The Nature of Insomnia

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S10) ◽  
pp. 3-5 ◽  
Author(s):  
Thomas Roth
Keyword(s):  
Behavioral Therapy ◽  
Clinical Information ◽  
Negative Results ◽  
Behavioral Therapies ◽  
Insomnia Treatment ◽  
Treatment Use ◽  
Patients Experience ◽  
Pharmacologic Agents ◽  
Impaired Quality

AbstractInsomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.

The Morbidity of Insomnia

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S10) ◽  
pp. 6-8
Author(s):  
Andrew D. Krystal
Keyword(s):  
Behavioral Therapy ◽  
Clinical Information ◽  
Negative Results ◽  
Behavioral Therapies ◽  
Insomnia Treatment ◽  
Treatment Use ◽  
Patients Experience ◽  
Pharmacologic Agents ◽  
Impaired Quality

AbstractInsomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.

Therapeutics for the Treatment of Insomnia

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S10) ◽  
pp. 9-12
Author(s):  
Joseph A. Lieberman
Keyword(s):  
Behavioral Therapy ◽  
Clinical Information ◽  
Negative Results ◽  
Behavioral Therapies ◽  
Insomnia Treatment ◽  
Treatment Use ◽  
Patients Experience ◽  
Pharmacologic Agents ◽  
Impaired Quality

AbstractInsomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.

Panic Disorder: Broadening Conceptualizations and Improving Treatment

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S12) ◽  
pp. 4-4 ◽  
Author(s):  
Mark H. Pollack
Keyword(s):  
Panic Disorder ◽  
Psychological Factors ◽  
Behavioral Therapy ◽  
Explanatory Models ◽  
Cognitive Behavioral ◽  
Medical Comorbidity ◽  
Complex Interplay ◽  
Fear And Anxiety ◽  
Pharmacologic Agents

Attempts to understand the underlying etiology of panic disorder have, at times, oscillated between reductionistic biologic or psychologic characterizations that have put pharmacotherapists and cognitive-behavioral therapists on opposite sides of a fence with patients caught in the middle. However, research emerging over the last couple of decades is pointing to a more complex interplay between dysregulated neurobiological systems and psychological factors that influence the manifestations of fear and anxiety and permit a more nuanced view of the etiology of panic disorder while pointing to potential rational strategies for treating patients. The articles in this supplement explore a range of explanatory models relevant to the underlying etiology of panic disorder, and then focus on treatment, including pharmacologic agents, and a paradigm in which cognitive-behavioral therapy (CBT) can be efficiently and effectively integrated with pharmacotherapy in an attempt to optimize patient care.In the first article, David Baldwin, MB, BS, DM, FRCPsych, discusses the burden of panic disorder to patients and society; the difficulties associated with misdiagnosis and inadequate treatment; the challenges imposed by excess healthcare utilization, reduced quality of life, and psychiatric and medical comorbidity; and the implications for therapeutics.

scholarly journals Sleep disorders in acute and chronic pain

2021 ◽  
Vol 13 (3) ◽  
pp. 125-130
Author(s):  
M. G. Poluektov ◽  
A. O. Golovatyuk
Keyword(s):  
Sleep Disorders ◽  
Sleep Duration ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Experimental Studies ◽  
Pain Sensation ◽  
Analgesic Effects ◽  
Pain Syndromes ◽  
Insomnia Treatment

Pain is one of the leading causes of decline in quality of life. When pain syndromes occur, a person may experience unpleasant sensory sensations and concomitant disorders, which can lead to pain aggravation and sleep disturbances. According to experimental studies, increased pain sensation with reduced sleep duration occurs due to opioid, serotonergic, noradrenergic, and dopaminergic antinociceptive systems dysfunction. In clinical practice, a reduction in sleep duration is usually associated with insomnia, which is the most common sleep disorder. In pain syndromes, insomnia occurs in 53–90% of patients (for comparison: in the general population – in 7.4%). Non-pharmacological (cognitive-behavioral therapy) and pharmacological approaches are used in insomnia treatment. Some medications (amitriptyline, mirtazapine, trazodone, gabapentin, pregabalin) have both hypnotic and analgesic effects, which allows to use them for pain syndromes with sleep disturbances. It has been shown that the correction of sleep disorders can reduce the severity and frequency of pain.

Milnacipran Hydrochloride in the Treatment of Fibromyalgia Syndrome: Safety, Efficacy and Tolerability

2012 ◽  
Vol 4 ◽  
pp. CMT.S2247
Author(s):  
Howard S. Smith ◽  
Patrick D. Meek
Keyword(s):  
Behavioral Therapy ◽  
Treatment Options ◽  
Common Adverse Effect ◽  
Chronic Widespread Pain ◽  
Physical Medicine ◽  
Federal Drug Administration ◽  
Nonrestorative Sleep ◽  
The Us ◽  
Pharmacologic Agents

Fibromyalgia is a central sensitization disorder characterized by chronic widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction as well as a number of somatic symptoms; that reduces physical/emotional function/quality of life. Treatment options include: Patients education, behavioral medicine strategies, (eg, cognitive behavioral therapy), physical medicine strategies (eg, exercise/aerobic and strength training), and pharmacologic agents. Currently there are three agents approved by the US Federal Drug Administration for the treatment of Fibromyalgia: pregabalin, duloxetine, and milnacipran. Milnacipran is a norepinephrine-serotonin reuptake inhibitor that is only approved in the US for fibromyalgia. It has 3-fold increased selectivity for norepinephrine compared to serotonin. Milnacipran is well absorbed (85% bioavailability), has a half-life of 6-8 hours, and does not undergo cytochrome P450 metabolism. Milnacipran in doses of 50 mg PO BID to 100 mg PO BID has been shown to have efficacy for fibromyalgia. The most common adverse effect is nausea.

scholarly journals Wait Times for Gastroenterology Consultation in Canada: The Patients’ Perspective

2010 ◽  
Vol 24 (1) ◽  
pp. 28-32 ◽  
Author(s):  
WG Paterson ◽  
AN Barkun ◽  
WM Hopman ◽  
DJ Leddin ◽  
P Paré ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Gastrointestinal Symptoms ◽  
Wait Time ◽  
Wait Times ◽  
Canadian Association ◽  
Serious Disease ◽  
One Year ◽  
Patients Experience ◽  
Impaired Quality

Long wait times for health care have become a significant issue in Canada. As part of the Canadian Association of Gastroenterology’s Human Resource initiative, a questionnaire was developed to survey patients regarding wait times for initial gastroenterology consultation and its impact. A total of 916 patients in six cities from across Canada completed the questionnaire at the time of initial consultation. Self-reported wait times varied widely, with 26.8% of respondents reporting waiting less than two weeks, 52.4% less than one month, 77.1% less than three months, 12.5% reported waiting longer than six months and 3.6% longer than one year. One-third of patients believed their wait time was too long, with 9% rating their wait time as ‘far too long’; 96.4% believed that maximal wait time should be less than three months, 78.9% believed it should be less than one month and 40.3% believed it should be less than two weeks. Of those working or attending school, 22.6% reported missing at least one day of work or school because of their symptoms in the month before their appointment, and 9.0% reported missing five or more days in the preceding month. A total of 20.2% of respondents reported being very worried about having a serious disease (ie, scored 6 or higher on 7-point Likert scale), and 17.6% and 14.8%, respectively, reported that their symptoms caused major impairment of social functioning and with the activities of daily living. These data suggest that a significant proportion of Canadians with digestive problems are not satisfied with their wait time for gastroenterology consultation. Furthermore, while awaiting consultation, many patients experience an impaired quality of life because of their gastrointestinal symptoms.

1276: Lower Urinary Tract Symptoms: Local Ischemia Assessed by Sonographic Findings and Correlated to Impaired Quality of Life

2006 ◽  
Vol 175 (4S) ◽  
pp. 410-411
Author(s):  
Germar M. Pinggera ◽  
Michael Mitterberger ◽  
Leo Pallwein ◽  
Peter Rehder ◽  
Ferdinand Frauscher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Local Ischemia ◽  
Urinary Tract Symptoms ◽  
Impaired Quality ◽  
Lower Urinary

An Evaluation of Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Application of Tolin’s Criteria for Empirically Supported Treatments

2019 ◽  
Author(s):  
Cassandra L. Boness ◽  
Rachel Hershenberg ◽  
Joanna Kaye ◽  
Margaret-Anne Mackintosh ◽  
Damion Grasso ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Empirically Supported Treatments ◽  
Inclusion Criteria ◽  
American Psychological ◽  
Strong Recommendation ◽  
Empirically Supported ◽  
High Quality Evidence

The American Psychological Association’s Society of Clinical Psychology recently adopted the “Tolin Criteria” to evaluate empirically supported treatments. These criteria better account for strength and quality of rapidly accumulating evidence bases for various treatments. Here we apply this framework to Cognitive Behavioral Therapy for Insomnia (CBT-I). Following procedures outlined by Tolin and colleagues (2015), Step 1 included an examination of quantitative systematic reviews; nine met inclusion criteria. Step 2 evaluated review quality and effect size data. We found high-quality evidence that CBT-I produces clinically and statistically significant effects on insomnia and other sleep-related outcomes. Based on the Tolin Criteria, the literature merits a “strong” recommendation for CBT-I. This report is a working model for subsequent applications of the Tolin Criteria.

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