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Latest & greatest articles for insomnia
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on insomnia or other clinical topics then use Trip today.
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Paradoxical Intention for Insomnia Paradoxical Intention for Insomnia – Society of Clinical Psychology Description Paradoxical intention is a cognitive technique that consists of persuading a patient to engage in his or her most feared behavior. In the context of insomnia, this type of therapy is premised on the idea that performance anxiety inhibits sleep onset. Paradoxically, if a patient stops trying to fall asleep and instead stays awake for as long as possible, the performance anxiety (...) is expected to diminish; thus, sleep may occur more easily. In clinical practice, some patients are fairly reluctant to use this procedure, and compliance is often problematic. Sleep restriction therapy, a similar technique with a different rationale, may be more readily accepted by patients. Key References (in reverse chronological order) Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence
Belsomra (suvorexant) - To treat difficulty in falling and staying asleep (insomnia) Drug Approval Package: Brand Name (Generic Name) NDA # Drug Approval Package U.S. Food & Drug Administration Search FDA Drug Approval Package - Belsomra (suvorexant, MK-4305) Oral Tablets Company: Merck & Co., Inc. Application No.: 204569 Approval Date: 8/13/2014 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. (PDF) (PDF) (PDF) (PDF) (PDF) (PDF
Relaxation Training for Insomnia Relaxation Training for Insomnia – Society of Clinical Psychology Description In relaxation-based treatments, patients are taught formal exercises focused on reducing somatic tension (e.g., progressive muscle relaxation, autogenic training) or intrusive thoughts at bedtime (e.g., imagery training, meditation). Multiple weekly or biweekly sessions are typically required to adequately teach relaxation skills. Practice at home is also encouraged, so patients can (...) gain mastery of the relaxation techniques. Although relaxation therapy is demonstrably effective, there is little evidence suggesting differential effectiveness across the range of relaxation modalities. Key References (in reverse chronological order) Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep , 29, 1398-1414. Edinger, J.D., Wohlgemuth, W.K., Radtke, R.A
Sleep Restriction Therapy for Insomnia Sleep Restriction Therapy for Insomnia – Society of Clinical Psychology Description Sleep restriction therapy utilizes a form of systematic sleep deprivation in which a sleep window is established and maintained to allow the body to (re)learn proper sleeping dynamics and increase sleep efficiency. For example, if a patient reports spending about 8 hours per night in bed, but only sleeps 6 of those hours, the amount of time in bed would be reduced (...) to closely match the amount of time the patient typically sleeps in bed (in this case, 6 hours). Periodic adjustments to this sleep window are made contingent upon sleep efficiency, until an optimal sleep duration is reached. Key References (in reverse chronological order) Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep , 29, 1398-1414. Lichstein, K.L., Riedel, B.W
Cognitive Behavioral Therapy for Insomnia Cognitive Behavioral Therapy for Insomnia – Society of Clinical Psychology Treatment: Cognitive Behavioral Therapy for Insomnia : Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings Strong: Moderate- to high-quality evidence that treatment improves (...) -designed studies conducted by independent investigators. Modest: Support from one well-designed study or several adequately designed studies. Controversial: Conflicting results, or claims regarding mechanisms are unsupported. Strength of Research Support Empirical Review Status (Tolin et al. Recommendation) Very Strong Strong Weak Insufficient Evidence Treatment pending re-evaluation (Chambless et al. EST) Strong Modest Controversial specializing in Cognitive Behavioral Therapy for Insomnia. Brief
Non-Pharmacological Therapies for the Treatment of Insomnia in Adults: Clinical Evidence and Guidelines TITLE: Non-Pharmacological Therapies for the Treatment of Insomnia in Adults: Clinical Evidence and Guidelines DATE: 29 April 2013 RESEARCH QUESTIONS 1. What is the clinical evidence regarding the use of non-pharmacological therapies for the treatment of insomnia in adults? 2. What are the evidence-based guidelines regarding the use of non-pharmacological therapies for the treatment (...) of insomnia in adults? KEY MESSAGE Twelve systematic reviews and meta-analyses, 31 randomized controlled trials, and one evidence-based guideline were identified regarding non-pharmacological therapies for the treatment of insomnia in adults. Due to the volume of literature identified, only citations published between 2011 and 2013 were included. METHODS A limited literature search was conducted on key resources including PubMed, The Cochrane Library (2013, Issue 4), University of York Centre for Reviews
Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Chronic Insomnia in Older Adults RxFiles: Q&A Summary www.RxFiles.ca - Oct 2013 Debbie Bunka Chronic Insomnia in Older Adults Sleep patterns naturally change as one gets older. Compared to younger people, older adults: 1,2,3 • Sleep fewer hours & take longer to fall asleep • Wake up more often during the night & are more easily disturbed by light, noise, pain, etc… • May not adapt as quickly to changes, such as a new bed • Have changes in their sleep cycle, e.g. older adults spend less time (...) in the most restful stage of sleep (less deep sleep) Ö Result: tend to experience ? daytime sleepiness What is chronic insomnia? 4,5 difficulty falling asleep, staying asleep, waking up too early, or sleep that is non-restorative. Sleep difficulty, lasting = 1 month 3 nights/week , occurs despite adequate opportunity for sleep. Insomnia is clinically relevant if associated with significant distress or daytime impairment (fatigue, mood, cognitive, social/work dysfunction, etc…) Sleep & Aging: Quality
Orexin receptor antagonism for treatment of insomnia: A randomized clinical trial of suvorexant To assess the utility of orexin receptor antagonism as a novel approach to treating insomnia.We evaluated suvorexant, an orexin receptor antagonist, for treating patients with primary insomnia in a randomized, double-blind, placebo-controlled, 2-period (4 weeks per period) crossover polysomnography study. Patients received suvorexant (10 mg [n = 62], 20 mg [n = 61], 40 mg [n = 59], or 80 mg [n = 61 (...) for sleep induction (latency to persistent sleep) and maintenance (wake after sleep onset). Suvorexant was generally well tolerated.The data suggest that orexin receptor antagonism offers a novel approach to treating insomnia.This study provides Class I evidence that suvorexant improves sleep efficiency over 4 weeks in nonelderly adult patients with primary insomnia.
Ramelteon in the treatment of chronic insomnia: systematic review and meta-analysis As a melatonin receptor agonist, ramelteon has been approved in the United States as a treatment for insomnia. As a potential alternation, ramelteon should be further evaluated in different doses and populations. This systematic review with meta-analysis aims to determine the efficacy and safety of ramelteon in the treatment of chronic insomnia.We systematically searched and identified in Medline, Embase (...) , PsycINFO and Cochrane Library until September 2011. We only included randomised controlled trials focused on ramelteon, vs. placebo, or any other treatment for patients with chronic insomnia. Data were extracted and evaluated by two independent investigators. If neither clinical nor statistical heterogeneity was found, we pooled results using a fixed-effect model.Eight studies were selected to include from 175 identified references. There were significant improvements in all the outcomes (subjective
Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Chronic insomnia. Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long (...) -term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help
Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review Mitchell MD, Gehrman P, Perlis M, Umscheid CA CRD summary The review concluded that cognitive behavioural therapy was an effective treatment for insomnia that can produce durable results in a relatively small number (...) of visits. Given the small evidence base, unclear reporting of some results and limited quality, the authors' conclusions cannot be considered reliable Authors' objectives To evaluate the effectiveness of cognitive behavioural therapy (CBT) compared to medication in patients with primary and comorbid insomnia. Searching MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO were searched to September 2011 without language or publication restrictions. Search terms were
Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. To investigate the effectiveness of non-benzodiazepine hypnotics (Z drugs) and associated placebo responses in adults and to evaluate potential moderators of effectiveness in a dataset used to approve these drugs.Systematic review and meta-analysis.US Food and Drug Administration (FDA).Randomised double blind parallel placebo controlled trials
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 To determine whether nightly administration of melatonin, magnesium, and zinc improves primary insomnia in long-term care facility residents.Double-blind, placebo-controlled clinical trial.One long-term care facility in Pavia, Italy.Forty-three participants with primary insomnia (22 in the supplemented group, 21 in the placebo group (...) ) aged 78.3 ± 3.9.Participants took a food supplement (5 mg melatonin, 225 mg magnesium, and 11.25 mg zinc, mixed with 100 g of pear pulp) or placebo (100 g pear pulp) every day for 8 weeks, 1 hour before bedtime.The primary goal was to evaluate sleep quality using the Pittsburgh Sleep Quality Index. The Epworth Sleepiness Scale, the Leeds Sleep Evaluation Questionnaire (LSEQ), the Short Insomnia Questionnaire (SDQ), and a validated quality-of-life instrument (Medical Outcomes Study 36-item Short
Insomnia: treatment pathways, costs and quality of life Insomnia: treatment pathways, costs and quality of life Insomnia: treatment pathways, costs and quality of life Scott GW, Scott HM, O'Keeffe KM, Gander PH Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study (...) and the conclusions drawn. CRD summary This study examined the cost-effectiveness of several treatments for insomnia in adults aged 20 to 59 years. The authors concluded that successful treatment for insomnia was highly cost-effective, despite conservative assumptions. Most of the data were from interviews with experts and the treatment pathways were not fully described, but the authors’ conclusions appear to be valid and robust. Type of economic evaluation Cost-utility analysis Study objective This study
Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial Acupressure on the Shenmen point (indexed as HT7) can improve insomnia, but there has been no longitudinal study to evaluate its efficacy for residents of long-term care facilities. No evidence from the existing literature indicates how long its efficacy can be maintained after stopping acupressure.The aim of this study was to evaluate the effectiveness of acupressure (...) on the Shenmen point for residents of long-term care facilities with insomnia.Fifty residents with insomnia in long-term care facilities were enrolled in a randomized controlled trial, with 25 participants allocated to the experimental group and 25 participants to the control group. For a 5-week period, the experimental group received standard acupressure on the HT7 points of both wrists, whereas the control group received only light touch on the same places. Insomnia was measured with the Athens Insomnia
Adult Primary Insomnia - Diagnosis to Management 1 InsomniaInsomnia Diagnosis to Management Guideline for Adult Primary Introduction • The management of primary insomnia is based on the foundation of behavioural and cognitive non-pharmacologic strategies. Pharmacologic interventions are adjunctive to the nonpharmacologic strategies. Adjunctive pharmacotherapy is used on a short-term (less than 7-14 days on a nightly basis) or intermittent (2-3 nights per week) for the sole purpose (...) of preventing an exacerbation of the primary insomnia • The patient must be an active participant in treatment process. Primary insomnia is a chronic illness that requires regular follow-up and monitoring to evaluate the patient’s response to treatment and motivation to resolve the problem • The goal of management is to provide the patient with the tools necessary to manage the chronic nature of the illness and minimize dependence on sedative medications. Non-pharmacologic Non-pharmacologic therapies
Adult Insomnia - Assessment to Diagnosis 1 Guideline for Adult Introduction Acute Insomnia: 1. Duration of 4 weeks or less. 2,3,4,5 Chronic Insomnia: 2. Duration of 4 weeks or more. 2,3,4,5 Primary Sleep Disorder: 3. A primary or intrinsic sleep disorder is one that arises out of the physiological processes of sleep. Examples of primary sleep disorders are obstructive sleep apnea, restless legs syndrome, periodic limb movement disorder or parasomnias. 2 Secondary Insomnia 4. : Secondary (...) insomnia refers to difficulty initiating and/ or maintaining sleep that occurs as a result of or co-morbidly in conjunction with a medical, psychiatric or psychological process. Examples of secondary insomnia include: pain associated with rheumatoid arthritis that disrupts initiation and/or maintenance of sleep, insomnia co-morbidly associated with a major depressive episode, or insomnia associated with an acute emotional stressor. 6,7 Primary Insomnia 5. (also known as psychophysiologic insomnia (PPI