of Psychiatry, Robert Wood Johnson Medical School, Piscataway, New Jersey 08854, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|