insomnia
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Introduction
The perception by patients that their sleep is inadequate or abnormal.
The term may also be used by patients in reference to fatigue, daytime sleepiness or mood disturbances.
Etiology
- psychophysiologic insomnia
- transient psychophysiologic insomnia
- < 3 weeks duration
- generally secondary to stressful event
- chronic psychophysiologic insomnia
- > 3 weeks duration, commonly > 3 months duration
- may be secondary to inadequate management of transient insomnia
- transient psychophysiologic insomnia
- secondary insomnia
- nocturnal dyspnea
- nocturia
- abdominal pain/discomfort
- cardiac angina
- limb pain/discomfort
- nocturnal leg cramps, degenerative arthritis, peripheral vascular disease
- chronic pain syndromes & somatization disorders
- menopausal symptoms
- affective disorder
- anxiety (most common cause)
- anxiety disorder
- metabolic causes of anxiety
- hypothyroidism, alcohol abuse, stimulant abuse, drug abstinence
- cognitive disorder
- poor sleep habits
- pharmaceutical agents
- high glycemic index diet[56]
- environmental sleep disorder
- shift work, jet lag
- primary insomnia (much less common than secondary insomnia)
- central sleep apnea
- restless legs syndrome
- periodic limb movement disorder
- rapid eye movement (REM) sleep disorder
- actually a parasomnia
- active, sometimes violent movements
- often more disturbing to partner than to patient
- more common in men over 50
- sleep phase asynchrony
- mismatch of the biological sleep clock with the environment
- may result from time zone changes (jet lag), altered sleep schedules (shift work), or idiopathic
- adolescents tend to have a delayed sleep phase
- elderly tend to fall asleep & awake too early
- childhood onset insomnia
- not associated with a sense of choking on waking[4]
- sleep state misperception[2]
- objectively normal sleep perceived as abnormal by patient
Epidemiology
- tends to increase with age
- may be as high as 30-50% in adults > 65 years of age[62]
- more prevalent among women; however, laboratory studies show that older men have more disrupted sleep
- more common among divorced, widowed, separated than married
- lower socioeconomic status correlates with insomnia
- in 2020, 6.3% of adults took sleep medication every day in the last 30 days[72]
- sleep medication use higher in women than men & more frequent with older age[72]
History
- onset of problem
- frequency of occurences
- course of change over time
- sleep patterns
- daytime sleepiness/naps
- medications, alcohol, tobacco, caffeine
- cardiac/respiratory
- neurologic
- pain, paresthesias, parkinsonism, restless legs, seizure, stroke[62]
- psychiatric history
- social history
- history from partner
Clinical manifestations
- difficulty falling asleep, staying asleep, or waking up too early[62]
- daytime sleepiness
- mood disorders may result from insomnia
- manifestations of underlying disorder:
- obstructive sleep apnea (snoring, apnea)
- heart failure (orthopnea)
- pulmonary disease (dyspnea, wheezing*)
- restless legs or periodic limb movement[2]
- anxiety disorder
- substance abuse
* not all that wheezes is asthma
Laboratory
- urine toxicology
- abnormal liver function tests suggests alcoholism
Diagnostic procedures
- diagnostic testing generally unnecessary[2]
- polysomnography[8]
- continuous overnight pulse oximetry
- has not been validated as a screening tool for OSA
Complications
- mood disorders, including major depression, anxiety
- increased risk of automobile accidents
- pain[13]
- rebound insomnia after discontinuation of medication[2]
- independent risk factor for cardiovascular disease[54]
- sleep deprivation
- increased risk of cognitive impairment[60]
- daytime sleepiness[2]
- increased 10 year risk of stroke[75]
- disease interaction(s) of osteoarthritis with insomnia
- disease interaction(s) of depression with insomnia
- disease interaction(s) of obstructive sleep apnea (OSA) with insomnia
Management
general measures
- sleep diary
- sleep hygiene
- sleep hygiene education alone has a minimal impact on chronic insomnia[2][49][64]
- consistent awakening time
- exercise
- regular dietary habits
- comfortable sleeping place
- develop a sleep ritual
- avoid daytime naps
- avoid caffeine, alcohol & CNS-active agents before bedtime
- avoid large meals before bedtime
- avoid difficult emotional or physical activity immediately before bedtime
- avoid use of electronic devices befor sleep[2]
- stimulus control therapy (sleep restriction) if sleep hygiene unsuccessful[2]
- a component of cognitive behavioral therapy (CBT)
- alone, not best initial therapy; CBT is best initial therapy
- lie down to sleep only when sleepy
- use bed only for sleep or sexual activity
- if unable to fall asleep after 10-20 minutes, get up & leave the bedroom; repeat as necessary
- get up at the same time every morning
- gradual increase in total sleep time[2]
- avoid daytime napping
- a component of cognitive behavioral therapy (CBT)
- relaxation
- progressive muscle relaxation
- self hypnosis
- yoga beneficial after 6 months of practice[4][69]
- biofeedback
- cognitive behavioral therapy (CBT) 1st line[11][14][28][37][38][44][52][69]
- most appropriate management of chronic insomnia in the elderly[66]
- especially useful if associated with affective or anxiety disorder
- combine with CBT for pain if pain is a factor in the insomnia[4]
- combined behavioral therapy for pain & insomnia[4]
- CBT results in greater improvements in sleep in patients with worse baseline pain including pain from osteoarthritis[78]
- 1st line for menopausal women with hot flashes[52]
- effective in patients with obstructive sleep apnea[4]
- time management, appropriate self expectations, problem-solving skills
- 19-minute reduction in sleep onset latency relative to control groups[37]
- shorter time awake after sleep onset[37]
- 10% greater sleep efficiency[37]
- best outcomes when used alone for maintenance therapy[14]
- in combination with sedative/hypnotic[14]
- improves markers of inflammation in older adults[35]
- number need to treat to benefit 1 patient = 2-3[19]
- internet-base programs effective[41][46][54]
- Sleepwell increases adoption of CBT for insomnia[79][80]
- brief behavioral therapy (behavioral activation) when CBT is not an option[2][64]
- focuses on sleep restriction, stimulus control, & some sleep hygiene
- delivered in person in an individual or group setting
- cognitive refocusing therapy
- mindfulness meditation[49]
- intensive sleep retraining (done in sleep lab)[23]
- light therapy
- bright light exposure during the day[4]
management of specific disorders
- transient psychophysiologic insomnia
- maintenance of sleep hygiene
- avoid stimulants
- brief course of benzodiazepines
- COPD: therapeutic trial of oxygen
- obstructive sleep apnea: therapeutic trial of continuous positive airway pressure (CPAP)
- sleep phase asynchronies
- treat depression
- treat restless legs syndrome
- hemodialysis: no difference in effectiveness between trazodone, cognitive behavioral therapy, & placebo[77]
- trazodone associated with higher risk of cardiovascular events[77]
pharmacologic agents (also see sleeping pill)
- general principles
- use in patients refractory to non-pharmaceutical measures[2]
- use lowest effective dose, for the shortest time
- doses should be reduced in the elderly & patients with renal or hepatic insufficiency
- used with caution in patients with pulmonary disease
- all start to work in about 30 minutes[8]
- all increase the risk of falls in the elderly[24]
- overprescribing may be driven by the availability of pharmaceuticals rather medical necessity[21]
- choice based on patient profile, preferences, prior response, & consideration of adverse effects[48]
- all recommendations weak, based on low-quality evidence k ) long-term sleep medication use not supported by data[65]
- sedative/hypnotics
- limit therapy to 1 month[2]
- benzodiazepines*
- zolpidem (Ambien) or triazolam (Halcion)
- eszopiclone (Lunesta) 2-3 mg QHS, 1-2 mg QHS (elderly)
- only sleeping pill NOT labeled for short-term use
- useful for sleep maintenance[39][48][76]
- may not increase risk of falls in the elderly[45]
- associated with same risk of falls as benzodiazepines (GRS11)[4]
- lemborexant (orexin antagonist)
- lemborexant and eszopiclone showed the best efficacy, acceptability, & tolerability for acute & long-term insomnia treatment[71]
- suvorexant 5-20 mg QD (orexin antagonist)[57]
- daridorexant another orexin antagonist of benefit in clinical trial[57]
- zaleplon 5-10 mg QHS
- modestly effective for reducing sleep latency[29]
- adverse effects twice as likely as benefit in elderly[10]
- not first line agents in the elderly[30]
- antidepressants
- use only if depression coexists[2]
- tolerability & safety uncertain[53]
- trazodone, doxepin & mirtazapine have sedative effects
- low dose doxepin (only FDA-approved antidepressant)[2]
- low-dose trazodone may be of benefit in elderly
- selective serotonin reuptake inhibitors (SSRI)
- sertraline is the most sedating
- citalopram may be of benefit in posmenopausal women[7]
- benefit uncertain, insufficient evidence [53
- tricyclic antidepressants
- depressed patients
- may decrease alpha wave intrusion into non-REM sleep
- adverse anticholinergic effects & daytime sedation
- amitriptyline 10-15 mg QHS
- nortriptyline 25-50 mg QHS
- full doses if insomnia is secondary to depression
- no evidence for benefit of amytriptyline[53]
- associated with increased risk of falls[4]
- atypical antipsychotics
- depressed patients
- mirtazapine (Remeron)
- do NOT use quetiapine, risk outweighs benefit[16]
- antihistamines
- do not use for sleep[2] despite efficacy
- diphenhydramine 25-50 mg PO QHS
- anticholinergic side effects marked
- use with caution in elderly & patients with obstructive uropathy
- do not use for insomnia in elderly[24]
- NOT helpful for young children[12]
- diphenhydramine 25-50 mg PO QHS
- do not use for sleep[2] despite efficacy
- melatonin 2 mg QHS may be of benefit in some patients, including the elderly[5]
- used mainly for circadian rhythm disorders or jet lag
- some studies have shown improvement, others have not[4]
- melatonin (5 mg), zinc (11.25 mg), & magnesium (225 mg) QHS may be of benefit[20]
- American Academy of Sleep recommends against use for insomnia[67]
- ramelteon 8 mg QHS (melatonin receptor agonist) FDA-approved[4]
- tasimelteon is an investigational melatonin receptor agonist used for transient insomnia due to shift work or jet lag
- insomnia related to delirium
- olanzapine 2.5-5 mg QHS
- haloperidol 0.5-2 mg QHS
- quetiapine 25-50 mg QHS
- agents whose use should be discouraged
- chloral hydrate
- affectiveness disappears in 2 weeks
- physical dependence remains
- L-tryptophan
- was used with some success until appearance of eosinophilic-myalgia syndrome
- believed to be due to a contaminant in manufacturing
- may be useful agent in future
- barbiturates
- risk of abuse
- induction of cytochrome P450
- narrow therapeutic:toxic ratio
- alcohol may suppress REM temporarily with REM rebound disrupting sleep
- chloral hydrate
- higher health care resource use & costs associated with falls in the elderly among older Medicare recipients with medication use to treat insomnia[61]
unproven measures
- insufficient data to support use of acupuncture[4][30]
- American Academy of Medicine recommends against
- trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, valerian due to lack of evidence for their effectiveness[48]
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1087-90
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
Wilson JF. In the clinic. Insomnia. Ann Intern Med. 2008 Jan 1;148(1):ITC13-1-ITC13-1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18166757 - ↑ Kupfer DJ & Reynolds CF III Management of insomnia. N Eng J Med 336(5):341, 1997 PMID: https://www.ncbi.nlm.nih.gov/pubmed/9011788
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004;
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 5.0 5.1 Leger D et al, Am J Med 116:91, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14715322
Buscemi N et al, Efficiency and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: Meta-analysis. BMJ 2006; 332:385 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16473858
Herxheimer A, Does melatonin help people sleep? It's a misapplied but probably safe miracle drug. BMJ 2006; 332372 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16484240 - ↑ Prescriber's Letter 12(3): 2005 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210305&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 7.0 7.1 Journal Watch 25(5):40-41, 2005 Suvanto-Luukkonen E, Koivunen R, Sundstrom H, Bloigu R, Karjalainen E, Haiva-Mallinen L, Tapanainen JS. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo- controlled, double-blind study. Menopause. 2005 Jan-Feb;12(1):18-26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15668596
- ↑ 8.0 8.1 8.2 Prescriber's Letter 12(9): 2005 Comparison of Insomnia Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210901&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 12(9): 2005 Comparison of Insomnia Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211015&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 10.0 10.1 Glass J et al Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits BMJ 2005; 331:1169 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16284208
- ↑ 11.0 11.1 Sivertsen B et al, Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: A randomized, controlled trial. JAMA 2006; 295:2851 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16804151
- ↑ 12.0 12.1 Merenstein D, Diener-West M, Halbower AC, Krist A, Rubin HR. The trial of infant response to diphenhydramine: the TIRED study--a randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med. 2006 Jul;160(7):707-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16818836
Prescriber's Letter 13(9): 2006 Diphenhydramine for Sleep in Infants Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220908&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ 13.0 13.1 Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR. Epidemiology of insomnia: a longitudinal study in a UK population. Sleep. 2007 Mar 1;30(3):274-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17425223
Ozminkowski RJ, Wang S, Walsh JK. The direct and indirect costs of untreated insomnia in adults in the United States. Sleep. 2007 Mar 1;30(3):263-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17425222 - ↑ 14.0 14.1 14.2 14.3 Morin CM et al Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia. A Randomized Controlled Trial JAMA. 2009;301(19):2005-2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19454639 <Internet> http://jama.ama-assn.org/cgi/content/short/301/19/2005
- ↑ 15.0 15.1 Nixon GM et al Falling asleep: the determinants of sleep latency. Archives of Diseases of Childhood July 24, 2009 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19633062 <Internet> http://adc.bmj.com/cgi/content/abstract/adc.2009.157453v1
- ↑ 16.0 16.1 Prescriber's Letter 16(8): 2009 What's the best way to treat insomnia in the elderly? Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250902&pb=PRL (subscription needed) http://www.prescribersletter.com
Prescriber's Letter 16(8): 2009 Insomnia in the Elderly Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250902&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008 Oct 15;4(5):487-504 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18853708
- ↑ Prescriber's Letter 17(10): 2010 COMMENTARY: Oleptro (Trazodone) and Silenor (Doxepin) CHART: Comparison of Insomnia Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261005&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 19.0 19.1 Buysse DJ et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 2011 Jan 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21263078
- ↑ 20.0 20.1 Rondanelli M et al. The effect of melatonin, magnesium, and zinc on primary insomnia in long-term care facility residents in Italy: A double-blind, placebo-controlled clinical trial. J Am Geriatr Soc 2011 Jan; 59:82 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21226679
- ↑ 21.0 21.1 Moloney ME et al. The medicalization of sleeplessness: A public health concern. Am J Public Health 2011 Aug; 101:1429. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21680913
- ↑ 22.0 22.1 Bocca ML, Marie S, Lelong-Boulouard V, et al. Zolpidem and zopiclone impair similarly monotonous driving performance after a single nighttime intake in aged subjects. Psychopharmacology (Berl) 2011; 214(3):699-706. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21086117
- ↑ 23.0 23.1 Harris J et al. A randomized controlled trial of intensive sleep retraining (ISR): A brief conditioning treatment for chronic insomnia. Sleep 2012 Jan 1; 35:49. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22215918
Spielman AJ and Glovinsky PB. What a difference a day makes. Sleep 2012 Jan 1; 35:11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22215913 - ↑ 24.0 24.1 24.2 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Prescriber's Letter 19(4): 2012 COMMENTARY: Medications for Insomnia: A Wake-Up Call PATIENT EDUCATION HANDOUT: Strategies for a Good Night's Sleep Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280421&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 19(5): 2012 Comparison of Insomnia Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280525&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 27.0 27.1 Gellis LA Cognitive refocusing treatment for insomnia: A randomized controlled trial in university students. Behav Ther 2012 Jul 27 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22309052 <Internet> http://www.sciencedirect.com/science/article/pii/S0005789412000883
- ↑ 28.0 28.1 Morgan K et al. Self-help treatment for insomnia symptoms associated with chronic conditions in older adults: A randomized controlled trial. J Am Geriatr Soc 2012 Oct; 60:1803. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23035962
- ↑ 29.0 29.1 29.2 Huedo-Medina TB et al Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ 2012;345:e8343 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23248080 <Internet> http://www.bmj.com/content/345/bmj.e8343
- ↑ 30.0 30.1 30.2 Cheuk DK, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev. 2012 Sep 12;9:CD005472. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22972087
- ↑ Gooneratne NS. Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med. 2008 Feb;24(1):121-38, viii. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18035236
- ↑ Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev. 2011 Apr;15(2):99-106. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20965131
- ↑ 33.0 33.1 Montgomery P, Dennis J. Physical exercise for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2002;(4):CD003404 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12519595
- ↑ Prescriber's Letter 21(7): 2014 Comparison of Insomnia Treatments. Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300709&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 35.0 35.1 Irwin MR et al. Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late life insomnia: A randomized controlled trial. Biol Psychiatry 2015 Feb 4 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25748580 <Internet> http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2815%2900079-7/abstract
- ↑ Choosing Wisely: Five Things Physicians and Patients Should Question. An Initiative of the ABIM Foundation. American Geriatrics Society http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/choosingwisely
- ↑ 37.0 37.1 37.2 37.3 37.4 Trauer JM et al Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. Published online 9 June 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26054060 <Internet> http://annals.org/article.aspx?articleid=2301405
Morin CM Cognitive Behavioral Therapy for Chronic Insomnia: State of the Science Versus Current Clinical Practices. Ann Intern Med. Published online 9 June 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26052868 <Internet> http://annals.org/article.aspx?articleid=2301407 - ↑ 38.0 38.1 Wu JQ, Appleman ER, Salazar RD, Ong JC Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis. JAMA Intern Med. Published online July 06, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26147487 <Internet> http://archinte.jamanetwork.com/article.aspx?articleID=2363024
Grandner MA, Perlis ML Treating Insomnia Disorder in the Context of Medical and Psychiatric Comorbidities. JAMA Intern Med. Published online July 06, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26147221 <Internet> http://archinte.jamanetwork.com/article.aspx?articleID=2363021 - ↑ 39.0 39.1 Winkelman JW Insomnia Disorder N Engl J Med 2015; 373:1437-1444. October 8, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26444730 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1412740
- ↑ Agency for Healthcare Research & Quality (AHRQ) Management of Insomnia Disorder Dec 30, 2015 http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2164
- ↑ 41.0 41.1 Christensen H, Batterham PJ, Gosling JA et al Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. The Lancet Psychiatry. Published Online: 27 January 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26827250 <Internet> http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900536-2/abstract
Munoz RF, Bunge EL Prevention of depression worldwide: a wake-up call. The Lancet Psychiatry. Published Online: 27 January 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26827251 <Internet> http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900555-6/abstract - ↑ Masters PA. In the clinic. Insomnia. Ann Intern Med. 2014 Oct 7;161(7):ITC1-15; quiz ITC16. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25285559
- ↑ Morgenthaler T, Kramer M, Alessi C et al Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep. 2006 Nov;29(11):1415-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17162987
- ↑ 44.0 44.1 Qaseem A et al Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Published online 3 May 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27136449 <Internet> http://annals.org/article.aspx?articleid=2518955
Kathol RG, Arnedt JT. Cognitive Behavioral Therapy for Chronic Insomnia: Confronting the Challenges to Implementation. Ann Intern Med. Published online 3 May 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27136604 <Internet> http://annals.org/article.aspx?articleid=2518956
Wilt TJ et al. Pharmacologic treatment of insomnia disorder: An evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 2016 May 3; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27136278
Brasure M et al. Psychological and behavioral interventions for managing insomnia disorder: An evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 2016 May 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27136619 - ↑ 45.0 45.1 Tom SE, Wickwire EM, Park Y, Albrecht JS. Nonbenzodiazepine Sedative Hypnotics and Risk of Fall-Related Injury. Sleep. 2016 May 1;39(5):1009-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26943470
- ↑ 46.0 46.1 Ritterband LM et al. Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year follow-up: A randomized clinical trial. JAMA Psychiatry 2016 Nov 30; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27902836
Krystal AD, Prather AA. Should internet cognitive behavioral therapy for insomnia be the primary treatment option for insomnia? Toward getting more SHUTi. JAMA Psychiatry 2016 Nov 30; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27902827 - ↑ 47.0 47.1 Pillai V, Roth T, Roehrs T, Moss K, Peterson EL, Drake CL. Effectiveness of benzodiazepine receptor agonists in the treatment of insomnia: An examination of response and remission rates. Sleep. 2016 Oct 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27855734
- ↑ 48.0 48.1 48.2 48.3 Sateia MJ, Sherrill WC Jr, Winter-Rosenberg C, Heald JL. Payer Perspective of the American Academy of Sleep Medicine Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia. J Clin Sleep Med. 2017 Jan 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28095976 <Internet> http://aasmnet.org/jcsm/ViewAbstract.aspx?pid=30933
Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(2):307-349 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27998379 PMCID: PMC5263087 Free PMC article https://jcsm.aasm.org/doi/10.5664/jcsm.6470 - ↑ 49.0 49.1 49.2 Black DS, O'Reilly GA, Olmstead R, Breen EC, Irwin Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med. 2015 Apr;175(4):494-501. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25686304 Free PMC Article
- ↑ Kay-Stacey M, Attarian H. Advances in the management of chronic insomnia. BMJ. 2016 Jul 6;354:i2123. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27383400 Free Article
- ↑ Buysse DJ, Rush J, Reynolds CF III et al Clinical Management of Insomnia Disorder JAMA. 2017;318(20):1973-1974 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29059360 https://jamanetwork.com/journals/jama/article-abstract/2659566
- ↑ 52.0 52.1 52.2 Guthrie KA, Larson JC, Ensrud KE et al. Effects of pharmacologic and nonpharmacologic interventions on insomnia symptoms and subjective sleep quality in women with hot flashes: A pooled analysis of individual participant data from 4 MsFLASH trials. Sleep 2017 Nov 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29165623 https://academic.oup.com/sleep/advance-article-abstract/doi/10.1093/sleep/zsx190/4642822?redirectedFrom=fulltext
- ↑ 53.0 53.1 53.2 53.3 53.4 Everitt H. Baldwin DS, Stuart B et al Antidepressants for insomnia in adults. Cochrane Database Syst Rev. 2018 May 14;5:CD010753 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29761479 <Internet> http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD010753.pub2/abstract
- ↑ 54.0 54.1 54.2 Espie CA, Emsley R, Kyle SD et al. Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: A randomized clinical trial. JAMA Psychiatry 2018 Sep 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30264137 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2704019
- ↑ Zheng B, Yu C, LV J et al Insomnia symptoms and risk of cardiovascular diseases among 0.5 million adults: A 10-year cohort. Neurology. November 6, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31694922 https://n.neurology.org/content/early/2019/11/06/WNL.0000000000008581
- ↑ 56.0 56.1 Rapaport L High-Glycemic Diet Tied to Insomnia in Older Women. Annals of Long-Term Care. Dec 19, 2019 https://www.managedhealthcareconnect.com/content/high-glycemic-diet-tied-insomnia-older-women
Gangwisch JE, Hale L, St-Onge MP et al High glycemic index and glycemic load diets as risk factors for insomnia: analyses from the Women's Health Initiative. Am J Clin Nutr. 2019 Dec 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31828298 - ↑ 57.0 57.1 57.2 Dauvilliers Y, Zammit G, Fietze I et al. Daridorexant, a new dual orexin receptor antagonist to treat insomnia disorder. Ann Neurol 2020 Mar; 87:347. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31953863 https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25680
Herring WJ, Ceesay P, Snyder E et al. Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: A randomized trial. Alzheimers Dement 2020 Jan 15; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/31944580 https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12035 - ↑ Facts About Insomnia http://www.nhlbi.nih.gov/health/public/sleep/insomnia.htm
- ↑ 59.0 59.1 Zammit G, Dauvilliers Y, Pain S, et al. Daridorexant, a new dual orexin receptor antagonist, in elderly subjects with insomnia disorder. Neurology 2020 May 26; 94:e2222 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32341187 https://n.neurology.org/content/94/21/e2222
- ↑ 60.0 60.1 Greb E Insomnia With Short Sleep Linked to Cognitive Impairment Medscape - Oct 19, 2020 https://www.medscape.com/viewarticle/939386
- ↑ 61.0 61.1 Frech F, Juday T Higher Health Care Resource Use, Costs Associated With Falls Among Older Medicare Beneficiaries on Commonly Used Insomnia Medications in the United States. Annals of Long-Term Care. 2020. Dec 17 https://www.managedhealthcareconnect.com/content/higher-health-care-resource-use-costs-associated-falls-among-older-medicare-beneficiaries
- ↑ 62.0 62.1 62.2 62.3 62.4 62.5 Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
- ↑ Constantinescu AM, Warness JR, Virk N Optimizing Sleep for Residents in Long-Term Care Without Sedatives. Annals of Long-Term Care. December 2019 https://www.hmpgloballearningnetwork.com/site/altc/articles/optimizing-sleep-residents-long-term-care-without-sedatives
- ↑ 64.0 64.1 64.2 Mysliwiec V, Martin JL, Ulmer CS et al The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med. 2020 Mar 3;172(5):325-336. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32066145 Free article
- ↑ 65.0 65.1 Garcia J Long-term Use of Prescription Sleep Meds Unsupported by New Data. Medscape. May 19, 2021 https://www.medscape.com/viewarticle/951472
Solomon DH, Ruppert K, Habel LA et al Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study. BMJ Open. 2021 May 11;11(5):e045074 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33975865 Free PMC article. https://bmjopen.bmj.com/content/11/5/e045074 - ↑ 66.0 66.1 Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. J Clin Sleep Med. 2018;14(6):1017-1024 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29852897 PMCID: PMC5991956 Free PMC article https://jcsm.aasm.org/doi/10.5664/jcsm.7172
- ↑ 67.0 67.1 Lillie L Deprived of Sleep, Many Turn to Melatonin Despite Risks. Medscape. April 19, 2022 https://www.medscape.com/viewarticle/972397
Li J, Somers VK, Xu H et al Trends in Use of Melatonin Supplements Among US Adults, 1999-2018. JAMA. 2022;327(5):483-485. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35103775 PMCID: PMC8808329 (available on 2022-08-01) https://jamanetwork.com/journals/jama/article-abstract/2788539 - ↑ Chawla J, Benbadis SR Insomnia. Medscape. Updated Jan 27, 2022 https://emedicine.medscape.com/article/1187829-overview
- ↑ 69.0 69.1 69.2 Whitlock Burton K Yoga, CBT Provide Long-term Improvement in Insomnia, Worry. Medscape. Sept 1, 2022 https://www.medscape.com/viewarticle/980100
Danhauer SC et al Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults. Geriatric Psychiatry. 2022. Feb 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35260292 https://www.ajgponline.org/article/S1064-7481(22)00034-3/pdf - ↑ 70.0 70.1 Monaco K Trazodone Commonly Used Off-Label for Insomnia. Not much data to support efficacy or safety "as a surrogate hypnotic medication," researcher says. MedPage Today September 20, 2022 https://www.medpagetoday.com/meetingcoverage/psychcongress/100819
- ↑ 71.0 71.1 Brooks M Best Meds for Insomnia Identified? Medscape. July 15, 2022 https://www.medscape.com/viewarticle/977318
- ↑ 72.0 72.1 72.2 Reuben C, Elgaddal N, Black LI Sleep Medication Use in Adults Aged 18 and Over: United States, 2020 NCHS Data Brief. No. 462. January 2023 https://www.cdc.gov/nchs/data/databriefs/db462.pdf
- ↑ Marbin A et al Zaleplon Versus Zolpidem Use in Older Adults Being Treated for Insomnia: A Review. Am J Geriatr Psychiatr. 2023. 31(3)S68-S69 Not indexed in PubMed https://www.sciencedirect.com/science/article/abs/pii/S1064748123000544
- ↑ Adjaye-Gbewonyo D, Ng AE, Black LI Sleep Difficulties in Adults: United States, 2020. Centers for Disease Control & Prevention (CDC) NCHS Data Brief No. 436, June 2022 https://www.cdc.gov/nchs/products/databriefs/db436.htm
- ↑ 75.0 75.1 Sawadogo W et al Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study. Neurology. 2023. June 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37286360 https://n.neurology.org/content/early/2023/06/07/WNL.0000000000207449
- ↑ 76.0 76.1 NEJM knowledge+
Buysse DJ. Insomnia. JAMA. 2013 Feb 20;309(7):706-16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23423416 PMCID: PMC3632369 Free PMC article. Review - ↑ 77.0 77.1 77.2 Mehrotra R et al Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis. A Randomized Clinical Trial. Ann Intern Med. 2024. Jan 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38224591 https://www.acpjournals.org/doi/10.7326/M23-1794
- ↑ 78.0 78.1 Erickson AJ, Rodriguez JC, Ravyts SG et al. The effectiveness of cognitive behavioral therapy for insomnia on sleep outcomes in the context of pain among older adult veterans. J Am Geriatr Soc 2024 Aug; 72:2319. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38888493 Clinical Trial https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18910
Vitiello MV et al Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: the lifestyles randomized controlled trial. J Am Geriatr Soc. 2013 Jun;61(6):947-56. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23711168 - ↑ 79.0 79.1 Gardner DM, Turner JP, Magalhaes S, Rajda M, Murphy AL. Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep: The YAWNS NB Randomized Clinical Trial. JAMA Psychiatry. 2024 Sep 18:e242731. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39292452
- ↑ 80.0 80.1 MySleepwell.ca. Sleepwell home page. https://mysleepwell.ca/