Bonnet , Donna L. Core body temperature is elevated during constant wakefulness in elderly poor sleepers. Kurt Lushington , Drew Dawson , L.
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Evaluation of Chronic Insomnia Michael J. Sateia , Karl Doghramji , Peter J. Hauri , Charles M. Occupational and environmental toxicology of mercury and its compounds. Hidetoshi Satoh.
Diagnosis and treatment of insomnia. Lamotrigine associated with insomnia. Mark Sadler. Heart rate variability in insomniacs and matched normal sleepers. Sleep disturbance in healthy middle-aged women. Jane F. The prevalence of hypnotic usage, i. A UK study reported an increase in hypnotic usage from 0. A German study described the prevalence of having taken a hypnotic, at least once, increased from 4. In general, it is not clear how many patients with insomnia in Europe regularly take hypnotics — further research is necessary to determine the exact scale of this issue.
However, the association between a short sleep duration and insomnia is not yet fully understood. Significant evidence has been gathered with respect to the relationship between insomnia and mental disorders Riemann and Voderholzer, This study ranked sleep disorders ninth among all neuropsychiatric disorders with respect to direct and indirect costs. Thus, it can be concluded that insomnia represents a high financial burden to European healthcare systems, either through direct costs, i. Relaxation therapy. Relaxation therapy includes clinical procedures aimed at reducing somatic tension e.
Behavioural strategies sleep restriction, stimulus control. For example, if a patient with insomnia reports sleeping 6. On a weekly basis, adjustments to this sleep window are made. Cognitive therapy. Cognitive strategies are psychological methods designed to identify, challenge and change misconceptions about sleep and faulty beliefs about insomnia and its perceived daytime consequences Morin and Espie, These strategies include methods aimed at reducing or preventing excessive monitoring of, and worrying about, insomnia and its correlates or consequences.
Other psychotherapeutic approaches. Hypnotherapy is also conceived as a mind—body intervention bearing similarities to meditation techniques. As will be discussed in more detail in the section on hypnotics, the placebo effect needs to be noted in the context of the efficacy of psychotherapy. Thus, due to this methodological difficulty, psychotherapy studies may overestimate treatment efficacy. Several overviews of hypnotics for insomnia have been published Riemann and Nissen, This finding held true for both subjectively and polysomnographically measured sleep parameters.
It should be noted that dosages for antidepressants to treat insomnia are usually much lower than the recommended doses for depression. Only a few randomized controlled trials have evaluated the efficacy of these mostly sedating antidepressants.
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The authors of these publications came unanimously to the conclusion that the methodological quality of the studies included was poor and further studies are warranted. However, the effects were small from a clinical point of view. Of particular importance for the current guideline, both light therapy and exercise have also been suggested to be efficacious in patients with insomnia. While moderately positive effects were shown on several sleep parameters, it has to be stressed that most original studies did not focus on clinically relevant insomnia. Given the fact that both light therapy and exercise are supported by extensive basic and public health research, further studies should be devoted to delineate their effects in patients with insomnia.
In the area of complementary and alternative medicine, several treatments for insomnia have been suggested, including acupuncture, acupressure, aromatherapy, foot reflexology, homeopathy, meditative movement therapies, moxibustion, music therapy and yoga. Overall, the studies underlying this evidence are methodologically poor and thus difficult to evaluate. However, evaluation of the studies on this topic is difficult for the authors of this guideline because most of the original articles are published in Chinese.
There is no evidence supporting the efficacy of aromatherapy or homeopathy. However, the methodological quality of these studies is questionable. A similar picture arises for foot reflexology, moxibustion and meditative movement therapies, including yoga. However, in some studies the effects decreased over time. Moreover, it has to be noted that some of the investigated substances, i. As such, sleep restriction therapy can only be recommended without restrictions when there are no safety concerns, for example, sleep restriction may be contraindicated in professional drivers.
However, there are little data available on the number of patients who will become dependent when taking BZ or BZRA for a certain period of time. A combination of alcohol use and BZ intake further increases the risk for accidents.
Of note, sedating antidepressants also increase the risk of accidents. These authors showed that the occasional intake of BZ was associated with an increase in mortality. These studies also showed an increased mortality in those using psychotropic agents. Additionally, a clinical algorithm for the diagnostic and therapeutic process is summarized in Fig. Please note that these recommendations largely correspond to the guidelines for insomnia treatment of the American College of Physicians ACP, Substances like trazodone, tiagabine, diphenhydramine, melatonin, tryptophan and valerian were explicitly not recommended in this guideline.
It is assumed that only a minority of patients with chronic insomnia will receive this treatment in Europe. Thus, more work is necessary to dismantle the effects of these components in randomized controlled studies. It would be especially helpful to know before the first prescription, which patient will abuse these substances or become dependent on them. Newer hypnotic drugs like ramelteon or suvorexant have been introduced into the healthcare system of the USA, but not in Europe. In particular, it remains an open question whether the orexin receptor antagonists will be available on the European market in the near future.
Light therapy has clear effects on several biological parameters.
Clinical Handbook of Insomnia (2017)
In this context it is also suggested that further research into circadian underpinnings of insomnia might be helpful to gain new insights into its pathophysiology. However, the efficacy for those with insomnia remains to be seen. However, whether it has specific effects on insomnia remains unclear. Very new treatments include brain cooling and electrostimulation. Further research needs to be conducted and published on the efficacy of these treatments. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors.
Any queries other than missing content should be directed to the corresponding author for the article. Volume 26 , Issue 6. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Journal of Sleep Research Volume 26, Issue 6. European insomnia guideline Free Access. Dieter Riemann Corresponding Author E-mail address: dieter.
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Clinical Handbook of Insomnia | Hrayr P. Attarian | Springer
Summary This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. Insomnia Aetiology and pathophysiology This guideline primarily targets insomnia as an independent disorder, and not as an isolated symptom or a syndrome closely related to, or even directly caused by, other somatic or mental disorders.
Disturbance of sleep onset or sleep maintenance, or poor sleep quality. The afflicted individuals focus extremely on their sleep disorder especially during the night and worry about the negative consequences of insomnia. The insufficient sleep duration and quality is coupled with a high degree of suffering or impairs daily activities. The patient reports, or the patient's parent or caregiver observes, one or more of the following: Difficulty initiating sleep.
Difficulty maintaining sleep. Waking up earlier than desired. Resistance to going to bed on appropriate schedule. Difficulty sleeping without parent or caregiver intervention. Attention, concentration or memory impairment. Impaired social, family, occupational or academic performance. Daytime sleepiness. Behavioural problems e. Concerns about or dissatisfaction with sleep. The sleep disturbance and associated daytime symptoms occur at least three times per week. Medical history and examination strong recommendation The anamnesis should include caregivers if necessary Former and present somatic disorders including pain Substance use medication, alcohol, caffeine, nicotine, illegal drugs Physical examination Additional measures if indicated : laboratory testing including, e.
Pharmacotherapy Several overviews of hypnotics for insomnia have been published Riemann and Nissen, Complementary and alternative medicine In the area of complementary and alternative medicine, several treatments for insomnia have been suggested, including acupuncture, acupressure, aromatherapy, foot reflexology, homeopathy, meditative movement therapies, moxibustion, music therapy and yoga.
ESZ: Figure 1 Open in figure viewer PowerPoint. Clinical algorithm for the diagnosis and treatment of insomnia. Positive results in any of these areas should lead to corresponding interventions i. Abbott, S.
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