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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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of deployment of CBT-I to provide effective first-line treatment of insomnia into general medical and healthcare practice. Similar studies should be conducted to replicate and extend this finding and explore its likely generalisability beyond the older veteran population. Such research should explore which patients with insomnia respond best to non-clinical sleep coaches and which might require referral to practitioners with greater clinical expertise. Context Insomnia is the most common sleepdisorder (...) is effective, safe and highly deployable Michael V Vitiello Statistics from Altmetric.com Commentary on: Alessi C , Martin JL , Fiorentino L , et al . Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial . Implications for practice and research The ability of non-clinician sleep coaches to deliver efficacious cognitive–behavioural therapy for insomnia (CBT-I) was demonstrated, suggesting such coaches can increase the rate and range
Cognitive behavioural therapy for chronic insomnia RACGP - Handbook of Non-Drug Interventions (HANDI) Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship
alcohol consumption or pain). In patients reporting excessive daytime sleepiness, consider obstructivesleepapnoea. Do not use sleep restriction strategies with patients who have bipolar disorder as this can precipitate manic episodes. Sleep restriction may be contraindicated in people with unstable or untreated medical or psychiatric conditions, seizure disorders or excessive daytime sleepiness, or those who already demonstrate sleep restriction (<6 hours in bed). Advise those who drive vehicles (...) waking behaviours, the physiological systems that regulate sleep (homeostatic and circadian drives) can be modified. Indication Chronic primary insomnia in adults Primary insomnia is defined as repeated difficulty with sleep initiation, duration, consolidation or quality despite adequate time and opportunity for sleep, lasting for at least a month. Precautions Ensure the diagnosis is most likely to be primary insomnia (there are no other conditions or causes such as anxiety, depression, excessive
for single agents. Finally, there was insufficient evidence found to determine the balance of benefits versus harms. BACKGROUND Insomniadisorder is defined in the International Classification of SleepDisorders, Third Edition as a complaint of trouble initiating or maintaining sleep which is associated with daytime consequences and is not attributable to environmental circumstances or inadequate opportunity to sleep. The disorder is identified as chronic when it has persisted for at least three months (...) for treatment of chronic insomnia in the adult populations regardless of comorbidities. In summary, the analysis indicates moderate and significant improvement in major sleep parameters with both BZDs and BzRAs in both objective (PSG) and subjective (sleep diary) assessments, with the exception of PSG results for wake after sleep onset (WASO) and TST, which yielded results just below the range of significance. Far fewer studies were available for antidepressants. These showed significant reduction in sleep
Mayo Clinic, Rochester, MN; 7 American Academy of Sleep Medicine, Darien, IL ABSTRACT Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructivesleepapnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disorderedbreathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review (...) -determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA (e.g., unrefreshing sleep, daytime sleepiness, fatigue or insomnia, awakening with a gasping or choking sensation, loud snoring, or witnessed apneas), or an obstructive RDI ≥ 15 events/h (even in the absence of symptoms). In addition to apneas and hypopneas that are included in the AHI, the RDI includes respiratory effort-related arousals (RERAs). The scoring of respiratory events
a general introduc- tion to circadian biology, addresses “exogenous” circadian rhythm sleepdisorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the “endogenous” circadian rhythm sleepdisorders, including advanced sleep phase disorder (ASPD), de- layed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non–24-hour sleep-wakesyndrome (nonentrained type) or free- running disorder (FRD). These practice parameters were developed (...) for sleep related complaints. For example, shift workers with hypersomnia may have both suspected obstructivesleepapnea and clinical characteristics consistent with shift work dis- order. In this event, PSG is indicated to evaluate and establish appropriate therapy for OSA. 3.2 Recommendations for Evaluation and Treatments of Circadian Rhythm SleepDisorders 3.2.1 Shift Work Disorder Shift work refers to non-standard work schedules, including permanent or intermittent night work, early morning work
Otolaryngol Head Neck Surg . 2015;141(11):990–996. [ ] 25 Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleepapnea. N Engl J Med . 2013;368(25):2366–2376. [ ][ ] 26 Kasapkara CS, Tumer L, Aslan AT, et al. Home sleep study characteristics in patients with mucopolysaccharidosis. SleepBreath . 2014;18(1):143–149. [ ] 27 Jheeta S, McGowan M, Hadjikoumi I. Is oximetry an effective screening tool for obstructivesleepapnoea in children with Down syndrome? Arch (...) , Rosen C, Larkin E, Tishler P, Aylor J, Redline S. Predictors of sleep-disorderedbreathing in children with a history of tonsillectomy and/or adenoidectomy. Sleep . 2001;24(7):823–829. [ ] 8 Gozal D, Capdevila OS, Kheirandish-Gozal L. Metabolic alterations and systemic inflammation in obstructivesleepapnea among nonobese and obese prepubertal children. Am J Respir Crit Care Med . 2008;177(10):1142–1149. [ ][ ] 9 Gozal D, Kheirandish-Gozal L. Cardiovascular morbidity in obstructivesleepapnea
. Marcus CL, Brooks LJ, Draper KA, et al.; American Academy of Pediatrics. Diagnosis and Management of Childhood ObstructiveSleepApneaSyndrome. Pediatrics. 2012;130(3):576-584. 9. Roland PS, Rosenfeld RM, Brooks LJ, et al; American Academy of Otolaryngology—Head and Neck Surgery Foundation. Clinical practice guideline: polysomnography for sleep-disorderedbreathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011 Jul;145(1 Suppl):S1-15. Other Literature 1. Berry RB, Hill G (...) and/or cognitive impairment are not suitable candidates for home sleep studies. Patients with sleepdisorders other than OSA are not suitable candidates for home sleep testing. Regardless of the site of testing, sleep studies objectively measure the degree of respiratory disturbance during sleep. Episodes of apnea (cessation of breathing lasting at least 10 seconds and hypopnea (reduction, but not a cessation of air exchange, with an associated fall in oxygen saturation [at least 3% to 4%] or arousal
. Longitudinal study of moderate weight change and sleep-disorderedbreathing. JAMA . 2000;284(23):3015-21. Jonas DE, Amick HR, Feltner C, et al. Primary care screening for and treatment of obstructivesleepapnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA . 2017;317(4):415-33. Mold JW, Quattlebaum C, Schinnere E, Boeckman L, Orr W, Hollabaugh K. Identification by primary care clinicians of patients with obstructivesleepapnea: a Practice-Based Research (...) Network (PBRN) study. J Am Board Fam Med . 2011;24(2):138-45. Caples SM, Gami AS, Somers VK. Obstructivesleepapnea. Ann Intern Med. 2005;142(3):187-97. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructivesleepapnea? The Rational Clinical Examination systematic review. JAMA . 2013;310(7):731-41. Young T, Shahar E, Nieto FJ, et al; Sleep Heart Health Study Research Group. Predictors of sleep-disorderedbreathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern
Hypoglossal nerve stimulation for obstructivesleepapnea: A review of the literature To review the indications and clinical evidence supporting hypoglossal nerve stimulation (HNS) therapy for the treatment of moderate-to-severe obstructivesleepapnea (OSA).Peer reviewed literature on hypoglossal nerve stimulation therapy for obstructivesleepapnea from 2001 to 2016.The only currently FDA-approved HNS device for the treatment of moderate-to-severe OSA is produced by Inspire Medical Systems (...) , which recently published its 36-month outcomes data from its Stimulation Therapy for Apnea Reduction (STAR) trial. HNS therapy is currently indicated for moderate-to-severe OSA patients who are CPAP-intolerant, have a body mass index <32, apnea-hypopnea index <50, and without a concentric pattern of upper airway collapse on sleep endoscopy.Data from the STAR trial suggests that a subset of OSA patients can achieve a significant therapeutic response from hypoglossal nerve stimulation. However