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PubMed1985

Drug treatment of insomnia: indications and complications.

The evaluation and treatment of sleep disorders represent an important area of research and clinical practice. Attempts to improve disturbed sleep are often needed, and treatment of the primary disorder associated with the insomnia, rather than the symptom of sleep disturbance, is always desirable. Our insight into sleep physiology and homeostasis is, however, rather limited. There may be several causative factors behind sleeping problems, and the treatment must be chosen accordingly. Of the drugs marketed, benzodiazepines are the drugs of choice, but other types of drugs are often useful in selected patients. The pharmacological profiles of the various types of benzodiazepines differ markedly from one another. The rate of distribution of the drug determines the duration of effects after a single dose whereas the elimination half-life is the determining factor during continuous intake. A treatment programme based on the individual patient and the type of sleep disturbance is usually necessary. An understanding of the quality and occurrence of such phenomena as carry-over, withdrawal and rebound effects as well as dependence problems reduces treatment complications and unnecessary use of sleeping pills. A good patient/doctor relationship is also needed to minimize the potential risks as well as the unnecessary use of hypnotic drugs.

Benzodiazepines↗

PubMed2005

Insomnia, depression and anxiety disorders and their association with benzodiazepine drug use among the community-dwelling elderly: implications for mental health nursing.

Benzodiazepine (BZD) drug use among seniors is an important public health issue because the benefit from their use is moderate and of short duration and numerous adverse events have been linked to their use. Furthermore, there is a significant discrepancy between the prevalence of mental health disorders and BZD drug use in the elderly population, which can be attributed to a measurement issue. The goal of this cross-sectional descriptive study was to determine the prevalence of mental health disorders among seniors using BZD and living in the community, basing this information on both a thorough face-to-face interview and a pair of self-reported validated instruments. Among the 216 seniors recruited in our study, nearly 20 % were users of BZD and over three quarters of them had been using this drug for more than a year. Thirteen subjects were recognized as depressed according to a self-report measure compared to 18 according to the interview. Likewise, 13 seniors were categorized as anxious, based on a self-report questionnaire compared to 39 based on the interview. Among self-reported measures of mental health variables, logistic regression indicated that insomnia increases by 7 the likelihood of using BZD (odds ratio: 7.2) and is the only statistically significant variable associated with BZD consumption. Based on thorough interviews, logistic regression showed that insomnia (odds ratio: 6.9) is still the dominant symptom associated with BZD drugs. In conclusion, our results clearly support the assertion that mental health status is influenced according to how it is measured. Finally, nurses should be aware that not all individuals are capable of expressing their mental health problems using either psychological or emotional terminologies. They may opt for expressing their psychological suffering as a physical symptom such as sleeping problems.

Aged↗

PubMedDate not supplied

Diagnosis of obstructive sleep apnea.

The diagnosis of obstructive sleep apnea is frequently made by taking a meticulous history coupled with a high index of suspicion. Snoring and hypersomnolence are clinical features common to individuals with sleep apnea. Since snoring is said to be a "disease of listeners," it is not uncommon that bed partners reported an increased incidence of depression and marital displeasure. It is for this reason that the spouse or bed partner should be interviewed, since the patient may not be aware of any sleeping problems. Physicians should also be alert to complaints of excessive daytime somnolence, because studies have shown that patients with obstructive sleep apnea are at increased risk for automobile crashes. It has been estimated that approx 58,000 motor vehicle accidents involving people with sleep apnea will occur in the US each yr. By proper diagnosis and treatment, the physician is in a unique position to prevent at least some of the automobile accidents that result from falling asleep while driving. Polysomnography is the only definitive way to obtain a diagnosis of sleep apnea. This allows the physician not only to diagnosis the disorder, but also helps in the evaluation of the severity of the syndrome and selection of therapy. An ENT evaluation is also important in ruling out anatomic disorders that can cause upper airway obstruction. Certain factors, such as alcohol and sedative ingestion, may aggravate the condition in a person predisposed to sleep apnea, and subtle changes, such as unexplained hypertension, polycythemia, and cor pulmonale, should lead one to investigate the possibility of sleep apnea as the etiology.

Disorders of Excessive Somnolence↗

PubMed2006

Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia.

We examined between and within-person variability, affective correlates, and diagnostic differences in daily fatigue in women with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia syndrome (FMS). Two hundred and fifty-five female patients recruited from the community served as participants for this project. The patients had a physician-confirmed diagnosis of RA (n=89), OA (n=76), or FMS (n=90). Individuals completed an initial questionnaire and up to 32 daily diaries assessing illness symptoms and psychosocial variables (i.e., fatigue, pain, sleep problems, depression, and affect). The primary outcome for the current project was variability in fatigue. We examined affective, pain, and sleep correlates of fatigue, and tested whether these relations varied by diagnosis. Results indicated that FMS patients had higher overall levels of and greater daily variability in fatigue compared with the other pain groups. For all patients, fatigue correlated highly with lower positive affect (PA). Moreover, day-to-day increases in fatigue were associated with decreases in PA, particularly among FMS patients, and with increases in negative affect (NA). Daily pain was associated with increased fatigue in all groups, although OA patients showed less pain reactivity than either FMS or RA patients. These findings indicate that fatigue is a common feature of rheumatologic conditions. Nonetheless, there are important differences between RA, OA, and FM patients in both the everyday manifestations and the biopsychosocial correlates of fatigue.

Activities of Daily Living↗

PubMed1998

Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids.

BACKGROUND: Allergic rhinitis (AR) is a frequent disease affecting up to 20% of the population. AR causes a hypersensitivity reaction, which results in inflamed nasal mucosa and nasal congestion. Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse, airway obstruction, and an increased number of sleep microarousals. Sleep disturbances and microarousals can detrimentally affect daytime energy levels, mood, and daytime function. It is unknown whether treatment directed to reduce congestion may reduce these microarousals, sleep problems, and, consequently, associated daytime fatigue. OBJECTIVE: We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints and daytime sleepiness. METHOD: We enrolled 20 subjects in a double-blind, placebo-controlled study using Balaam's Design. Patients were treated with topical nasal corticosteroids or placebo. Subjective data were collected by use of a daily diary, which focused on nasal symptoms, sleep, and daytime sleepiness. RESULTS: The results demonstrated that nasal congestion and subjective sleep improved significantly in the topical corticosteroid-treated subjects but not in the placebo group. Sleepiness improved, but not significantly (p = 0.08). CONCLUSION: Often, people with perennial allergies may attribute their daytime fatigue to causes such as the side effects of medications, when in fact, the fatigue may be a result of nasal congestion and associated sleep fragmentation. Decreasing nasal congestion with nasal steroids may improve sleep, daytime fatigue, and the quality of life of patients with AR.

Administration, Topical↗

PubMedDate not supplied

Correlates of sleep behavior among hemodialysis patients. The kidney outcomes prediction and evaluation (KOPE) study.

BACKGROUND: Given the importance of sleep to overall physical and mental well-being, we sought to identify the correlates of seven sleep disturbances in a cross-sectional study of a biracial population of male and female patients treated with hemodialysis. METHODS: Univariate and multivariate analyses of a cohort study of adult patients with end-stage renal disease. Demographic, psychosocial, clinical, and health and physical functioning variables were included. RESULTS: Waking up during the night (57%) and waking up too early (55%) were the most commonly reported sleep problems. Multivariate analyses consistently indicated that levels of pain, depressive symptoms, and physical functioning were consistently associated with the seven sleep disturbances. CONCLUSION: Sleep disturbances are common in patients with end-stage renal disease. Physical and mental well-being were consistently related to the seven sleep disturbances.

Activities of Daily Living↗

PubMed2001

Sleep abnormalities during abstinence in alcohol-dependent patients. Aetiology and management.

Virtually every type of sleep problem occurs in alcohol-dependent patients. Typically, these individuals take a longer time to fall asleep and show decreased sleep efficiency, shorter sleep duration and reduced amounts of slow wave sleep when compared with healthy controls. Their sleep patterns are fragmented, and the typical time course of electroencephalogram (EEG) delta wave activity is severely disrupted. The amount of rapid eye movement (REM) sleep may be reduced or increased. Sleep changes can persist during months or years of abstinence, and recent studies indicate that certain alterations in sleep architecture, as well as subjective sleep complaints, predict relapse to alcoholism. The mechanisms of action of short and long term alcohol administration on sleep are incompletely understood. They may arise from an interaction with gamma-aminobutyric acid (GABA), serotonin (5-hydroxytryptamine; 5-HT), adenosine or other neurotransmitter systems. While only a few pharmacological and nonpharmacological strategies to improve or normalise disturbed sleep in individuals who have recovered from alcoholism have been studied, the use of benzodiazepines, other hypnosedatives or selective serotonin reuptake inhibitors is not recommended. Therapies include sleep hygiene, bright light therapy, meditation, relaxation methods, and other nonpharmacological approaches. Further studies are needed to clarify the relationship between sleep, sleep abnormalities and alcoholism, and to establish new approaches to improve sleep in alcohol-dependent patients and to prevent withdrawal reactions that affect sleep during abstinence.

Alcoholism↗

PubMed2005

An epidemiologic review on occupational sleep research among Japanese workers.

Epidemiologic sleep research on Japanese workers has been increasing in recent years. It is timely to give an overview of the sleep issues facing the Japanese working population by reviewing the accumulated epidemiological evidence, which will contribute to the promotion of a sound occupational health policy and the development of occupational sleep research in epidemiology. This paper reviews 24 studies, 13 for non-shift and 11 for shift Japanese workers, identified by using MEDLINE and Japan Cetra Revuo Medicina. The results reviewed are as follows: 1) the prevalence of insomnia and other sleep problems is substantially varied, 5 to 45% for non-shift and 29 to 38% for shift workers, 2) poor sleep quality is related to health, occupational activities and personal relations, 3) the risk or associated factors are identified in pathophysiology (e.g., hypertension), lifestyle behaviors (e.g., diet, alcohol, tobacco), job-related conditions (e.g., job stress, social support, job dissatisfaction, workload, shift schedules) and psychopathology (e.g., depressed mood). The methodological limitations found in the studies and the strategies of future epidemiologic sleep research in workers are discussed.

Epidemiologic Studies↗

PubMed1993

Sleep and heart rate circadian rhythm in depression: the necessity to separate.

In order to determine whether a decrease in the amplitude of heart rate circadian rhythm (HRCR) could represent a chronobiological marker of depression and to answer the question of the possible role of this alteration in the reduction of rapid eye movement sleep latency (REM latency) observed in depression, 22 major depressed patients (DSM III R, Montgomery Asberg Depression Rating Scale) and 11 healthy volunteers entered this study, which included the simultaneous recordings of sleep and heart rate (HR) during two consecutive 24-h periods. After a smoothing procedure, the HR data, obtained from a portable device providing mean HR/min, were computed with the single cosinor method for the classical circadian parameters. We also determined the cosinor fitting index (CFI = percentage to fit). When studied as a single group and compared to the control group, the depressed patients, who had difficulties in sleep initiation and whose REM latencies were within normal limits, were characterized by a dampening of the amplitude HRCR and of the day-night HR difference. This was linked to a lesser increase of HR during the day and a reduced decrease at night. No significant phase modification of HRCR was observed in this group of depressives. In a second step, the depressives were divided into a depressed arrhythmic group (DAG, CFI < 50%, 11 patients) and a depressed rhythmic group (DRG, CFI > 50%, 11 patients) who did not differ on MADRS scores. Even though the amplitude of HRCR was reduced in the DAG only, with HR higher at night and lower during the daytime than for controls, both DAG and DRG significantly differed from controls on those items related to sleep induction and maintenance. In the DAG only was there a tendency toward a reduction of total sleep time and REM sleep time while REM latency was normal. This finding suggests that sleep problems are not responsible for the differences in HRCR parameters between the two depressed groups. These differences in HR and sleep parameters between two groups of similarly depressed patients also suggest that a short REM latency does not systematically imply a disruption of all circadian clocks.

Adult↗

PubMed2000

Three young children with Smith-Magenis syndrome: their distinct, recognisable behavioural phenotype as the most important clinical symptoms.

We report on the development and behaviour of three young children with Smith-Magenis syndrome (SMS), del 17p11.2. The behaviour problems and the psychomotor delay in preschool children with SMS are often more striking than the dysmorphic features and can serve as a useful clue to the diagnosis. We compare the behaviour with reported data. The behaviour problems in the three four year olds include very demanding behaviour, severe temper tantrums, hyperactivity, aggressive behaviour, self injurious behaviour, sleeping problems and stereotypic behaviour. Head banging, hand, wrist or finger biting are present. Onychotyllomania is not observed. Insertion of objects in the mouth as well as excessive nose picking is very frequent, although polyembolokoilomania is not present. The so called self hug when excited is present in one child. The behaviour problems and psychomotor delay represent a major management problem for the parents.

Child↗

PubMed1990

Napping and sleep disturbances in the elderly.

Elderly patients often describe sleep problems that present diagnostic dilemmas. This study sought to clarify the relationship between patients' reports of daytime napping and nocturnal sleep disturbances by surveying 132 older adults (ages 58-95). Prevalence, frequency, and duration of napping were analyzed with respect to (a) age and sex, and (b) indicators of nocturnal sleep disturbance, including awakenings, latency to sleep onset, and subjective estimates of sleep quality. Age had the greatest effect on napping, with older subjects taking more frequent and longer naps. Although a non-significant trend suggested that the duration of naps may be associated with increased difficulty initiating nocturnal sleep, no significant relationship was observed between any reported napping dimension and indicators of nocturnal sleep difficulty except for a small subgroup who used pharmacologic sleep aids.

Aged↗

PubMed2005

How do topical nasal corticosteroids improve sleep and daytime somnolence in allergic rhinitis?

Therapy for rhinitis improves sleep quality and symptoms of daytime sleepiness. This improvement with therapy may be secondary to anti-inflammatory effects, leading to a reduction of inflammatory mediators, or to a mechanical reduction of congestion directly leading to improvement in sleep disturbance. We combined our data from 3 placebo-controlled studies of intranasal corticosteroids in patients with perennial rhinitis to determine whether a correlation between the reduction of congestion and improved sleep and daytime somnolence existed. The pooled data of budesonide, flunisolide, and fluticasone demonstrated significantly decreased nasal congestion, sleep problems, and sleepiness in treated patients. The data demonstrated a correlation between a reduction in nasal congestion and an improvement of sleep (P < .01) and daytime somnolence (P = .01). Thus, topical intranasal corticosteroids should be used to decrease nasal congestion and to improve sleep and daytime somnolence in patients manifesting these symptoms.

Administration, Intranasal↗

PubMed2004

How do individuals sleep around the world? Results from a single-day survey in ten countries.

BACKGROUND AND PURPOSE: To describe between-country differences in both the prevalence and type of sleep disorders seen across the globe, and to provide information on how impaired sleep impacts daytime functioning. PATIENTS AND METHODS: The study is a large-scale, global cross-sectional survey conducted on International Sleep Well Day (March 21), 2002. A standardized questionnaire was used in 10 countries under the guidance of local survey managers. In addition, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were completed. Subjects included in the study were adults from 10 countries representing different continents with clear variations in lifestyle. RESULTS: The total number of questionnaires collected was 35,327. Overall, 24% of subjects reported that they did not sleep well. According to self-assessments using the AIS, 31.6% of subjects had 'insomnia', while another 17.5% could be considered as having 'sub-threshold insomnia'. According to ESS scores, 11.6% of subjects were found to be 'very sleepy' or 'dangerously sleepy' during the day. CONCLUSIONS: Although there seem to be important global variations in the prevalence of insomnia, its symptoms and their management, about one in four individuals do not think they sleep well. Moreover, self-reported sleep problems could be underestimated in the general population. Overall, there is a need for increased awareness of the importance of disturbed sleep and the improved detection and management of sleep disorders.

Aging↗

PubMedDate not supplied

Creation and analysis of a computerized database of interventions to facilitate adult sleep.

BACKGROUND: Although sleep problems are a frequent complaint of ill and older adults, there is no ready source of continually updated scientific knowledge about sleep promotion interventions used by nurses. OBJECTIVES: To create a database of sleep promotion research and to describe the nature and strength of studies about nursing interventions used to promote sleep in adults. METHODS: Computer, hand, ancestry, and author searches were used to identify nursing and related-discipline studies of sleep promotion in adults. An experimental software program, arcs, was used to store, retrieve, examine, and summarize sleep research findings. RESULTS: Twelve interventions within the basic scope of nursing practice were identified. All were nonpharmacologic. Interventions were grouped according to their presumed mechanism of action: 1) to relax the sleeper, 2) to manage noise, 3) to re-pattern the sleep-wake schedule, or 4) to inform the sleeper about sleep hygiene. CONCLUSIONS: The research base underpinning sleep promotion practices in nursing is sparse. The use of relaxation approaches to promote sleep in those with chronic insomnia has the most support. Extensive research involving other interventions and populations is needed. As more studies become available, they can be added to the computer database, thus facilitating dissemination of scientific knowledge to guide nursing practice.

Adult↗

PubMedDate not supplied

Diagnosis and management of insomnia in dialysis patients.

Sleep-related complaints affect 50-80% of patients on dialysis. Sleep disorders impair quality of life significantly. Increasing evidence suggests that sleep disruption has a profound impact both on an individual and on a societal level. The etiology of sleep disorders is often multifactorial: biologic, social, and psychological factors play a role. This is especially true for insomnia, which is the most common sleep disorder in different populations, including patients on dialysis. Biochemical and metabolic changes, lifestyle factors, depression, anxiety, and other underlying sleep disorders can all have an effect on the development and persistence of sleep disruption, leading to chronic insomnia. Insomnia is defined as difficulty initiating or maintaining sleep, or having nonrestorative sleep. It is also associated with daytime consequences, such as sleepiness and fatigue, and impaired daytime functioning. In most cases, the diagnosis of insomnia is based on the patient's history, but in some patients objective assessment of sleep pattern may be necessary. Optimally the treatment of insomnia involves the combination of both pharmacologic and nonpharmacologic approaches. In some cases acute insomnia resolves spontaneously, but if left untreated, it may lead to chronic sleep problems. The treatment of chronic insomnia is often challenging. There are only a few studies specifically addressing the management of this sleep disorder in patients with chronic renal disease. Considering the polypharmacy and altered metabolism in this patient population, treatment trials are clearly needed. This article reviews the diagnosis of sleep disorders with a focus on insomnia in patients on dialysis.

Chronic Disease↗

PubMed2004

Sociodemographic profile of insomniac patients across national surveys.

INTRODUCTION: A survey of 2121 insomniac patients was conducted in France, Germany, Italy and the United Kingdom. DESIGN: The survey collected data on the sociodemographic and clinical features of the subjects by interview, as well as on healthcare resource utilization. A complementary analysis of physician attitudes to insomnia provided insights into the types of treatment prescribed and expectations of medical treatment. RESULTS: Slightly more women than men reported insomnia, but the difference was not significant. The age distribution of insomniac patients varied from country to country. Insomnia was more frequent in the unemployed and in those individuals living alone. The most frequently cited causes of insomnia were stress, loneliness and bereavement. Insomnia was usually reported as chronic, and frequently as episodic. Frequently cited symptoms were poor sleep quality, interrupted sleep, early awakening, difficulties in getting to sleep and daytime fatigue. CONCLUSIONS: Many individuals hesitate to consult their doctor about insomnia, whereas physicians question their patients about possible sleep problems relatively infrequently and systematically underestimate the severity of insomnia and the resulting functional impairment. Physicians frequently recommended lifestyle changes and sleep hygiene measures to patients complaining of insomnia. Hypnotic agents were the most frequently prescribed class of medication. Patient satisfaction with treatment was relatively high.

Adult↗

PubMed2006

[Application of music therapy for managing agitated behavior in older people with dementia].

Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia.

Aged↗

PubMed1990

[Physical and psychosocial sequelae of total larynx extirpation and the use of a heat and moisture exchanger].

The incidence and severity of respiratory symptoms after total laryngectomy and their influence on everyday life were studied in 59 patients. Almost all patients (98%) have daily complaints of excessive sputum production and 64% of coughing. More than half the patients (57%) use forced expectoration more than 5 times a day in order to clear the airways and 37% have to clean the stoma more than 5 times a day. Respiratory problems appear to impair the quality of the voice, social contacts and psychological wellbeing and are associated with increased fatigue and sleep problems. In a prospective study the effect of a heat and moisture exchanger (HME) was measured in 42 patients. The frequency of sputum production, forced expectoration to clear the airways and stoma cleaning diminished significantly. As a result, feelings of fatigue decreased and social contacts improved. Respiratory problems after total laryngectomy deserve more attention. Treatment with an HME can in selected cases improve several other physical and psychosocial problems associated with this operation.

Adaptation, Psychological↗