Comprehensive Therapy

, Volume 26, Issue 4, pp 298–306 | Cite as

The diagnosis of primary insomnia and treatment alternatives

  • Michael L. Perlis
  • Shawn D. Youngstedt
Original Article
Received:
Accepted:

Abstract

This review provides information about the diagnosis and treatment of primary insomnia. Several treatment strategies are reviewed including the use of hypnotics, naturopathic remedies and behavioral interventions. We suggest that nonpharmacologic interventions are likely to be the most safe and effective.

Keywords

Melatonin Obstructive Sleep Apnea Sleep Disorder Zolpidem Triazolam 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    American Sleep Disorders Association. The International Classification of Sleep Disorders. Diagnostic and Coding Manual. Rochester, MN, American Sleep Disorders Association 1990.Google Scholar
  2. 2.
    Nowell PT, Mazumdar S, Buysse DJ, Dew MA, Reynolds III ICF, Kupfer DJ. Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. JAMA. 1997;278:2170–2177.PubMedCrossRefGoogle Scholar
  3. 3.
    Johnson LC, Chernik DA. Sedative-hypnotics and human performance. Psychopharmacology. 1982;76:101–113.PubMedCrossRefGoogle Scholar
  4. 4.
    Wesensten NJ, Balkin TJ, Belenky GL. Effects of daytime administration of zolpidem versus triazolam on memory. J Clin Pharmacol. 1995;48:115–122.Google Scholar
  5. 5.
    Berlin I, Warot D, Hergueta T, Molinier P, Bagot C, Puech AJ. Comparison of the effects of zolpidem and triazolam on memory functions, psychomotor performances, and postural sway in healthy subjects. J Clin Psychopharmacol. 1993;13:100–106.PubMedCrossRefGoogle Scholar
  6. 6.
    Scharf MG, Mendels J, Thorpy M, Weiss B. Safety of long-term zolpidem treatment in patients with insomnia. Curr Ther Res. 1994;55:1100–1111.CrossRefGoogle Scholar
  7. 7.
    Schlich D, L'Heritier C, Coquelin J, Attali P. Long-term treatment of insomnia with zolpidem: a multicentre general practitioner study of 107 patients. J Int Med Res. 1991;19: 19–27.Google Scholar
  8. 8.
    Kripke DF, Klauber MR, Wingard DL, Fell RL, Assmus JD, Garfinkel L. Mortality hazard associated with prescription hypnotics. Biol Psychiat. 1998;43:687–693.PubMedCrossRefGoogle Scholar
  9. 9.
    Kripke DF. Chronic hypnotics use: deadly risks, doubtful benefit. Sleep Med Rev. 2000;1:5–21.CrossRefGoogle Scholar
  10. 10.
    Hohagen F, Montero RF, Weiss E. Treatment of primary insomnia with trimipramine: An alternative to benzodiazepine hypnotics? Eur Arch Psychiat Clin Neurosci. 1994; 244:65–72.CrossRefGoogle Scholar
  11. 11.
    Hajak G, Rodenbeck A, Adler L, et al. Nocturnal melatonin secretion and sleep after doxepin administration in chronic primary insomnia. Pharmacopsychiatry. 1996;29:187–192.PubMedCrossRefGoogle Scholar
  12. 12.
    Mendelson WB. Efficacy of melatonin as a hypnotic agent. J Biol Rhythms. 1997;12:651–656.PubMedGoogle Scholar
  13. 13.
    Sack RL, Lewy AJ, Hughes RJ. Use of melatonin for sleep and circadian rhythm disorders. Ann Med. 1998;30:115–121.PubMedGoogle Scholar
  14. 14.
    Viwanathan M, Laitinen JT, Saavedra JM. Expression of melatonin receptors in arteries involved in thermoregulation. Proc Nat Acad Sci USA. 1990;87:6200–6203.CrossRefGoogle Scholar
  15. 15.
    Voordouw BCG, Euser R, Vedonk RER, et al. Melatonin and melatonin-progestin combinations alter pituitary-ovarian function in women and can inhibit ovulation. J Clin Endocrin Metab. 1992;74:108–117.CrossRefGoogle Scholar
  16. 16.
    Vuori I, Urponen H, Hasan J, Partinen M. Epidemiology of exercise effects on sleep. Acta Physiol Scand. 1988;133(S574):3–7.Google Scholar
  17. 17.
    Youngstedt SD, O'Connor PJ, Dishman RK. The effects of acute exercise on sleep: a quantitative synthesis. Sleep. 1997;20:203–214.PubMedGoogle Scholar
  18. 18.
    King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA. 1997;277:32–37.PubMedCrossRefGoogle Scholar
  19. 19.
    Holick MF, Jung EG (eds). Biologic Effects of Light. Norwell, MA: Kluwer Academic Publishers. 1988.Google Scholar
  20. 20.
    Campbell SS, Dawson D, Anderson MW. Alleviation of sleep maintenance insomnia with timed exposure to bright light. J Am Geriatr Soc. 1993;41:829–836.PubMedGoogle Scholar
  21. 21.
    Kripke DF. Timing of phototherapy and occurrence of mania. Biol Psychiat. 1991;29:1156–1157.PubMedCrossRefGoogle Scholar
  22. 22.
    Labbate LA, Lafer B, Thibault A, Sachs GS. Side effects induced by bright light treatment for seasonal affective disorders. J Clin Psychiat. 1994;55:189–191.Google Scholar
  23. 23.
    Buysse DJ, Perlis ML. The evaluation and treatment of insomnia. J Prac Psych Behav Health. 1996;3:80–93.Google Scholar
  24. 24.
    Bootzin, RR, Perlis ML. Nonpharmacologic treatments of insomnia. J Clin Psychol. 1992;53:37–40.Google Scholar
  25. 25.
    Morin CM, Culvert JP, Schwartz SM. Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. Am J Psychiat. 1994;151:1172–1180.PubMedGoogle Scholar
  26. 26.
    Murtagh DR, Greenwood KM. Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol. 1995;63:79–89.PubMedCrossRefGoogle Scholar
  27. 27.
    McClusky HY, Milby JB, Switzer PK. Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia. Am J Psychiat. 1991;148:121–126.PubMedGoogle Scholar
  28. 28.
    Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999;281:991–1035.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2000

Authors and Affiliations

  • Michael L. Perlis
    • 1
  • Shawn D. Youngstedt
    • 2
  1. 1.Department of Psychiatry and PsychologyUniversity of Rochesterrochester
  2. 2.Department of Psychiatry, 0667University of California at San DiegoLa JollaUSA

Personalised recommendations