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At least 919 records · Page 51Linked to original sources

PubMed2003

Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial.

OBJECTIVE: To evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug users in general practice. DESIGN: A pragmatic randomised controlled trial with two treatment arms (a CBT treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments commencing at 3 and 6 months. SETTING: Twenty-three general practices in Sheffield, UK. PARTICIPANTS: Two hundred and nine serially referred patients aged 31-92 years with chronic sleep problems who had been using hypnotic drugs for at least 1 month (mean duration = 13.4 years). RESULTS: At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). Older age presented no barrier to successful treatment outcomes. The total cost of service provision was 154.40 per patient, with a mean incremental cost per quality-adjusted life-year of 3416 (at 6 months). However, there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilisation of primary care services. CONCLUSIONS: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favourable cost among long-term hypnotic users with chronic sleep difficulties.

Adult↗

PubMed2000

Survey into health problems of elderly people: a comparison of self-report with proxy information.

BACKGROUND: This study was conducted as part of the Medical Research Council Cognitive Function and Ageing Study. OBJECTIVE: To compare information given by elderly people on their past and current health and family history of illness with similar information obtained from a relative, friend or carer. DESIGN: Screening and assessment stages of a prevalence study. SETTING: Three urban and two rural areas of England and Wales. PARTICIPANTS: A subsample weighted by age and cognitive status of random population samples of people >/=65 years, living in their own home or in a residential or nursing home, interviewed between 1991 and 1994. A relative, friend or carer identified by each elderly person to provide proxy information. INTERVIEW: Computerized schedules including items on demographic details, cognitive function, lifetime illnesses, current health problems and family history of illness. RESULTS: The rate of proxy 'don't know' responses and the agreement between the elderly person and their proxy were calculated for each item, both for the overall sample and for subgroups based on characteristics of the respondent and of the proxy and on the relationship between them. Higher 'don't know' rates were found to be particularly associated with more distant relationships, questions on family history, a shorter length of time known and a lack of co-residence. Agreement was strongly related to the nature of the question and less to co-residence, with other factors such as relationship having much smaller effects. CONCLUSIONS: Proxy information on past and current health problems can be almost complete and in good agreement with self-report, particularly where the proxy lives with the respondent. On family history of illness, history of head injury or boxing and current sleep problems, proxy information is likely to be less complete and show poor agreement. A proxy who is not a close relative is likely to give less complete information but agreement will not be substantially lower.

Aged↗

PubMed2002

Sleep disorders in Parkinson's disease: epidemiology and management.

Sleep problems are an under-emphasised cause of disability in Parkinson's disease (PD) and may be seen independently of PD, associated with primary PD pathology, or as a result of antiparkinsonian medications. Common sleep disorders include excessive daytime sleepiness, rapid eye movement (REM) sleep behaviour disorder, night-time wakefulness and restless legs syndrome. A number of strategies may be used to improve sleep cycle disturbances, and often these interventions do not require pharmacological manipulation. Restoring traditional mealtimes and scheduling activities during predicted periods of sleepiness may help alleviate daytime somnolence; the use of controlled-release levodopa preparations or administration of a catechol-O-methyl transferase (COMT) inhibitor with levodopa at bedtime may reduce periods of night-time wakefulness. Administration of clonazepam at bedtime may assist with REM sleep behaviour disorder but, because this agent can result in daytime somnolence, experimentation with dosage times is recommended. Sleep attacks are described as a sudden, unavoidable transition from wakefulness to sleep and, although rare, have been described with pramipexole, ropinirole and other dopamine agonists. Although the condition has yet to be recognised by the International Association of Sleep Disorders, patients with PD who report rapid sleep onset should be evaluated for the possibility of sleep attacks. If sleep attacks are suspected, it is reasonable to strongly caution patients regarding potentially risk-associated activities such as driving, and to consider careful withdrawal of dopaminergic therapy.

Antiparkinson Agents↗

PubMedDate not supplied

Development and evaluation of the Sleep Treatment and Education Program for Students (STEPS).

University students report significantly worse sleep quality than the general population. Sleep problems are related to increased health concerns, irritability, depression, fatigue, and attention and concentration difficulties, along with poor academic performance. Clinical research indicates that psychoeducational interventions are among the most effective methods for improving sleep quality in the general population. Similar studies for university students are lacking. In this study, the authors describe the development of the Sleep Treatment and Education Program for Students (STEPS) and evaluate its effectiveness with a double blind, experimental design. Students in the treatment group reported significantly improved sleep quality and sleep hygiene behaviors at 6 weeks posttreatment.

Adolescent↗

PubMed2005

Depression and anxiety complaints; relations with sleep disturbances.

Objectives were to assess the relations of various sleep complaints with depressive and anxiety complaints in a non-clinical population. Four-hundred-and-two randomly approached adults received three questionnaires. Results showed a high interrelatedness between sleep and depressive/anxiety complaints. Both assessment and treatment of depressive and anxiety complaints should address sleep problems.

Anxiety↗

PubMed2004

Sleep patterns in college students: gender and grade differences.

OBJECTIVE: Since gender effect is inconsistent and grade effect has not been addressed in previous studies, we investigated both effects on the daily sleep patterns in a group of young college students. METHODS: The sample consisted of 237 students aged 18-24 years. Each subject completed a 7-day sleep log. RESULTS: Gender differences were found in several sleep variables and those were mostly not dependent on weekday/weekend difference. The female students went to bed and rose earlier and had longer sleep latency, more awakenings, and poorer sleep quality than the male. Gender differences were also shown in the relationship between sleep quality and other sleep variables. The correlation between sleep quality and rise time, time in bed, and sleep efficiency was stronger in men than in women. In contrast, grade differences were mostly dependent on weekday/weekend difference. The freshmen rose earlier and had shorter sleep time than did the other students on weekdays only. Sleep latency was the longest in seniors on weekdays only. CONCLUSION: This study showed that gender differences in sleep patterns and sleep difficulties were remarkable in the group of young college students. Alarmed by the high prevalence of sleep difficulties among general college students, it is recommended that the students should be informed of their sleep problems and the consequences.

Adolescent↗

PubMedDate not supplied

Sleep in the older adult: implications for nurses (CE).

Normal aging is accompanied by sleep pattern changes that may result in daytime sleepiness and affect the quality of life in older adults. These changes also can signal more serious sleep problems, which become more prevalent with aging. More than half of adults older than 65 living at home and about two-thirds of those in long-term care facilities have some difficulties with sleep. It is important for nurses to understand the normal changes in sleep that accompany aging and be able to differentiate them from the symptoms of serious sleep disorders to ensure holistic care for older adults.

Aged↗

PubMedDate not supplied

Physical complaints, medical service use, and social and employment changes following mild traumatic brain injury: a 6-month longitudinal study.

Using a prospective, dual-cohort study design in which selected preinjury factors were controlled, we present outcomes of 235 patients in a case cohort and 235 patients in a comparison cohort following emergency-department-diagnosed mild traumatic brain injury (MTBI). Symptoms, medical services use, and social and employment concerns were evaluated 6 months after the injury. After adjusting for preinjury characteristics, headaches, dizziness, vision difficulties, memory or learning problems, and alcohol intolerance were found to occur significantly more often in the MTBI cohort than in the comparison cohort. Problems sleeping, use of prescribed medications, and changes in employment were less likely in the MTBI cohort. Although MTBI is not life threatening, our findings suggest that 6 months after injury persons still have related health problems that require routine medical management.

Adolescent↗

PubMed2004

Psychological treatment for insomnia in the regulation of long-term hypnotic drug use.

OBJECTIVES: To evaluate the clinical and cost impact of providing, in routine general practice settings, a cognitive-behaviour therapy (CBT) package for insomnia to long-term hypnotic drug users with chronic sleep difficulties; and to identify factors associated with variations in clinical outcomes. DESIGN: A pragmatic cluster randomised controlled trial with two treatment arms (a CBT-treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments starting at 3, 6 and 12 months. SETTING: Twenty-three general practices in Sheffield, UK. PARTICIPANTS: In total, 209 patients (aged 31-92 years) with chronic sleep problems who had been receiving repeat hypnotic drug prescriptions for at least 1 month (mean = 13.4 years) were recruited into the trial. INTERVENTIONS: The intervention consisted of six 50-minute sessions as follows: introduction and sleep assessment, basic sleep hygiene, stimulus control and sleep restriction procedures, progressive relaxation, cognitive treatments, and review and discharge. MAIN OUTCOME MEASURES: These included: global sleep quality [as measured by the Pittsburgh Sleep Quality Index (PSQI)], frequency of hypnotic drug use, mean dose of hypnotics consumed, health-related quality of life [as measured by the Short-Form 36 (SF-36)], NHS service costs and overall cost utility. RESULTS: At 3- and 6-month follow-ups, patients treated with CBT showed improved global PSQI scores as well as improvements in the SF-36 dimensions of vitality at 3 months and physical functioning and mental health at 6 months. CBT-treated patients also reported reductions in the frequency of hypnotic drug use compared with the control group, with many CBT-treated patients reporting zero drug use at the follow-up assessments. Clinical improvements were maintained within the CBT group at the 12-month follow-up, with PSQI scores and the frequency of hypnotic drug use continuing to show significant reductions relative to the control group. Multiple regression analyses of PSQI scores within the sleep clinic group alone indicated that the magnitude of pre- to post-treatment change in overall sleep quality was closely related to Hospital Anxiety and Depression Scale depression scores at 3-, 6-and 12-month follow-ups. In each model higher depression scores at baseline were associated with poorer treatment outcomes. No significant relationship was found between the patient's age and PSQI outcomes in any of these analyses. Within the sleep clinic group, reductions in drug use showed no significant association with the hypnotic product consumed. At the 3-month follow-up low-frequency drug use was reported by 22.9% (8/35) of temazepam users, 33.3% (5/15) of nitrazepam users and 38.9% (7/18) of zopiclone users. The total cost of service provision was GBP154.40 per patient (1999/2000 prices). The mean incremental cost per quality-adjusted life-year (QALY) at 6 months was GBP3418; this figure was insensitive to changes in costs. A simple model also showed that extending the evaluation period beyond 6 months may improve the cost-effectiveness of CBT. The incorporation of hidden costs associated with hypnotic drug treatment (e.g. accidents) also reduces the cost per QALY ratio, although to a much lesser degree. CONCLUSIONS: In routine general practice settings, psychological treatment for insomnia can improve sleep quality, reduce hypnotic drug use, and improve health-related quality of life at a favourable cost among long-term hypnotic users with chronic sleep difficulties. These positive outcomes appear robust over time, persisting for at least 1 year among the more treatment-adherent patients. While these benefits may be reduced among those patients presenting with higher levels of psychological distress, the present study clearly indicates that older age per se presents no barrier to successful treatment outcomes. Further research should assess the long-term clinical and cost-effectiveness of psychological treatments for insomnia among non-hypnotic-using patients, and establish the minimum psychological treatment input required.

Adult↗

PubMed2000

The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children.

STUDY OBJECTIVES: To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group. DESIGN: Cross-sectional survey. SETTING: Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital. PARTICIPANTS: Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The CSHQ showed adequate internal consistency for both the community sample (p=0.68) and the clinical sample (p=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72. CONCLUSIONS: The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.

Child↗

PubMed2001

Primary care services promoting optimal child development from birth to age 3 years: review of the literature.

OBJECTIVE: To examine the evidence base for primary health care services promoting the optimal development of typically developing children aged birth to 3 years. DATA SOURCES: Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases. STUDY SELECTION: Criteria for selection were as follows: (1) publication between 1979 and 1999; (2) evaluation of efficacy or effectiveness of education, intervention, and care coordination services or validation of assessment approaches; (3) services applicable to an office practice setting; (4) target population including children aged birth to 3 years; and (5) publication in English. DATA EXTRACTION: A total of 312 publications were abstracted and reviewed by both of us; 47 were selected for inclusion. DATA SYNTHESIS: Assessments of parental concerns and psychosocial risk factors using validated approaches seem to be more accurate in identifying developmental problems than clinicians' appraisals. In general, study results support the efficacy of (1) primary care educational efforts toward promoting optimal parent-child interaction, parents' understanding of child temperament, book-sharing activities, and approaches to healthy sleep habits and (2) office interventions such as counseling for the management of excessive infant crying and sleep problems. CONCLUSIONS: The literature suggests that many primary care activities promoting the optimal development of children are efficacious. Evaluations of developmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and health care policy are discussed.

Child Development↗

PubMed2000

The effects of antidepressants on sleep in patients with depression.

This paper reviews sleep disturbances in patients with major depressive disorders and the effects of different classes of antidepressants on sleep. It is clear from the studies reviewed that not all antidepressants improve sleep, and, indeed, some worsen sleep disturbances in patients with depression. Whether sleep is improved or further disrupted is of high clinical significance, because persistent sleep problems elevate the risk of relapse, recurrence, or suicide, as well as the need for augmenting medications.

Antidepressive Agents↗

PubMed2006

Sleep, health and the dynamics of biomedicine.

This paper examines the relationship between sleep and health from a sociological perspective. Two interrelated case studies are explored: the emergence of the category of obstructive sleep apnoea syndrome, nowadays the most commonly diagnosed sleep disorder, and the shaping of continuous positive airway pressure, the therapy of choice for sleep apnoea in contemporary clinical practice. Data were gathered through a historical review of relevant literature and observation of online patient discussion groups. The examples analysed show that although the social organisation of the relationship between sleep and health can be understood as a process of medicalisation, this framework is insufficient for understanding how researchers, clinicians and patients interactively deploy the knowledge, techniques and technologies through which different 'sleep problems' are understood and managed. By exploring the generative aspects of those processes of contestation and divergence within biomedicine it is possible to initiate a re-evaluation of the role of patients' identity in the transformation of sleep medicine and associated health technologies.

Biomedical Research↗

PubMed2003

Double-blind, placebo-controlled study of the efficacy of trazodone in alcohol post-withdrawal syndrome: polysomnographic and clinical evaluations.

Alcohol detoxification is accompanied by sustained difficulties in sleep initiation and maintenance. These difficulties are thought to be an important cause of relapse to alcohol use. However, the treatment of sleep problems with hypnotic drug is made difficult by cross-tolerance between benzodiazepines and alcohol. In this report, we evaluated the capacity of trazodone (TRZ), a second-generation antidepressant with anxiolytic and sedative properties, to increase the sleep efficiency in alcohol-dependent patients after detoxification. Sixteen patients completed the TRZ (n = 8) or the placebo (PL; n = 8) treatment arms. Polysomnographies were performed at baseline, after the 1st drug dose, and after 4 weeks of treatment. The main outcome was sleep efficiency. Secondary outcomes included changes in other sleep parameters, Hamilton Depression Rating and Clinical Global Impression scales. Sleep efficiency was increased in the TRZ group when it was computed after sleep onset, both immediately after 1st administration of the drug and after 4 weeks of treatment. No benefit was observed in the PL group. Sleep improvement under TRZ also included the number of awakenings, intermittent wake sleep time, and non-rapid eye movement sleep. Hamilton and Clinical Global scales were better for the TRZ group. TRZ is thus a potential option in the treatment of alcohol post-withdrawal insomnia.

Adolescent↗

PubMedDate not supplied

A practical approach to allergic rhinitis and sleep disturbance management.

Sleep quality can be significantly impacted by nasal congestion, a common symptom related to allergic rhinitis (AR). This may lead to decreased learning ability, productivity at work or school, and a reduced quality of life. A number of inflammatory cells and the release of inflammatory mediators lead to increased nasal congestion, causing disrupted sleep and subsequent daytime somnolence. Therefore, it is important to treat AR with medications that improve congestive symptoms without worsening sedation. Second-generation antihistamines and anticholinergic drugs are well tolerated but have little effect on congestion and therefore are limited in their ability to reduce AR-associated daytime somnolence. However, intranasal corticosteroids reduce congestion, improve sleep and sleep problems, and reduce daytime sleepiness, fatigue, and inflammation. Montelukast, a leukotriene receptor antagonist, has joined the approved therapies for AR. Montelukast significantly improves both daytime and nighttime symptoms. AR treatment should endeavor to improve daytime and nighttime symptoms, sleep, and productivity thereby improving quality of life.

Circadian Rhythm↗

PubMed1995

[Sleep of sleep research personnel--results of the Munster Congress survey].

Due to different knowledge of sleep and sleep disorders (i.e. focussing) sleep quality of sleep-researchers may be better or worse than the sleep of other scientists. On the Münster Congress for Sleep-research and Sleep medicine in March 1994 we investigated this question using the Pittsburger Sleep Quality Index (PSQI). 46 sleep researchers, 52 practitioners and 103 scientists of other disciplines from the Münster University filled out the questionnaire. Results show no difference in overall sleep quality between the three groups, but only sleep quality in the group of sleep researchers shows a bimodal distribution suggesting a subpopulation with more serious sleep problems. 10 to 15% of the total academic population can be regarded as "poor" sleepers. Especially the group of practitioners, in which we found the highest values of daytime sleepiness, seems to be a risk-population for sleep disorders.

Adult↗

PubMed2005

Insomnia in women: an overlooked epidemic?

Insomnia is a common and significant healthcare problem, and affects a large percentage of women seen by general practitioners, obstetrician-gynecologists and mental health professionals. Specific risk factors for insomnia may be gender-related, including higher prevalence rates of depression and anxiety among women, environmental and social factors, as well as reproductive-related factors (e.g., peri-menstrual difficulties and menopause-related symptoms). Sleep problems interfere significantly with daytime functioning and overall well-being, and may lead to serious clinical consequences. Treatment options include benzodiazepines, non-benzodiazepines, nonprescription sleep aids, and non-pharmacologic interventions such as sleep hygiene measures. This article reviews the existing literature on the prevalence, clinical characteristics of insomnia in women, and highlights some of the treatment options available. Healthcare providers should be aware of the variety of pharmacologic and non-pharmacologic options for treatment of insomnia and, in particular, be able to weigh their efficacy against the risks of side effects and next-day sedation.

Disease Outbreaks↗

PubMed2004

The correlation between allergic rhinitis and sleep disturbance.

Nasal congestion, a common symptom related to allergic rhinitis (AR), often is associated with poor sleep quality, leading to decreased learning ability, decreased productivity at work or school, and a reduced quality of life. The release of inflammatory mediators and activation of inflammatory cells results in nasal congestion, causing disrupted sleep and subsequent daytime somnolence. Therefore it is important to treat AR with medications that improve congestive symptoms without exacerbating sedation. Second-generation antihistamines and anticholinergic drugs are well tolerated but have little effect on congestion and therefore are limited in their ability to reduce AR-associated daytime somnolence. However, intranasal corticosteroids reduce congestion, improve sleep and sleep problems, and reduce daytime sleepiness, fatigue, and inflammation. Recently, montelukast, a leukotriene receptor antagonist, has joined the approved therapies for AR. Montelukast significantly improves both daytime and nighttime symptoms. AR treatment should endeavor to improve daytime and nighttime symptoms, sleep, and productivity, thereby improving quality of life.

Circadian Rhythm↗