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PubMed2004

Insomnia and generalized anxiety disorder: effects of cognitive behavior therapy for gad on insomnia symptoms.

Although clinical practice suggests that sleep complaints are frequent among patients with generalized anxiety disorder (GAD), frequency, severity, types of insomnia complaints, and relationship to GAD diagnosis severity in patients diagnosed using Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria are not well documented. Clinical data about the impact on insomnia symptoms of treating GAD worries are also lacking. The present study examined these aspects in 44 GAD patients who participated in a treatment study specifically addressing excessive worries through CBT interventions. All patients were assessed using a structured clinical interview and the Anxiety Disorder Interview Schedule-IV (ADIS-IV). They also completed anxiety and insomnia inventories, including the Insomnia Severity Index (ISI), a self-report measure which assesses insomnia type, severity and interference with daily life. Among this sample, 47.7% reported difficulties initiating sleep, 63.6% reported difficulties maintaining sleep, and 56.8% complained of waking too early in the morning. The majority of these patients (86.5%) reported never having experienced insomnia without having excessive worries. However, insomnia severity and GAD severity were not correlated. In this sample, patients with severe GAD did not necessarily report more severe insomnia symptoms. Regarding treatment impact on insomnia complaints, ISI post-treatment scores were significantly lower after treatment. Mean post-treatment scores almost reached ISI's "absence of clinical insomnia" category. Results indicate that this CBT package for GAD does have a significant impact on sleep quality even if sleep disturbances were not specifically addressed during treatment.

Adult↗
PubMed2006

[Effects of lavender aromatherapy on insomnia and depression in women college students].

PURPOSE: The purpose of this study was to explore the effects of the lavender fragrance on sleep and depression in women college students. METHOD: Forty-two women college students who complained of insomnia were studied during a four-week protocol(control treatment week, 60% lavender fragrance treatment week, washout week, 100% lavender fragrance treatment week). All subjects were in the department of nursing in "K" college and the study was a single blind repeated measurements experiment. For the duration of the study, weekly evaluations of sleep, patterns of sleep disturbance, severity of insomnia scale, self satisfaction with sleep, and severity of depression were performed. RESULT: Among sleep variables, length of time taken to fall asleep, severity of insomnia, and self satisfaction with sleep were improved for the 60%(p=.000, p=.000, p=.000) and 100%(p=.000, p=.000, p=.000) week while the severity of depression was improved only for the 100%(p=.002) week. CONCLUSION: According to the study results, it can be concluded that the lavender fragrance had a beneficial effect on insomnia and depression in women college students. Repeated studies are needed to confirm effective proportions of lavender oil and carrier oil for insomnia and depression.

Adult↗
PubMed2001

Severe, childhood-onset, idiopathic, life-long insomnia responding selectively to opiate therapy: case report with 19 year follow-up.

BACKGROUND: Idiopathic (primary) insomnia can be difficult to treat; only two prior cases responsive to opiate therapy have been reported. A case is now presented of severe, idiopathic, childhood-onset, familial insomnia, with increased libido, absence of psychopathology, tardive emergence of restless legs syndrome (RLS), and selective response to opiate therapy. CASE REPORT: A 39-year-old woman was referred in 1981 by her physician who had discovered 3 years earlier that propoxyphene treatment of migraines also controlled her chronic insomnia. She had experienced severe insomnia since childhood, and during early adulthood the insomnia intensified, as she would sleep 0-3 h nightly and never napped. Daily generalized motor restlessness resulted in her frequently walking around the house while feeling exhausted. The quality of her life was considerably compromised by her insomnia, motor restlessness, and by an increased libido that was present since puberty and that was only partially relieved by having sex repeatedly with her husband. RESULTS: Nightly opiate therapy for 19 years has controlled the insomnia, motor restlessness, and excessive libido without affecting her normal libido. The insomnia had not responded to treatment with >25 agents covering >10 pharmacologic categories. During her first (unmedicated) polysomnographic (PSG) study in 1981, she slept 0 min while spending 436 min in bed. In 1984, four consecutive PSG studies were conducted in a design that confirmed the efficacy of propoxyphene therapy of her insomnia. In 1990, an ambulatory PSG revealed two runs of EEG rhythmic paroxysmal activity arising from sleep and wakefulness, without clinical correlate. Neurologic history was negative for seizures, but positive for complete right carotid artery occlusion and three transient ischemic attacks. At age 55 years, typical RLS emerged that was controlled with levodopa therapy, and a concurrent relapse of insomnia was controlled with oxycodone replacing propoxyphene. CONCLUSIONS: Nightly opiate therapy of severe idiopathic (primary) insomnia can remain effective during very long-term clinical follow-up. Guidelines are provided for when to consider such an unusual treatment in other cases of severe, chronic insomnia.

Journal Article↗
PubMed1998

Phenotypic variability in fatal familial insomnia (D178N-129M) genotype.

OBJECTIVE: To report the clinical and pathologic features of patients with the D178N-129M mutation living in Germany. METHODS: Patients with clinically suspected Creutzfeldt-Jakob disease (CJD) were seen in an ongoing, prospective epidemiologic study from June 1993 to August 1997 throughout Germany. Suspect patients were referred to the CJD unit by the participating hospitals or physicians. Patients were seen by a physician, and each patient underwent a detailed neurologic examination. Prion protein gene (PRNP) analysis was performed to distinguish patients with familial forms of CJD. RESULTS: The constellation D178N-129M was identified in eight individuals; in one patient, the diagnosis was made by neuropathologic examination. Four affected men and five women belong to eight unrelated families. A family history of a neurodegenerative disorder was recalled in only five patients. In contrast to the first reported fatal familial insomnia (FFI) patient, none of our patients complained of severe, untreatable insomnia in the early stages. Dysautonomia was observed in varying degrees in most patients. The clinical course of these patients resembled sporadic CJD. In six patients, brain tissue was available for neuropathologic study. In one patient, the neuropathologic examination showed changes that were more reminiscent of forms of sporadic CJD; in the remaining five, the histopathology was typical of FFI. CONCLUSIONS: The clinical presentation in patients with FFI may vary to a great extent. Genotyping of the patients was crucial in providing laboratory confirmation of the diagnosis of FFI, even when there was no family history of a prion disease.

Adult↗
PubMed1994

Zolpidem and rebound insomnia--a double-blind, controlled polysomnographic study in chronic insomniac patients.

In a parallel-group, placebo-controlled, polysomnographic study with randomization, the possible occurrence of rebound insomnia was evaluated in 24 patients suffering from moderate to severe chronic insomnia and receiving either triazolam 0.5 mg, zolpidem 10 mg, or placebo. Treatment duration was 27 nights, followed by three placebo-controlled withdrawal nights. Both drugs showed significant efficacy compared to placebo during the active treatment period. A trend toward tolerance was noted in the triazolam group but not in the zolpidem one. The increase in total sleep time in the zolpidem group was accompanied by an increase in the number of sleep cycles. When active treatment was discontinued, clear rebound insomnia was present in the triazolam group while it was not possible to observe any rebound in the placebo and zolpidem groups. Subjective feelings of the patients, which were assessed by means of visual analog scales, correlated well with polysomnographic data. Our findings tend to indicate that, even after long-term treatment, zolpidem does not induce rebound insomnia or daytime anxiety.

Adult↗
PubMed2004

Factors associated with insomnia among civilians seeking treatment for PTSD: an exploratory study.

This study explored relationships between insomnia (as measured by Item 13 of the Clinician-Administered PTSD [Posttraumatic Stress Disorder] Scale) and other PTSD symptoms, comorbidity, and measures of depression, worry, and panic in a mixed-trauma sample of 143 treatment-seeking civilians with PTSD (median age 39.4 years, 83% female, 96% White). Regression analyses showed that, adjusting for sleep medication use, severity of nightmares and diminished interest in pleasurable activities accounted for unique variance in insomnia severity level. Severity of nightmares and depression accounted for unique variance in the presence of severe insomnia. Findings support a role for conditioning related to nightmares in the etiology of PTSD-related insomnia.

Adult↗
PubMed1981

Evaluation of the efficacy and tolerance of orally administered midazolam as hypnotic agent compared with oxazepam in the treatment of insomnia of mild to moderate severity.

In a double-blind parallel study performed in 40 hospitalized patients, suffering from mild to moderate insomnia, the efficacy and tolerance of 15 mg of 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a][1,4]benzodiazepine (midazolam, Ro 21-3981, Dormicum) administered p.o. were compared with those of 7-chloro-1,3-dihydro-3-hydroxy-5-phenyl-2H-1,4-benzodiazepin-2-one (oxazepam) in the same dosage. The results show comparable values for the two drugs but with significantly better results for midazolam in the parameters: time taken to fall asleep and number of nocturnal awakenings.

Anti-Anxiety Agents↗
PubMed2003

[Treatment of insomnia in children: pharmacological aspects].

In the last few years topics related to sleep in children have aroused increased interest. Most hypnotic drugs and sedatives used to treat adult insomnia are not recommended in children. Even so, 56% of pediatricians use medication to treat childhood sleep disorders. We review the different causes of insomnia in children from birth to school age. The various therapeutic options are discussed and the therapeutic methods that have been demonstrated to be most effective in the various types of insomnia. The most frequent hypnotic drugs used in insomnia treatment are benzodiazepines and non-benzodiazepine hypnotics such as imidazopyridine, pyrazolopyrimidine and cyclopyrrolone. Few studies have been published on the use of melatonin in insomnia although several reports suggest that is useful and relatively safe in the treatment of insomnia in school-aged children. In children with insomnia, pediatricians should first of all obtain information about the characteristics of insomnia and the environmental characteristics surrounding the child and his/her family. Once an organic cause has been ruled out, treatment should be based on informing the parents about sleep physiology and on training them in sleep hygiene and the acquisition of sleep habits. When pharmacological treatment is required, it should be carefully selected using the smallest effective doses. Melatonin seems to have a promising future in insomnia treatment in healthy children and in those with neurological disorders.

Benzodiazepines↗
PubMed1989

Adverse reactions in a dose-ranging study with a new long-acting fluoroquinolone, fleroxacin.

New fluoroquinolones have generally been well tolerated. In a double-blind evaluation of oral fleroxacin, using 400, 600, or 800 mg once daily for 7 days in an ambulatory setting for treatment of uncomplicated genital infections, we encountered unexpectedly high rates of adverse reactions. The objective of this analysis was to determine whether any factors in addition to dose could be found to account for our observations. Adverse reactions developed in 66 (84%) of 79 individuals, and severe reactions arose in 38 (48%). Most frequent were central nervous system reactions (70%), with insomnia being especially frequent (49%); gastrointestinal reactions (39%) and photosensitivity reactions (10%) were also common. Development of any reaction (central nervous system reactions, insomnia, and severe intestinal reactions) was dose related. Development of photosensitivity reactions correlated with an outdoor occupation. No other factors, including usual daily caffeine use, correlated with the development of adverse reactions. In our study, fleroxacin taken as a single daily 600- or 800-mg dose was associated with an unacceptably high rate of adverse reactions. Other studies are required to determine whether this problem is unique to fleroxacin or will occur with higher doses of other fluoroquinolones possessing similar chemical modifications and/or good tissue penetration and very long half-lives.

Adolescent↗
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↗
PubMed2004

Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia.

Despite the growing literature indicating that insomnia is prevalent and a substantial risk factor for medical and psychiatric morbidity, the pathophysiology of both Primary and Secondary Insomnia is poorly understood. Multiple trait and state factors are thought to give rise to and/or moderate illness severity in insomnia, but 'hyperarousal' is widely believed to be the final common pathway of the disorder. To date, very little work has been undertaken using functional imaging to explore the CNS correlates, underpinnings, or consequences of hyperarousal as it occurs in Primary Insomnia. In fact, all but one of the extant studies have been of healthy good sleepers or subjects with Secondary Insomnia. In the present article, we: (1) review the studies that have been undertaken in good sleepers and in patients using functional neuroimaging methodologies, and (2) discuss how these data can inform a research agenda aimed at describing the neuropathophysiology of insomnia.

Brain↗
PubMed2003

Sleep disorders in Sanfilippo syndrome: a polygraphic study.

OBJECTIVE: A high prevalence of sleep disorders is reported in patients affected by Mucopolysaccharidosis III (Sanfilippo syndrome). These disorders have never been investigated by prolonged, objective, and instrumental evaluations. The present work is based on sleep duration and structure in Sanfilippo patients. STUDY DESIGN: The features of sleep/wake cycle in 6 Sanfilippo patients and 6 healthy controls were evaluated by means of sleep diaries and 48 hour ambulatory EEG and polygraphic recordings. Statistical analysis was performed by means of the U-test (Mann-Whitney). RESULTS: Four out of six Sanfilippo patients, the oldest patients in our sample, showed an extremely irregular sleep pattern, with several sleep episodes of inconstant duration, irregularly distributed along 24 hours. The two younger patients showed sleep maintenance insomnia with several nocturnal awakenings. CONCLUSIONS: These results suggest that sleep disruption in Sanfilippo syndrome consists of an irregular sleep/wake pattern, which at its onset might appear as a disorder of initiating or maintaining sleep. This could explain why same patients do not respond to conventional hypnotics. The present observation might suggest attempting therapies aimed at resynchronization, such as behavioral treatment, light therapy or melatonin.

Adolescent↗
PubMed1984

MMPI differences among mild and severe insomniacs and good sleepers.

Past research has attempted to delineate personality differences between insomniacs and good sleepers but has failed to control for type of insomnia or severity of the disorder. The purpose of this study was to compare MMPI scores of mild and severe sleep onset insomniacs with a control group of noninsomniacs . Results demonstrated that sleep onset insomniacs, regardless of degree of severity, differed significantly from noninsomniacs ; and that mild and severe insomniacs differed from each other on only one MMPI scale.

Adolescent↗
PubMedDate not supplied

Detection and assessment of insomnia.

Insomnia is one of the most common complaints encountered by the primary care physician. Yet, in many cases, physicians treat the symptom of insomnia rather than evaluating and treating the underlying causes of insomnia. Because the subjective complaint of insomnia does not always correlate with evidence of objective sleep disruption, a careful history and evaluation are required. Assessment of the duration of insomnia and quantification of the impact of nocturnal sleep disruption on daytime functioning provide the most reliable indices of severity. Primary insomnia may be due to a number of different causes, such as poor sleep hygiene or circadian rhythm disruption. Insomnia may also be the presenting symptom of other primary sleep disorders, such as sleep apnea syndrome or nocturnal myoclonus, or of a variety of medical or psychiatric illnesses. The treatment of the patient with insomnia should address the underlying cause, when identifiable. When the cause cannot be identified, treatment should be conservative; nonpharmacologic therapies should be used whenever possible. When pharmacologic approaches are indicated, short-acting benzodiazepines should be administered in concordance with strict prescribing guidelines. Frequent follow-up is necessary to ensure continued therapeutic efficacy of the prescribed therapy.

Age Factors↗
PubMed1993

The factor structure of the Turkish version of the General Health Questionnaire.

The 60-item General Health Questionnaire (GHQ) was translated into Turkish and administered to a community sample of 437 Turkish-speaking immigrants resident in Melbourne, Australia. The factor structures of the 60-item and 28-item versions of the GHQ were examined to determine the cross-cultural validity of the four subscales of the 28-item GHQ "anxiety/insomnia", "social dysfunction", "severe depression" and "somatic complaints". Four-factor principal components analyses yielded factors which corresponded to similar underlying traits, but the pattern of symptom loadings differed in several ways. Insomnia was less closely associated with anxiety, and general illness ratings such as "not feeling perfectly well" were not uniquely associated with somatic symptoms. The "anxiety/insomnia" and "severe depression" factors overlapped, with many symptoms partially correlated with both factors. These factors appeared to be due to variations in the frequency of occurrence of these symptoms rather than a qualitative distinction between anxiety and depression.

Acculturation↗