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Pharmacological Treatment of Insomnia

  • James M. Parish
Part of the Current Clinical Practice book series (CCP)

Abstract

The complaint of trouble sleeping is very common in the practice of sleep medicine, and every physician who wants to be known as a sleep specialist should be knowledgeable about insomnia and have an organized and systematic approach to this problem. It has been estimated that 9% of adults in the United States have a complaint of insomnia, although the prevalance may be as high as 22%. Patients with insomnia view their problem in very emotional terms and for them it is very serious. And when patients see improvement, they are very grateful patients. Additionally, a complaint of insomnia increases morbidity in the elderly, for reasons ranging from falls to coronary events. Utilization of health care resources is higher in patients with severe insomnia. Insomnia should be considered a serious complaint from the patient because of the associated impairment of psychosocial function and quality of life. Insomnia can impair daytime alertness, concentration, memory, and ability to carry out daily tasks.

Keywords

Chronic Obstructive Pulmonary Disease Sleep Medicine Chronic Insomnia Primary Insomnia Rebound Insomnia 
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.

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References

  1. 1.
    Sateia MJ, Pigeon WR (2004) Identification and management of insomnia. Med Clin North Am 88:567–596, vii.PubMedCrossRefGoogle Scholar
  2. 2.
    Morin CM, Colecchi C, Stone J, et al. (1999) Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA 281:991–999.PubMedCrossRefGoogle Scholar
  3. 3.
    Jacobs GD, Pace-Schott EF, Stickgold R, et al. (2004) Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 164:1888–1896.PubMedCrossRefGoogle Scholar
  4. 4.
    Walsh JK, Muehlbach MJ, Lauter SA, et al. (1996) Effects of triazolam on sleep, daytime sleepiness, and morning stiffness in patients with rheumatoid arthritis. J Rheumatol 23:245–252.PubMedGoogle Scholar
  5. 5.
    Krystal AD, Walsh JK, Laska E, et al. (2003) Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Eur Neuropsychopharmacol 14:793–799.Google Scholar
  6. 6.
    Ancoli-Israel S, Roth T (1999) Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep 22:S347–S353.Google Scholar
  7. 7.
    Shochat T, Umphress J, Israel AG, et al. (1999) Insomnia in primary care patients. Sleep 22:S359–S365.PubMedGoogle Scholar
  8. 8.
    Roehrs T, Pedrosi B, Rosenthal L, et al. (1996) Hypnotic self administration and dose escalation. Psychopharmacology 127:150–154.PubMedGoogle Scholar
  9. 9.
    Perlis ML, McCall WV, Krystal AD, et al. (2004) Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. J Clin Psychiatry 65:1128–1137.PubMedGoogle Scholar
  10. 10.
    Hobbs W, Rall T, Verdoon T. In: Goodman and Gilman’s: The Pharmacological Basis of Therapeutics. 9th ed. (Gilman AG, ed.) McGraw-Hill, New York, NY, 1996, pp. 361–396.Google Scholar
  11. 11.
    Hypnotic drugs. (2000) Med Lett 42:71–72.Google Scholar
  12. 12.
    Walsh JK, Schweitzer PK (1999) Ten-year trends in the pharmacological treatment of insomnia. Sleep 22:371–375.PubMedGoogle Scholar
  13. 13.
    James SP, Mendelson WB (2004) The use of trazodone as a hypnotic: a critical review. J Clin Psychiatry 65:752–755.PubMedCrossRefGoogle Scholar
  14. 14.
    Kaynak H, Kaynak D, Gozukirmizi E, et al. (2004) The effects of trazodone on sleep in patients treated with stimulant antidepressants. Sleep Med 5:15–20.PubMedCrossRefGoogle Scholar
  15. 15.
    Roehrs T, Roth T (2003) Hypnotics: an update. Curr Neurol Neurosci Rep 3:181–184.PubMedCrossRefGoogle Scholar
  16. 16.
    Nicholson A Clinical pharmacology and therapeutics. In: Principles and Practice of Sleep Medicine. 2nd ed. (Kryger M, Roth T, Dement W, eds.) WB Saunders, Philadelphia, PA, 1994, pp. 355–363.Google Scholar
  17. 17.
    Consensus conference: drugs and insomnia; the use of medication to promote sleep. (1984) JAMA 251:2410–2414.CrossRefGoogle Scholar
  18. 18.
    Greenblatt D (1991) Benzodiazepine hypnotics: sorting the pharmacokinetic facts. J Clin Psychiatry 52(Suppl):4–10.PubMedGoogle Scholar
  19. 19.
    Salva P, Costa J (1995) Clinical pharmacokinetics and pharmacodynamics of zolpidem: clinical implications. Clin Pharmacokinet 29:142–153.PubMedCrossRefGoogle Scholar
  20. 20.
    Lobo B, Greene W (1997) Zolpidem: distinct from triazolam? Clin Pharmacokinet 29:142–153.Google Scholar
  21. 21.
    Jovanovic U, Dreyfus J (1983) Polygraphic recording in insomniac patients under zopiclone or nitrazepam. Pharmacology 27(Suppl 2): 136–145.PubMedCrossRefGoogle Scholar
  22. 22.
    Walsh JK (2002) Zolpidem “as needed” for the treatment of primary insomnia: a double-blind, placebo-controlled study. Sleep Med Rev 6:S7–S10.PubMedCrossRefGoogle Scholar
  23. 23.
    Doghramji K (2000) The need for flexibility in dosing of hypnotic agents. Sleep 23:S16–S20.PubMedGoogle Scholar
  24. 24.
    Gillin JC, Spinweber CL, Johnson LC (1989) Rebound insomnia: a critical review. J Clin Psychopharmacol 9:161–172.PubMedCrossRefGoogle Scholar
  25. 25.
    Roehrs T, Merlotti L, Zorick F, et al. (1992) Rebound insomnia in normals and patients with insomnia after abrupt and tapered discontinuation. Psychopharmacology 108:67–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Merlotti L, Roehrs T, Zorick F, et al. (1991) Rebound insomnia: duration of use and individual differences. J Clin Psychopharmacol 11:368–373.PubMedCrossRefGoogle Scholar
  27. 27.
    Elie R, Ruther E, Farr I, et al. (1999) Sleep latency is shortened during 4 weeks of treatment with zaleplon, a novel nonbenzodiazepine hypnotic: Zaleplon Clinical Study Group. J Clin Psychiatry 60:536–544.PubMedCrossRefGoogle Scholar
  28. 28.
    Schlich D, L’Heritier C, Coquelin JP, et al. (1991) Long-term treatment of insomnia with zolpidem: a multicentre general practitioner study of 107 patients. J Int Med Res 19:271–279.PubMedGoogle Scholar
  29. 29.
    Voshaar RC, van Balkom AJ, Zitman FG (2004) Zolpidem is not superior to temazepam with respect to rebound insomnia: a controlled study. Eur Neuropsychopharmacol 14:301–306.PubMedCrossRefGoogle Scholar
  30. 30.
    Roehrs T, Bonahoom A, Pedrosi B, et al. (2002) Nighttime versus daytime hypnotic self-administration. Psychopharmacology 161:137–142.PubMedCrossRefGoogle Scholar
  31. 31.
    Nowell PD, Buysse DJ (2001) Treatment of insomnia in patients with mood disorders. Depress Anxiety 14:7–18.PubMedCrossRefGoogle Scholar
  32. 32.
    Phillips B, Ancoli-Israel S (2001) Sleep disorders in the elderly. Sleep Med 2:99–114.PubMedCrossRefGoogle Scholar
  33. 33.
    Grad RM (1995) Benzodiazepines for insomnia in community-dwelling elderly: a review of benefit and risk. J Fam Pract 41:473–481.PubMedGoogle Scholar
  34. 34.
    Ancoli-Israel S, Walsh J, Mangano R, et al. (1999) Zaleplon, a novel nonbenzodiazepine hypnotic, effectively treats insomnia in elderly patients without causing rebound effects. Prim Care Companion J Clin Psychiatry 1(4):114–120.PubMedGoogle Scholar
  35. 35.
    Leppik I, Roth-Schechter G, Gray G (1997) Double-blind, placebo-controlled comparison of zolpidem, triazolan, and temazepam in elderly patients with insomnia. Drug Dev Res 40:230–238.CrossRefGoogle Scholar
  36. 36.
    Kummer J, Guendel L, Linden J, et al. (1993) Long-term polysomnographic study of the efficacy and safety of zolpidem in elderly psychiatric in-patients with insomnia. J Int Med Res 21:171–184.PubMedGoogle Scholar
  37. 37.
    Ray WA, Griffin MR, Downey W (1989) Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA 262:3303–3307.PubMedCrossRefGoogle Scholar
  38. 38.
    Block AJ, Dolly FR, Slayton PC (1984) Does flurazepam ingestion affect breathing and oxygenation during sleep in patients with chronic obstructive lung disease? Am Rev Respir Dis 129:230–233.PubMedGoogle Scholar
  39. 39.
    George CF (2000) Perspectives on the management of insomnia in patients with chronic respiratory disorders. Sleep 23:S31–S35.PubMedGoogle Scholar
  40. 40.
    Steens R (1993) Effects of zolpidem and triazolam on sleep and respiration in mild to moderate chronic obstructive pulmonary disease. Sleep 16:318–326.PubMedGoogle Scholar
  41. 41.
    Basu R, Dodge H, Stoehr GP, et al. (2003) Sedative-hypnotic use of diphenhydramine in a rural, older adult, community-based cohort: effects on cognition. Am J Geriatr Psychiatry 11:205–213.PubMedCrossRefGoogle Scholar
  42. 42.
    Zhdanova IV, Wurtman RJ, Regan MM, et al. (2001) Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab 86:4727–4730.PubMedCrossRefGoogle Scholar
  43. 43.
    Almeida Montes LG, Ontiveros Uribe MP, Cortes Sotres J, et al. (2003) Treatment of primary insomnia with melatonin: a double-blind, placebo-controlled, crossover study. J Psychiatry Neurosci 28:191–196.Google Scholar
  44. 44.
    Coxeter PD, Schluter PJ, Eastwood HL, et al. (2003) Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of randomised n-of-1 trials. Complement Ther Med 11:215–222.PubMedCrossRefGoogle Scholar
  45. 45.
    Maarek L, Cramer P, Attali P, et al. (1992) The safety and efficacy of zolpidem in insomniac patients: a long-term open study in general practice. J Int Med Res 20:162–170.PubMedGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  • James M. Parish
    • 1
  1. 1.Sleep Disorders Center, Division of Pulmonary and Critical Care MedicineMayo ClinicScottsdale

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