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Poluektov MG. [The use of psychotropic medications for chronic insomnia in clinical practice]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:61-66. [PMID: 34078862 DOI: 10.17116/jnevro202112104261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic insomnia is a common sleep disorder. In its treatment, both non-drug and drug approaches are used. The therapeutic concept is based on a three-component model of sleep regulation. Psychotropic drugs of various pharmacological groups are used for the treatment of chronic insomnia. The peculiarities of the effect of these drugs in various clinical situations are discussed.
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Affiliation(s)
- M G Poluektov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Li H, Chen J, Xu G, Duan Y, Huang D, Tang C, Liu J. The Effect of Tai Chi for Improving Sleep Quality: A Systematic Review and Meta-analysis. J Affect Disord 2020; 274:1102-1112. [PMID: 32663938 DOI: 10.1016/j.jad.2020.05.076] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sleep quality is a major concern around the world, yet currently there are no recognized non-pharmacological treatments. A systematic review and meta-analysis investigated Tai Chi's effect on patients with sleep complaints, both those with insomnia and those with other conditions. METHODS 4 English language databases (MEDLINE, EMBASE, PsycINFO, and CENTRAL) and 4 Chinese databases (CNKI, CBM, VIP, and Wanfang Data) were searched from database inception through June 23, 2019. Searches were conducted in both English and Chinese language. Meta-analysis by mean difference (MD) and 95% confidence interval (CI) was performed with RevMan 5.3. Risk of bias for each study was accounted for according to the Cochrane Handbook. RESULTS Twenty randomized controlled studies from five countries covering 1,703 patients were included and divided into two control groups. Tai Chi had a significant effect on the Pittsburgh Sleep Quality Index (PSQI) compared with non-treatment and active treatment groups. Moreover, the articles were divided into groups according to Tai Chi styles. Both 24-form Yang-style Tai Chi and 8-form Yang-style Tai Chi had significant effects on PSQI. LIMITATIONS One limitation of our work was that there were some forms of insomnia for which conclusions could not be drawn. Also, no relationship between efficacy and any of the factors could be elucidated. CONCLUSIONS Compared with non-therapeutic and other active treatments, Tai Chi has a positive effect on improving sleep quality. In-depth analysis showed that 24-form and 8-form Yang style Tai Chi have significant positive effects on sleep quality, as assessed by PSQI.
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Affiliation(s)
- Huanjie Li
- Foshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine, Address: No.6 Qinren Road, Chancheng District, Foshan, 528000, China.
| | - Juexuan Chen
- American Academy of Acupuncture and Oriental Medicine, Address:1925 West County Road B2, Roseville, Minnesota, United States; Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Address: No.232 Waihuandong Road, Panyu District, Guangzhou, 510006, China.
| | - Guangzhen Xu
- Foshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine, Address: No.6 Qinren Road, Chancheng District, Foshan, 528000, China.
| | - Yuting Duan
- Hong Kong Chinese Medicine Clinical Study Centre, School of Chinese Medicine, Hong Kong Baptist University, Address: 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Kowloon Tong, Hong Kong SAR, China; Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Address: No.232 Waihuandong Road, Panyu District, Guangzhou, 510006, China.
| | - Danxuan Huang
- Foshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine, Address: No.6 Qinren Road, Chancheng District, Foshan, 528000, China.
| | - Chunzhi Tang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Address: No.232 Waihuandong Road, Panyu District, Guangzhou, 510006, China.
| | - Jihong Liu
- Foshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine, Address: No.6 Qinren Road, Chancheng District, Foshan, 528000, China.
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Christensen JAE, Wassing R, Wei Y, Ramautar JR, Lakbila-Kamal O, Jennum PJ, Van Someren EJW. Data-Driven Analysis of EEG Reveals Concomitant Superficial Sleep During Deep Sleep in Insomnia Disorder. Front Neurosci 2019; 13:598. [PMID: 31338014 PMCID: PMC6629891 DOI: 10.3389/fnins.2019.00598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/27/2019] [Indexed: 11/26/2022] Open
Abstract
Study Objectives: The subjective suffering of people with Insomnia Disorder (ID) is insufficiently accounted for by traditional sleep classification, which presumes a strict sequential occurrence of global brain states. Recent studies challenged this presumption by showing concurrent sleep- and wake-type neuronal activity. We hypothesized enhanced co-occurrence of diverging EEG vigilance signatures during sleep in ID. Methods: Electroencephalography (EEG) in 55 cases with ID and 64 controls without sleep complaints was subjected to a Latent Dirichlet Allocation topic model describing each 30 s epoch as a mixture of six vigilance states called Topics (T), ranked from N3-related T1 and T2 to wakefulness-related T6. For each stable epoch we determined topic dominance (the probability of the most likely topic), topic co-occurrence (the probability of the remaining topics), and epoch-to-epoch transition probabilities. Results: In stable epochs where the N1-related T4 was dominant, T4 was more dominant in ID than in controls, and patients showed an almost doubled co-occurrence of T4 during epochs where the N3-related T1 was dominant. Furthermore, patients had a higher probability of switching from T1- to T4-dominated epochs, at the cost of switching to N3-related T2-dominated epochs, and a higher probability of switching from N2-related T3- to wakefulness-related T6-dominated epochs. Conclusion: Even during their deepest sleep, the EEG of people with ID express more N1-related vigilance signatures than good sleepers do. People with ID are moreover more likely to switch from deep to light sleep and from N2 sleep to wakefulness. The findings suggest that hyperarousal never rests in ID.
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Affiliation(s)
- Julie Anja Engelhard Christensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Rick Wassing
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Yishul Wei
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Jennifer R Ramautar
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Oti Lakbila-Kamal
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands.,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
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European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017; 26:675-700. [DOI: 10.1111/jsr.12594] [Citation(s) in RCA: 878] [Impact Index Per Article: 125.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023]
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Sleep architecture in insomniacs with severe benzodiazepine abuse. Clin Neurophysiol 2017; 128:875-881. [DOI: 10.1016/j.clinph.2017.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/30/2016] [Accepted: 03/08/2017] [Indexed: 01/29/2023]
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Bastien C, Ceklic T, St-Hilaire P, Desmarais F, Pérusse A, Lefrançois J, Pedneault-Drolet M. Insomnia and sleep misperception. ACTA ACUST UNITED AC 2014; 62:241-51. [DOI: 10.1016/j.patbio.2014.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
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Krenk L, Jennum P, Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement. J Clin Sleep Med 2014; 10:321-6. [PMID: 24634631 DOI: 10.5664/jcsm.3540] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days. METHODS Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the first night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual. RESULTS Objective sleep data did not show a significant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed significantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups. CONCLUSIONS Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would significantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals. CITATION Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.
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Affiliation(s)
- Lene Krenk
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark
| | - Poul Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, and Centre for Healthy Ageing, Faculty of Health, University of Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark
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Staner L, Danjou P, Luthringer R. A new sublingual formulation of zolpidem for the treatment of sleep-onset insomnia. Expert Rev Neurother 2014; 12:141-53. [DOI: 10.1586/ern.11.197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Feige B, Baglioni C, Spiegelhalder K, Hirscher V, Nissen C, Riemann D. The microstructure of sleep in primary insomnia: An overview and extension. Int J Psychophysiol 2013; 89:171-80. [DOI: 10.1016/j.ijpsycho.2013.04.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 04/02/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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Srinivasan V, Brzezinski A, Pandi-Perumal SR, Spence DW, Cardinali DP, Brown GM. Melatonin agonists in primary insomnia and depression-associated insomnia: are they superior to sedative-hypnotics? Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:913-23. [PMID: 21453740 DOI: 10.1016/j.pnpbp.2011.03.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 01/20/2023]
Abstract
Current pharmacological treatment of insomnia involves the use of sedative-hypnotic benzodiazepine and non-benzodiazepine drugs. Although benzodiazepines improve sleep, their multiple adverse effects hamper their application. Adverse effects include impairment of memory and cognitive functions, next-day hangover and dependence. Non-benzodiazepines are effective for initiating sleep but are not as effective as benzodiazepines for improving sleep quality or efficiency. Furthermore, their prolonged use produces adverse effects similar to those observed with benzodiazepines. Inasmuch as insomnia may be associated with decreased nocturnal melatonin, administration of melatonin is a strategy that has been increasingly used for treating insomnia. Melatonin can be effective for improving sleep quality without the adverse effects associated with hypnotic-sedatives. Ramelteon, a synthetic analog of melatonin which has a longer half life and a stronger affinity for MT1 and MT2 melatonergic receptors, has been reportedly effective for initiating and improving sleep in both adult and elderly insomniacs without showing hangover, dependence, or cognitive impairment. Insomnia is also a major complaint among patients suffering from depressive disorders and is often aggravated by conventional antidepressants especially the specific serotonin reuptake inhibitors. The novel antidepressant agomelatine, a dual action agent with affinity for melatonin MT1 and MT2 receptors and 5-HT2c antagonistic properties, constitutes a new approach to the treatment of major depressive disorders. Agomelatine ameliorates the symptoms of depression and improves the quality and efficiency of sleep. Taken together, the evidence indicates that MT1/MT2 receptor agonists like ramelteon or agomelatine may be valuable pharmacological tools for insomnia and for depression-associated insomnia.
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Affiliation(s)
- Venkatramanujan Srinivasan
- Sri Sathya Sai Medical Educational and Research Foundation, Prsanthi Nilayam, Plot-40 Kovai Thirunagar, Coimbatore-641014, India
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Parrino L, Ferri R, Bruni O, Terzano MG. Cyclic alternating pattern (CAP): the marker of sleep instability. Sleep Med Rev 2011; 16:27-45. [PMID: 21616693 DOI: 10.1016/j.smrv.2011.02.003] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 11/16/2022]
Abstract
Cyclic alternating pattern CAP is the EEG marker of unstable sleep, a concept which is poorly appreciated among the metrics of sleep physiology. Besides, duration, depth and continuity, sleep restorative properties depend on the capacity of the brain to create periods of sustained stable sleep. This issue is not confined only to the EEG activities but reverberates upon the ongoing autonomic activity and behavioral functions, which are mutually entrained in a synchronized oscillation. CAP can be identified both in adult and children sleep and therefore represents a sensitive tool for the investigation of sleep disorders across the lifespan. The present review illustrates the story of CAP in the last 25 years, the standardized scoring criteria, the basic physiological properties and how the dimension of sleep instability has provided new insight into pathophysiolology and management of sleep disorders.
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Affiliation(s)
- Liborio Parrino
- Sleep Disorders Center, Department of Neurosciences, University of Parma, Italy
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Pinto LR, Alves RC, Caixeta E, Fontenelle JA, Bacellar A, Poyares D, Aloe F, Rizzo G, Minhoto G, Bittencourt LR, Ataide L, Assis M, Pradella-Hallinan M, Pinto MCR, Rodrigues RND, Hasan R, Fonseca R, Tavares S. New guidelines for diagnosis and treatment of insomnia. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 68:666-75. [PMID: 20730332 DOI: 10.1590/s0004-282x2010000400038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/18/2010] [Indexed: 11/22/2022]
Abstract
The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.
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Terzano MG, Parrino L. Neurological perspectives in insomnia and hyperarousal syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2010; 99:697-721. [PMID: 21056224 DOI: 10.1016/b978-0-444-52007-4.00003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Abstract
The almost ubiquitous sleep disturbances in patients with depression commonly, but not always, subside with the remission of depression. Evidence linking insomnia with the risk of relapses in recurrent depression, as well as suicide, makes optimization of the treatment of insomnia associated with depression a priority. However, most antidepressant agents do not adequately address the sleep complaints in depression: their effects on sleep range from sizeable improvement to equally significant worsening. One approach to the management of insomnia associated with depression is to choose a sedating antidepressant agent such as trazodone, mirtazapine or agomelatine. A second approach is to start with a non-sedating antidepressant (e.g. the selective serotonin reuptake inhibitors, bupropion, venlafaxine or duloxetine); those with a persistent or treatment-emergent insomnia can be switched to a more sedating antidepressant, or offered a hypnotic or cognitive-behavioural therapy as adjunctive treatment. The review discusses the advantages and disadvantages of all treatment options, pharmacological and otherwise.
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Affiliation(s)
- Ripu D Jindal
- University of Ottawa School of Medicine, Ottawa, Ontario, Canada.
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Grimaldi D, Provini F, Vetrugno R, Antelmi E, Donadio V, Liguori R, Pierangeli G, Cortelli P, Montagna P. Idiopathic central sleep apnoea syndrome treated with zolpidem. Neurol Sci 2008; 29:355-7. [PMID: 18941940 DOI: 10.1007/s10072-008-0995-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 07/10/2008] [Indexed: 11/25/2022]
Abstract
We report the case of a 47-year-old man with idiopathic central sleep apnoeas recurring during wake-sleep transitions at night or at diurnal naps. Symptoms associated with central apnoeas were sudden awakening with shortness of breath, sleep fragmentation and daytime tiredness. Following the failure of CPAP and BiPAP, we treated the patient with zolpidem which reduced central apnoea events, improved sleep and eliminated the patient's nocturnal disturbing symptoms. Beneficial effects were still present after two years of treatment. Our case demonstrates that zolpidem may be beneficial in the long term treatment of idiopathic central sleep apnoea syndrome.
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Affiliation(s)
- Daniela Grimaldi
- Department of Neurological Sciences, University of Bologna, Via U. Foscolo 7, Bologna, Italy.
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