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Wikipedia

Insomnia

February 21, 2023

This article is about the sleeping disorder. For other uses, see Insomnia (disambiguation).
"Trouble sleeping" redirects here. For other uses, see Trouble sleeping (disambiguation).

Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping.[1] They may have difficulty falling asleep, or staying asleep for as long as desired.[9][11] Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood.[1] It may result in an increased risk of motor vehicle collisions, as well as problems focusing and learning.[1] Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month.[1] The concept of the word insomnia has two possibilities: insomnia disorder and insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to.[12]

Insomnia
Other namesSleeplessness, trouble sleeping
Depiction of insomnia from the 14th century medical manuscript Tacuinum Sanitatis
Pronunciation
SpecialtyPsychiatry, sleep medicine
SymptomsTrouble sleeping, daytime sleepiness, low energy, irritability, depressed mood[1]
ComplicationsMotor vehicle collisions[1]
CausesUnknown, psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, others[2]
Diagnostic methodBased on symptoms, sleep study[3]
Differential diagnosisDelayed sleep phase disorder, restless leg syndrome, sleep apnea, psychiatric disorder[4]
TreatmentSleep hygiene, cognitive behavioral therapy, sleeping pills[5][6][7]
Frequency~20%[8][9][10]

Insomnia can occur independently or as a result of another problem.[2] Conditions that can result in insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine, and alcohol.[2][8] Other risk factors include working night shifts and sleep apnea.[9] Diagnosis is based on sleep habits and an examination to look for underlying causes.[3] A sleep study may be done to look for underlying sleep disorders.[3] Screening may be done with two questions: "do you experience difficulty sleeping?" and "do you have difficulty falling or staying asleep?"[9]

Although their efficacy as first line treatments is not unequivocally established,[13] sleep hygiene and lifestyle changes are typically the first treatment for insomnia.[5][7] Sleep hygiene includes a consistent bedtime, a quiet and dark room, exposure to sunlight during the day and regular exercise.[7] Cognitive behavioral therapy may be added to this.[6][14] While sleeping pills may help, they are sometimes associated with injuries, dementia, and addiction.[5][6] These medications are not recommended for more than four or five weeks.[6] The effectiveness and safety of alternative medicine is unclear.[5][6]

Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year.[8][9][10] About 6% of people have insomnia that is not due to another problem and lasts for more than a month.[9] People over the age of 65 are affected more often than younger people.[7] Females are more often affected than males.[8] Descriptions of insomnia occur at least as far back as ancient Greece.[15]

Signs and symptoms

 
Potential complications of insomnia.[16]

Symptoms of insomnia:[17]

  • Difficulty falling asleep, including difficulty finding a comfortable sleeping position
  • Waking during the night, being unable to return to sleep and waking up early
  • Not able to focus on daily tasks, difficulty in remembering
  • Daytime sleepiness, irritability, depression or anxiety
  • Feeling tired or having low energy during the day[18]
  • Trouble concentrating
  • Being irritable, acting aggressive or impulsive

Sleep onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours.[19]

It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle-of-the-night awakening.[20]

Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression.[21] Anxiety symptoms may well lead to insomnia. Some of these symptoms include tension, compulsive worrying about the future, feeling overstimulated, and overanalyzing past events.[22]

Poor sleep quality

Poor sleep quality can occur as a result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is defined as the individual not reaching stage 3 or delta sleep which has restorative properties.[23]

Major depression leads to alterations in the function of the hypothalamic–pituitary–adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive night-time urination, can also result in a poor quality of sleep.[24]

Subjectivity

Main article: Sleep state misperception

Some cases of insomnia are not really insomnia in the traditional sense, because people experiencing sleep state misperception often sleep for a normal amount of time.[25] The problem is that, despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, they do not feel like they have slept very much, if at all.[25] Because their perception of their sleep is incomplete, they incorrectly believe it takes them an abnormally long time to fall asleep, and they underestimate how long they stay asleep.[25]

Causes

While insomnia can be caused by a number of conditions, it can also occur without any identifiable cause. This is known as Primary Insomnia.[26] Primary Insomnia may also have an initial identifiable cause, but continues after the cause is no longer present. For example, a bout of insomnia may be triggered by a stressful work or life event. However the condition may continue after the stressful event has been resolved. In such cases, the insomnia is usually perpetuated by the anxiety or fear caused by the sleeplessness itself, rather than any external factors.[27]

Symptoms of insomnia can be caused by or be associated with:

Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated night-time levels of circulating cortisol and adrenocorticotropic hormone.[44] They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.[45]

Genetics

Heritability estimates of insomnia vary between 38% in males to 59% in females.[46] A genome-wide association study (GWAS) identified 3 genomic loci and 7 genes that influence the risk of insomnia, and showed that insomnia is highly polygenic.[47] In particular, a strong positive association was observed for the MEIS1 gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits.

It has been hypothesized that epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain-stress response having an impact as well on the brain plasticity.[48]

Substance-induced

Alcohol-induced

Main article: Alcohol use and sleep

Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs with; awakenings due to headaches, the need to urinate, dehydration, and excessive sweating. Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping him/her from reaching the deepest levels of sleep.[49] Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal, REM sleep is typically exaggerated as part of a rebound effect.[50]

Benzodiazepine-induced

Like alcohol, benzodiazepines, such as alprazolam, clonazepam, lorazepam, and diazepam, are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood).[51][52][53]

Opioid-induced

Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated insomnia.[33] However, dependence on opioids can lead to long-term sleep disturbances.[54]

Risk factors

Insomnia affects people of all age groups but people in the following groups have a higher chance of acquiring insomnia:[55]

  • Individuals older than 60
  • History of mental health disorder including depression, etc.
  • Emotional stress
  • Working late night shifts
  • Traveling through different time zones[11]
  • Having chronic diseases such as diabetes, kidney disease, lung disease, Alzheimer's, or heart disease[56]
  • Alcohol or drug use disorders
  • Gastrointestinal reflux disease
  • Heavy smoking
  • Work stress[57]

Mechanism

Two main models exists as to the mechanism of insomnia, cognitive and physiological. The cognitive model suggests rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia.

The physiological model is based upon three major findings in people with insomnia; firstly, increased urinary cortisol and catecholamines have been found suggesting increased activity of the HPA axis and arousal; second, increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia; and lastly, increased full body metabolism and heart rate in those with insomnia. All these findings taken together suggest a deregulation of the arousal system, cognitive system, and HPA axis all contributing to insomnia.[9][58] However, it is unknown if the hyperarousal is a result of, or cause of insomnia. Altered levels of the inhibitory neurotransmitter GABA have been found, but the results have been inconsistent, and the implications of altered levels of such a ubiquitous neurotransmitter are unknown. Studies on whether insomnia is driven by circadian control over sleep or a wake dependent process have shown inconsistent results, but some literature suggests a deregulation of the circadian rhythm based on core temperature.[59] Increased beta activity and decreased delta wave activity has been observed on electroencephalograms; however, the implication of this is unknown.[60]

Around half of post-menopausal women experience sleep disturbances, and generally sleep disturbance is about twice as common in women as men; this appears to be due in part, but not completely, to changes in hormone levels, especially in and post-menopause.[34][61]

Changes in sex hormones in both men and women as they age may account in part for increased prevalence of sleep disorders in older people.[62]

Diagnosis

In medicine, insomnia is widely measured using the Athens insomnia scale.[63] It is measured using eight different parameters related to sleep, finally represented as an overall scale which assesses an individual's sleep pattern.

A qualified sleep specialist should be consulted for the diagnosis of any sleep disorder so the appropriate measures can be taken. Past medical history and a physical examination need to be done to eliminate other conditions that could be the cause of insomnia. After all other conditions are ruled out a comprehensive sleep history should be taken. The sleep history should include sleep habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid illnesses, and sleep environment.[64] A sleep diary can be used to keep track of the individual's sleep patterns. The diary should include time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in the morning.[64] The sleep diary can be replaced or validated by the use of out-patient actigraphy for a week or more, using a non-invasive device that measures movement.[65]

Workers who complain of insomnia should not routinely have polysomnography to screen for sleep disorders.[66] This test may be indicated for patients with symptoms in addition to insomnia, including sleep apnea, obesity, a thick neck diameter, or high-risk fullness of the flesh in the oropharynx.[66] Usually, the test is not needed to make a diagnosis, and insomnia especially for working people can often be treated by changing a job schedule to make time for sufficient sleep and by improving sleep hygiene.[66]

Some patients may need to do an overnight sleep study to determine if insomnia is present. Such a study will commonly involve assessment tools including a polysomnogram and the multiple sleep latency test. Specialists in sleep medicine are qualified to diagnose disorders within the, according to the ICSD, 81 major sleep disorder diagnostic categories.[67] Patients with some disorders, including delayed sleep phase disorder, are often mis-diagnosed with primary insomnia; when a person has trouble getting to sleep and awakening at desired times, but has a normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.

In many cases, insomnia is co-morbid with another disease, side-effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders.[68] For those who have depression, "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms.[68] "In fact, it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder."[9] Insomnia occurs in between 60% and 80% of people with depression.[69] This may partly be due to treatment used for depression.[69]

Determination of causation is not necessary for a diagnosis.[68]

DSM-5 criteria

The DSM-5 criteria for insomnia include the following:[70]

Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:

  • Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
  • Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
  • Early-morning awakening with inability to return to sleep.

In addition:

  • The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
  • The sleep difficulty occurs at least three nights per week.
  • The sleep difficulty is present for at least three months.
  • The sleep difficulty occurs despite adequate opportunity for sleep.
  • The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
  • The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
  • Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

Types

Insomnia can be classified as transient, acute, or chronic.

  • Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.[71]
  • Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function.[72] Acute insomnia is also known as short term insomnia or stress related insomnia.[73]
  • Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Common causes of chronic insomnia include persistent stress, trauma, work schedules, poor sleep habits, medications, and other mental health disorders.[74] People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia.[75] Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue.[71]

Prevention

Prevention and treatment of insomnia may require a combination of cognitive behavioral therapy,[14] medications,[76] and lifestyle changes.[77]

Among lifestyle practices, going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia.[11] Avoidance of vigorous exercise and caffeinated drinks a few hours before going to sleep is recommended, while exercise earlier in the day may be beneficial.[77] Other practices to improve sleep hygiene may include:[77][78]

  • Avoiding or limiting naps
  • Treating pain at bedtime
  • Avoiding large meals, beverages, alcohol, and nicotine before bedtime
  • Finding soothing ways to relax into sleep, including use of white noise
  • Making the bedroom suitable for sleep by keeping it dark, cool, and free of devices, such as clocks, cell phones, or televisions
  • Maintain regular exercise
  • Try relaxing activities before sleeping

Management

It is recommended to rule out medical and psychological causes before deciding on the treatment for insomnia.[79] Cognitive behavioral therapy is generally the first line treatment once this has been done.[80] It has been found to be effective for chronic insomnia.[14] The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy.[81]

Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear.[8] Several different types of medications may be used.[82][83][76] Many doctors do not recommend relying on prescription sleeping pills for long-term use.[77] It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.[77][84] As of 2022, many people with insomnia were reported as not receiving overall sufficient sleep or treatment for insomnia.[85][86]

Non-medication based

Non-medication based strategies have comparable efficacy to hypnotic medication for insomnia and they may have longer lasting effects. Hypnotic medication is only recommended for short-term use because dependence with rebound withdrawal effects upon discontinuation or tolerance can develop.[87]

Non medication based strategies provide long lasting improvements to insomnia and are recommended as a first line and long-term strategy of management. Behavioral sleep medicine (BSM) tries to address insomnia with non-pharmacological treatments. The BSM strategies used to address chronic insomnia include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education, and relaxation therapy.[88] Some examples are keeping a journal, restricting the time spent awake in bed, practicing relaxation techniques, and maintaining a regular sleep schedule and a wake-up time.[84] Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include, learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to help with worry-reduction strategies and regulating the circadian clock.[84]

Music may improve insomnia in adults (see music and sleep).[89] EEG biofeedback has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as quality of sleep.[90] Self-help therapy (defined as a psychological therapy that can be worked through on one's own) may improve sleep quality for adults with insomnia to a small or moderate degree.[91]

Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene. Examples of such environmental modifications include using the bed for sleep and sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not occur in a reasonably brief period of time after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during night-time hours, and eliminating daytime naps.[92]

A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when sleep efficiency improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. Bright light therapy may be effective for insomnia.[93]

Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e. essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).[94]

Sleep hygiene

Sleep hygiene is a common term for all of the behaviors which relate to the promotion of good sleep. They include habits which provide a good foundation for sleep and help to prevent insomnia. However, sleep hygiene alone may not be adequate to address chronic insomnia.[65] Sleep hygiene recommendations are typically included as one component of cognitive behavioral therapy for insomnia (CBT-I).[65][6] Recommendations include reducing caffeine, nicotine, and alcohol consumption, maximizing the regularity and efficiency of sleep episodes, minimizing medication usage and daytime napping, the promotion of regular exercise, and the facilitation of a positive sleep environment.[95] The creation of a positive sleep environment may also be helpful in reducing the symptoms of insomnia.[96] On the other hand, a systematic review by the AASM concluded that clinicians should not prescribe sleep hygiene for insomnia due to the evidence of absence of its efficacy and potential delaying of adequate treatment, recommending instead that effective therapies such as CBT-i should be preferred.[13]

Cognitive behavioral therapy

Main article: Cognitive behavioral therapy for insomnia

There is some evidence that cognitive behavioral therapy for insomnia (CBT-I) is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia.[97] In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:

  • Unrealistic sleep expectations.
  • Misconceptions about insomnia causes.
  • Amplifying the consequences of insomnia.
  • Performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.

Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and the relaxation therapies. Hypnotic medications are equally effective in the short-term treatment of insomnia, but their effects wear off over time due to tolerance. The effects of CBT-I have sustained and lasting effects on treating insomnia long after therapy has been discontinued.[98][99] The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term when compared to short-term hypnotic medication such as zolpidem, CBT-I still shows significant superiority. Thus CBT-I is recommended as a first line treatment for insomnia.[100]

Common forms of CBT-I treatments include stimulus control therapy, sleep restriction, sleep hygiene, improved sleeping environments, relaxation training, paradoxical intention, and biofeedback.[101]

CBT is the well-accepted form of therapy for insomnia since it has no known adverse effects, whereas taking medications to alleviate insomnia symptoms have been shown to have adverse side effects.[102] Nevertheless, the downside of CBT is that it may take a lot of time and motivation.[103]

Acceptance and commitment therapy

Treatments based on the principles of acceptance and commitment therapy (ACT) and metacognition have emerged as alternative approaches to treating insomnia.[104] ACT rejects the idea that behavioral changes can help insomniacs achieve better sleep, since they require "sleep efforts" - actions which create more "struggle" and arouse the nervous system, leading to hyperarousal.[105] The ACT approach posits that acceptance of the negative feelings associated with insomnia can, in time, create the right conditions for sleep. Mindfulness practice is a key feature of this approach, although mindfulness is not practised to induce sleep (this in itself is a sleep effort to be avoided) but rather as a longer-term activity to help calm the nervous system and create the internal conditions from which sleep can emerge.

A key distinction between CBT-i and ACT lies in the divergent approaches to time spent awake in bed. Proponents of CBT-i advocate minimizing time spent awake in bed, on the basis that this creates cognitive association between being in bed and wakefulness. The ACT approach proposes that avoiding time in bed may increase the pressure to sleep and arouse the nervous system further.[105]

Research has shown that "ACT has a significant effect on primary and comorbid insomnia and sleep quality, and ... can be used as an appropriate treatment method to control and improve insomnia".[106]

Internet interventions

Despite the therapeutic effectiveness and proven success of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense.[107] One way to potentially overcome these barriers is to use the Internet to deliver treatment, making this effective intervention more accessible and less costly. The Internet has already become a critical source of health-care and medical information.[108] Although the vast majority of health websites provide general information,[108][109] there is growing research literature on the development and evaluation of Internet interventions.[110][111]

These online programs are typically behaviorally-based treatments that have been operationalized and transformed for delivery via the Internet. They are usually highly structured; automated or human supported; based on effective face-to-face treatment; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback.[111]

There is good evidence for the use of computer based CBT for insomnia.[112]

Medications

Many people with insomnia use sleeping tablets and other sedatives. In some places medications are prescribed in over 95% of cases.[113] They, however, are a second line treatment.[114] In 2019, the US Food and Drug Administration stated it is going to require warnings for eszopiclone, zaleplon, and zolpidem, due to concerns about serious injuries resulting from abnormal sleep behaviors, including sleepwalking or driving a vehicle while asleep.[115]

The percentage of adults using a prescription sleep aid increases with age. During 2005–2010, about 4% of U.S. adults aged 20 and over reported that they took prescription sleep aids in the past 30 days. Rates of use were lowest among the youngest age group (those aged 20–39) at about 2%, increased to 6% among those aged 50–59, and reached 7% among those aged 80 and over. More adult women (5%) reported using prescription sleep aids than adult men (3%). Non-Hispanic white adults reported higher use of sleep aids (5%) than non-Hispanic black (3%) and Mexican-American (2%) adults. No difference was shown between non-Hispanic black adults and Mexican-American adults in use of prescription sleep aids.[116]

Antihistamines

As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief by taking over-the-counter antihistamines such as diphenhydramine or doxylamine.[117] Diphenhydramine and doxylamine are widely used in nonprescription sleep aids. They are the most effective over-the-counter sedatives currently available, at least in much of Europe, Canada, Australia, and the United States, and are more sedating than some prescription hypnotics.[118] Antihistamine effectiveness for sleep may decrease over time, and anticholinergic side-effects (such as dry mouth) may also be a drawback with these particular drugs. While addiction does not seem to be an issue with this class of drugs, they can induce dependence and rebound effects upon abrupt cessation of use.[119] However, people whose insomnia is caused by restless legs syndrome may have worsened symptoms with antihistamines.[120]

Antidepressants

While insomnia is a common symptom of depression, antidepressants are effective for treating sleep problems whether or not they are associated with depression. While all antidepressants help regulate sleep, some antidepressants, such as amitriptyline, doxepin, mirtazapine, trazodone, and trimipramine, can have an immediate sedative effect, and are prescribed to treat insomnia.[121] Amitriptyline, doxepin, and trimipramine all have antihistaminergic, anticholinergic, antiadrenergic, and antiserotonergic properties, which contribute to both their therapeutic effects and side effect profiles, while mirtazapine's actions are primarily antihistaminergic and antiserotonergic and trazodone's effects are primarily antiadrenergic and antiserotonergic. Mirtazapine is known to decrease sleep latency (i.e., the time it takes to fall asleep), promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia.[122][123]

Agomelatine, a melatonergic antidepressant with claimed sleep-improving qualities that does not cause daytime drowsiness,[124] is approved for the treatment of depression though not sleep conditions in the European Union[125] and Australia.[126] After trials in the United States, its development for use there was discontinued in October 2011[127] by Novartis, who had bought the rights to market it there from the European pharmaceutical company Servier.[128]

A 2018 Cochrane review found the safety of taking antidepressants for insomnia to be uncertain with no evidence supporting long term use.[129]

Melatonin agonists

Melatonin receptor agonists such as melatonin and ramelteon are used in the treatment of insomnia. The evidence for melatonin in treating insomnia is generally poor.[130] There is low-quality evidence that it may speed the onset of sleep by 6 minutes.[130] Ramelteon does not appear to speed the onset of sleep or the amount of sleep a person gets.[130]

Usage of melatonin as a treatment for insomnia in adults has increased from 0.4% between 1999 and 2000 to nearly 2.1% between 2017 and 2018.[131]

Most melatonin agonists have not been tested for longitudinal side effects.[132] Prolonged-release melatonin may improve quality of sleep in older people with minimal side effects.[133][134]

Studies have also shown that children who are on the autism spectrum or have learning disabilities, attention-deficit hyperactivity disorder (ADHD) or related neurological diseases can benefit from the use of melatonin. This is because they often have trouble sleeping due to their disorders. For example, children with ADHD tend to have trouble falling asleep because of their hyperactivity and, as a result, tend to be tired during most of the day. Another cause of insomnia in children with ADHD is the use of stimulants used to treat their disorder. Children who have ADHD then, as well as the other disorders mentioned, may be given melatonin before bedtime in order to help them sleep.[135]

Benzodiazepines

 
Normison (temazepam) is a benzodiazepine commonly prescribed for insomnia and other sleep disorders.[136]

The most commonly used class of hypnotics for insomnia are the benzodiazepines.[36]: 363  Benzodiazepines are not significantly better for insomnia than antidepressants.[137] Chronic users of hypnotic medications for insomnia do not have better sleep than chronic insomniacs not taking medications. In fact, chronic users of hypnotic medications have more regular night-time awakenings than insomniacs not taking hypnotic medications.[138] Many have concluded that these drugs cause an unjustifiable risk to the individual and to public health and lack evidence of long-term effectiveness. It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible, especially in the elderly.[139] Between 1993 and 2010, the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24% to 11% in the US, coinciding with the first release of nonbenzodiazepines.[140]

The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side-effects such as day time fatigue, motor vehicle crashes and other accidents, cognitive impairments, and falls and fractures. Elderly people are more sensitive to these side-effects.[141] Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to tolerance, physical dependence, benzodiazepine withdrawal syndrome upon discontinuation, and long-term worsening of sleep, especially after consistent usage over long periods of time. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as – like alcohol – they promote light sleep while decreasing time spent in deep sleep.[142] A further problem is, with regular use of short-acting sleep aids for insomnia, daytime rebound anxiety can emerge.[143] Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm, prescriptions have continued to increase.[144] This is likely due to their addictive nature, both due to misuse and because – through their rapid action, tolerance and withdrawal they can "trick" insomniacs into thinking they are helping with sleep. There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the long-term use of benzodiazepines and is recommended whenever possible.[145][146]

Benzodiazepines all bind unselectively to the GABAA receptor.[137] Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity at the α1 subunit of the GABAA receptor compared to other benzodiazepines (for example, triazolam and temazepam have significantly higher activity at the α1 subunit compared to alprazolam and diazepam, making them superior sedative-hypnotics – alprazolam and diazepam, in turn, have higher activity at the α2 subunit compared to triazolam and temazepam, making them superior anxiolytic agents). Modulation of the α1 subunit is associated with sedation, motor impairment, respiratory depression, amnesia, ataxia, and reinforcing behavior (drug-seeking behavior). Modulation of the α2 subunit is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited to treat insomnia than others.[96]

Z-Drugs

Nonbenzodiazepine or Z-drug sedative–hypnotic drugs, such as zolpidem, zaleplon, zopiclone, and eszopiclone, are a class of hypnotic medications that are similar to benzodiazepines in their mechanism of action, and indicated for mild to moderate insomnia. Their effectiveness at improving time to sleeping is slight, and they have similar—though potentially less severe—side effect profiles compared to benzodiazepines.[147] Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders to 13.7% in 2010.[140]

Orexin antagonists

Orexin receptor antagonists are a more recently introduced class of sleep medications and include suvorexant, lemborexant, and daridorexant, all of which are FDA-approved for treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance.[148][149]

Antipsychotics

Certain atypical antipsychotics, particularly quetiapine, olanzapine, and risperidone, are used in the treatment of insomnia.[150][151] However, while common, use of antipsychotics for this indication is not recommended as the evidence does not demonstrate a benefit, and the risk of adverse effects are significant.[150][152][153][154] A major 2022 systematic review and network meta-analysis of medications for insomnia in adults found that quetiapine did not demonstrate any short-term benefits for insomnia.[155] Some of the more serious adverse effects may also occur at the low doses used, such as dyslipidemia and neutropenia.[156][157] Such concerns of risks at low doses are supported by Danish observational studies that showed an association of use of low-dose quetiapine (excluding prescriptions filled for tablet strengths >50 mg) with an increased risk of major cardiovascular events as compared to use of Z-drugs, with most of the risk being driven by cardiovascular death.[158] Laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at 1-year follow-up.[159] Concerns regarding side effects are greater in the elderly.[132]

Other sedatives

Gabapentinoids like gabapentin and pregabalin have sleep-promoting effects but are not commonly used for treatment of insomnia.[160] Gabapentin is not effective in helping alcohol related insomnia.[161][162]

Barbiturates, while once used, are no longer recommended for insomnia due to the risk of addiction and other side effects.[163]

Comparative effectiveness

A major systematic review and network meta-analysis of medications for the treatment of insomnia was published in 2022.[155] It found a wide range of effect sizes (standardized mean difference (SMD)) in terms of efficacy for insomnia.[155] The assessed medications included benzodiazepines (SMDs 0.58 to 0.83), Z-drugs (SMDs 0.03 to 0.63), sedative antidepressants and antihistamines (SMDs 0.30 to 0.55), quetiapine (SMD 0.07), orexin receptor antagonists (SMDs 0.23 to 0.44), and melatonin receptor agonists (SMDs 0.00 to 0.13).[155] The certainty of evidence varied and ranged from high to very low depending on the medication.[155] The meta-analysis concluded that the orexin antagonist lemborexant and the Z-drug eszopiclone had the best profiles overall in terms of efficacy, tolerability, and acceptability.[155]

Alternative medicine

Herbal products, such as valerian, kava, chamomile, and lavender, have been used to treat insomnia.[164][165][166][167] However, there is no quality evidence that they are effective and safe.[164][165][166][167] The same is true for cannabis and cannabinoids.[168][169][170] It is likewise unclear if acupuncture is useful in the treatment of insomnia.[171]

Prognosis

 
Disability-adjusted life year for insomnia per 100,000 inhabitants in 2004.
  no data
  less than 25
  25–30.25
  30.25–36
  36–41.5
  41.5–47
  47–52.5
  52.5–58
  58–63.5
  63.5–69
  69–74.5
  74.5–80
  more than 80

A survey of 1.1 million residents in the United States found that those that reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those that slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Getting 8.5 or more hours of sleep per night was associated with a 15% higher mortality rate. Severe insomnia – sleeping less than 3.5 hours in women and 4.5 hours in men – is associated with a 15% increase in mortality.[172]

With this technique, it is difficult to distinguish lack of sleep caused by a disorder which is also a cause of premature death, versus a disorder which causes a lack of sleep, and the lack of sleep causing premature death. Most of the increase in mortality from severe insomnia was discounted after controlling for associated disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate.[172]

The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on mortality.[172] It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.[172]

Epidemiology

Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year, making it the most common sleep disorder.[9][8][10][173] About 6% of people have insomnia that is not due to another problem and lasts for more than a month.[9] People over the age of 65 are affected more often than younger people.[7] Females are more often affected than males.[8] Insomnia is 40% more common in women than in men.[174]

There are higher rates of insomnia reported among university students compared to the general population.[175]

Society and culture

The word insomnia is from Latin: in + somnus "without sleep" and -ia as a nominalizing suffix.

The popular press have published stories about people who supposedly never sleep, such as that of Thái Ngọc and Al Herpin.[176] Horne writes "everybody sleeps and needs to do so," and generally this appears true. However, he also relates from contemporary accounts the case of Paul Kern, who was shot in wartime and then "never slept again" until his death in 1943.[177] Kern appears to be a completely isolated, unique case.

References

  1. ^ a b c d e f g "What Is Insomnia?". NHLBI. 13 December 2011. from the original on 28 July 2016. Retrieved 9 August 2016.
  2. ^ a b c d "What Causes Insomnia?". NHLBI. 13 December 2011. from the original on 28 July 2016. Retrieved 9 August 2016.
  3. ^ a b c "How Is Insomnia Diagnosed?". NHLBI. 13 December 2011. from the original on 11 August 2016. Retrieved 9 August 2016.
  4. ^ Watson NF, Vaughn BV (2006). Clinician's Guide to Sleep Disorders. CRC Press. p. 10. ISBN 978-0-8493-7449-4.
  5. ^ a b c d "How Is Insomnia Treated?". NHLBI. 13 December 2011. from the original on 28 July 2016. Retrieved 9 August 2016.
  6. ^ a b c d e f Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD (July 2016). "Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians". Annals of Internal Medicine. 165 (2): 125–133. doi:10.7326/M15-2175. PMID 27136449.
  7. ^ a b c d e Wilson JF (January 2008). "In the clinic. Insomnia". Annals of Internal Medicine. 148 (1): ITC13–1–ITC13–16. doi:10.7326/0003-4819-148-1-200801010-01001. PMID 18166757. S2CID 42686046.
  8. ^ a b c d e f g "Dyssomnias" (PDF). WHO. pp. 7–11. (PDF) from the original on 18 March 2009. Retrieved 25 January 2009.
  9. ^ a b c d e f g h i j Roth T (August 2007). "Insomnia: definition, prevalence, etiology, and consequences". Journal of Clinical Sleep Medicine. 3 (5 Suppl): S7–10. doi:10.5664/jcsm.26929. PMC 1978319. PMID 17824495.
  10. ^ a b c Tasman A, Kay J, Lieberman JA, First MB, Riba M (2015). Psychiatry, 2 Volume Set (4 ed.). John Wiley & Sons. p. 4253. ISBN 978-1-118-75336-1.
  11. ^ a b c Punnoose AR, Golub RM, Burke AE (June 2012). "JAMA patient page. Insomnia". JAMA. 307 (24): 2653. doi:10.1001/jama.2012.6219. PMID 22735439.
  12. ^ Banno M, Tsujimoto Y, Kohmura K, Dohi E, Taito S, Someko H, Kataoka Y (September 2022). "Unclear Insomnia Concept in Randomized Controlled Trials and Systematic Reviews: A Meta-Epidemiological Study". International Journal of Environmental Research and Public Health. 19 (19): 12261. doi:10.3390/ijerph191912261. PMC 9566752. PMID 36231555.
  13. ^ a b Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, et al. (February 2021). "Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment". Journal of Clinical Sleep Medicine. 17 (2): 263–298. doi:10.5664/jcsm.8988. PMC 7853211. PMID 33164741.
  14. ^ a b c Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D (August 2015). "Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis". Annals of Internal Medicine. 163 (3): 191–204. doi:10.7326/M14-2841. PMID 26054060. S2CID 21617330.
  15. ^ Attarian HP (2003). "chapter 1". Clinical Handbook of Insomnia. Springer Science & Business Media. ISBN 978-1-59259-662-1.
  16. ^ Insomnia > Complications 8 February 2009 at the Wayback Machine. Mayo Clinic. Retrieved on 5 May 2009
  17. ^ Consumer Reports; Drug Effectiveness Review Project (January 2012). "Evaluating New Sleeping Pills Used to Treat: Insomnia Comparing Effectiveness, Safety, and Price" (PDF). Best Buy Drugs Consumer Reports: 4. (PDF) from the original on 9 December 2013. Retrieved 4 June 2013.
  18. ^ "Symptoms". Retrieved 15 April 2019.
  19. ^ Kertesz RS, Cote KA (2011). "Event-related potentials during the transition to sleep for individuals with sleep-onset insomnia". Behavioral Sleep Medicine. 9 (2): 68–85. doi:10.1080/15402002.2011.557989. PMID 21491230. S2CID 30439961.
  20. ^ Doghramji K (2007). Clinical Management of Insomnia. Caddo, OK: Professional Communications, Inc. p. 28. ISBN 978-1-932610-14-7.
  21. ^ Morin C (2003). Insomnia: A Clinician's Guide to Assessment and Treatment. New York: Kluwer Academic/Plenum Publishers. p. 16. ISBN 978-0-306-47750-8.
  22. ^ "What Causes Insomnia?". Retrieved 24 April 2019.
  23. ^ "What Happens When You Sleep?". 22 December 2009. from the original on 5 March 2017. Retrieved 24 February 2017.
  24. ^ Adler CH, Thorpy MJ (June 2005). "Sleep issues in Parkinson's disease". Neurology. 64 (12 Suppl 3): S12–20. doi:10.1212/WNL.64.12_suppl_3.S12. PMID 15994219. S2CID 24024570.
  25. ^ a b c Harvey AG, Tang NK (January 2012). "(Mis)perception of sleep in insomnia: a puzzle and a resolution". Psychological Bulletin. 138 (1): 77–101. doi:10.1037/a0025730. PMC 3277880. PMID 21967449.
  26. ^ Moawad, H. (2020) Primary insomnia: A lifelong problem, Psychiatric Times. Available at: https://www.psychiatrictimes.com/view/primary-insomnia-lifelong-problem (Accessed: December 29, 2022).
  27. ^ Meadows, G. (2015) The sleep book: How to sleep well every night. London, UK: Orion Publishing Group. p.21
  28. ^ Edinger JD (2013). Insomnia, An Issue of Sleep Medicine Clinics. Elsevier Health Sciences. p. 389. ISBN 978-0-323-18872-2.
  29. ^ a b c d e f "Insomnia". University of Maryland Medical Center. from the original on 3 July 2013. Retrieved 11 July 2013.
  30. ^ Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ (February 2007). "Comorbidity of chronic insomnia with medical problems". Sleep. 30 (2): 213–18. doi:10.1093/sleep/30.2.213. PMID 17326547.
  31. ^ a b "Insomnia Causes". Mayo Clinic. from the original on 21 October 2013. Retrieved 11 July 2013.
  32. ^ . National Heart Lung and Blood Institute. Archived from the original on 3 August 2013. Retrieved 11 July 2013.
  33. ^ a b Ramakrishnan K, Scheid DC (August 2007). "Treatment options for insomnia". American Family Physician. 76 (4): 517–26. PMID 17853625.
  34. ^ a b Santoro N, Epperson CN, Mathews SB (September 2015). "Menopausal Symptoms and Their Management". Endocrinology and Metabolism Clinics of North America. 44 (3): 497–515. doi:10.1016/j.ecl.2015.05.001. PMC 4890704. PMID 26316239.
  35. ^ "What causes insomnia?". National Heart, Lung, and Blood Institute. from the original on 3 July 2013. Retrieved 11 July 2013.
  36. ^ a b Geddes J, Price J, McKnight R, Gelder M, Mayou R (2012). Psychiatry (4th ed.). Oxford: Oxford University Press. ISBN 978-0-19-923396-0.
  37. ^ Bendz LM, Scates AC (January 2010). "Melatonin treatment for insomnia in pediatric patients with attention-deficit/hyperactivity disorder". The Annals of Pharmacotherapy. 44 (1): 185–91. doi:10.1345/aph.1M365. PMID 20028959. S2CID 207263711.
  38. ^ Ouellet MC, Beaulieu-Bonneau S, Morin CM (2006). "Insomnia in patients with traumatic brain injury: frequency, characteristics, and risk factors". The Journal of Head Trauma Rehabilitation. 21 (3): 199–212. doi:10.1097/00001199-200605000-00001. PMID 16717498. S2CID 28255648.
  39. ^ Schenkein J, Montagna P (September 2006). "Self management of fatal familial insomnia. Part 1: what is FFI?". MedGenMed. 8 (3): 65. PMC 1781306. PMID 17406188.
  40. ^ The epidemiological survey of exercise-induced insomnia in chinese athletes 9 September 2009 at the Wayback Machine Youqi Shi, Zhihong Zhou, Ke Ning, Jianhong LIU. Athens 2004: Pre-Olympic Congress.
  41. ^ Schmerler J. "Q&A: Why Is Blue Light before Bedtime Bad for Sleep?". Scientific American. Retrieved 19 October 2018.
  42. ^ Roth T (August 2007). "Insomnia: definition, prevalence, etiology, and consequences". Journal of Clinical Sleep Medicine. 3 (5 Suppl): S7-10. doi:10.5664/jcsm.26929. PMC 1978319. PMID 17824495.
  43. ^ a b c "What Causes Insomnia?". Sleep Foundation. Sleep Foundation. 2021. Retrieved 26 February 2021.
  44. ^ Hirotsu C, Tufik S, Andersen ML (November 2015). "Interactions between sleep, stress, and metabolism: From physiological to pathological conditions". Sleep Science. 8 (3): 143–152. doi:10.1016/j.slsci.2015.09.002. PMC 4688585. PMID 26779321.
  45. ^ Mendelson WB (2008). "New Research on Insomnia: Sleep Disorders May Precede or Exacerbate Psychiatric Conditions". Psychiatric Times. 25 (7). from the original on 19 October 2009.
  46. ^ Lind MJ, Aggen SH, Kirkpatrick RM, Kendler KS, Amstadter AB (September 2015). "A Longitudinal Twin Study of Insomnia Symptoms in Adults". Sleep. 38 (9): 1423–30. doi:10.5665/sleep.4982. PMC 4531410. PMID 26132482.
  47. ^ Hammerschlag AR, Stringer S, de Leeuw CA, Sniekers S, Taskesen E, Watanabe K, Blanken TF, Dekker K, Te Lindert BH, Wassing R, Jonsdottir I, Thorleifsson G, Stefansson H, Gislason T, Berger K, Schormair B, Wellmann J, Winkelmann J, Stefansson K, Oexle K, Van Someren EJ, Posthuma D (November 2017). "Genome-wide association analysis of insomnia complaints identifies risk genes and genetic overlap with psychiatric and metabolic traits". Nature Genetics. 49 (11): 1584–92. doi:10.1038/ng.3888. PMC 5600256. PMID 28604731.
  48. ^ Palagini L, Biber K, Riemann D (June 2014). "The genetics of insomnia – evidence for epigenetic mechanisms?". Sleep Medicine Reviews. 18 (3): 225–35. doi:10.1016/j.smrv.2013.05.002. PMID 23932332.
  49. ^ Perry L (12 October 2004). . HowStuffWorks. Archived from the original on 15 March 2010. Retrieved 20 November 2011.
  50. ^ Lee-chiong T (24 April 2008). Sleep Medicine: Essentials and Review. Oxford University Press. p. 105. ISBN 978-0-19-530659-0.
  51. ^ Ashton H (May 2005). "The diagnosis and management of benzodiazepine dependence". Current Opinion in Psychiatry. 18 (3): 249–55. doi:10.1097/01.yco.0000165594.60434.84. PMID 16639148. S2CID 1709063.
  52. ^ Morin CM, Bélanger L, Bastien C, Vallières A (January 2005). "Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse". Behaviour Research and Therapy. 43 (1): 1–14. doi:10.1016/j.brat.2003.12.002. PMID 15531349.
  53. ^ Poyares D, Guilleminault C, Ohayon MM, Tufik S (1 June 2004). "Chronic benzodiazepine usage and withdrawal in insomnia patients". Journal of Psychiatric Research. 38 (3): 327–34. doi:10.1016/j.jpsychires.2003.10.003. PMID 15003439.
  54. ^ Asaad TA, Ghanem MH, Samee AM, El-Habiby MM (2011). "Sleep Profile in Patients with Chronic Opioid Abuse". Addictive Disorders & Their Treatment. 10: 21–28. doi:10.1097/ADT.0b013e3181fb2847. S2CID 76376646.
  55. ^ "Insomnia – Symptoms and causes". Mayo Clinic. Retrieved 5 February 2018.
  56. ^ "Risk Factors For Insomnia". Retrieved 14 April 2019.
  57. ^ Lichstein, K. L., Taylor, D. J., McCrae, C. S., & Petrov, M. (2010). Insomnia: Epidemiology and Risk Factors. Principles and Practice of Sleep Medicine: Fifth Edition, 827–37. doi:10.1016/B978-1-4160-6645-3.00076-1
  58. ^ Bonnet MH (April 2009). "Evidence for the pathophysiology of insomnia". Sleep. 32 (4): 441–42. doi:10.1093/sleep/32.4.441. PMC 2663857. PMID 19413138.
  59. ^ Levenson JC, Kay DB, Buysse DJ (April 2015). "The pathophysiology of insomnia". Chest. 147 (4): 1179–92. doi:10.1378/chest.14-1617. PMC 4388122. PMID 25846534.
  60. ^ Mai E, Buysse DJ (1 January 2008). "Insomnia: Prevalence, Impact, Pathogenesis, Differential Diagnosis, and Evaluation". Sleep Medicine Clinics. 3 (2): 167–74. doi:10.1016/j.jsmc.2008.02.001. PMC 2504337. PMID 19122760.
  61. ^ Shaver JL, Woods NF (August 2015). "Sleep and menopause: a narrative review". Menopause. 22 (8): 899–915. doi:10.1097/GME.0000000000000499. PMID 26154276. S2CID 23937236.
  62. ^ Lord C, Sekerovic Z, Carrier J (October 2014). "Sleep regulation and sex hormones exposure in men and women across adulthood". Pathologie-Biologie. 62 (5): 302–10. doi:10.1016/j.patbio.2014.07.005. PMID 25218407.
  63. ^ Soldatos CR, Dikeos DG, Paparrigopoulos TJ (June 2000). "Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria". Journal of Psychosomatic Research. 48 (6): 555–60. doi:10.1016/S0022-3999(00)00095-7. PMID 11033374.
  64. ^ a b Passarella, S, Duong, M. "Diagnosis and treatment of insomnia." 2008.
  65. ^ a b c Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (October 2008). "Clinical guideline for the evaluation and management of chronic insomnia in adults" (PDF). Journal of Clinical Sleep Medicine. 4 (5): 487–504. doi:10.5664/jcsm.27286. PMC 2576317. PMID 18853708. (PDF) from the original on 9 February 2015. Retrieved 30 July 2015. Actigraphy is indicated as a method to characterize circadian patterns or sleep disturbances in individuals with insomnia, ...
  66. ^ a b c American College of Occupational and Environmental Medicine (February 2014), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Occupational and Environmental Medicine, from the original on 11 September 2014, retrieved 24 February 2014
  67. ^ Thorpy MJ (October 2012). "Classification of sleep disorders". Neurotherapeutics. 9 (4): 687–701. doi:10.1007/s13311-012-0145-6. PMC 3480567. PMID 22976557.
  68. ^ a b c Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. (November 2010). "British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders". Journal of Psychopharmacology. 24 (11): 1577–1601. doi:10.1177/0269881110379307. PMID 20813762. S2CID 16823040.
  69. ^ a b Luca A, Luca M, Calandra C (2013). "Sleep disorders and depression: brief review of the literature, case report, and nonpharmacologic interventions for depression". Clinical Interventions in Aging. 8: 1033–39. doi:10.2147/CIA.S47230. PMC 3760296. PMID 24019746.
  70. ^ "Sleep Wake Disorders." Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association, 2013.
  71. ^ a b Roth T, Roehrs T (2003). "Insomnia: epidemiology, characteristics, and consequences". Clinical Cornerstone. 5 (3): 5–15. doi:10.1016/S1098-3597(03)90031-7. PMID 14626537.
  72. ^ Archived from the original on 29 March 2008. Retrieved 29 April 2008.
  73. ^ "Acute Insomnia – What is Acute Insomnia". Sleepdisorders.about.com. from the original on 29 March 2013. Retrieved 10 March 2013.
  74. ^ "Types of Insomnia". Sleep Foundation. 2020-08-31. Retrieved 2022-07-15.
  75. ^ Simon H. "In-Depth Report: Causes of Chronic Insomnia". The New York Times. from the original on 8 November 2011. Retrieved 4 November 2011.
  76. ^ a b Abad VC, Guilleminault C (September 2018). "Insomnia in Elderly Patients: Recommendations for Pharmacological Management". Drugs & Aging. 35 (9): 791–817. doi:10.1007/s40266-018-0569-8. PMID 30058034. S2CID 51866276.
  77. ^ a b c d e "Insomnia: Diagnosis and treatment". Mayo Clinic. 15 October 2016. Retrieved 11 October 2018.
  78. ^ Pathak N (17 January 2017). "Insomnia (Acute & Chronic): Symptoms, Causes, and Treatment". WebMD. Retrieved 11 October 2018.
  79. ^ Wortelboer U, Cohrs S, Rodenbeck A, Rüther E (2002). "Tolerability of hypnosedatives in older patients". Drugs & Aging. 19 (7): 529–39. doi:10.2165/00002512-200219070-00006. PMID 12182689. S2CID 38910586.
  80. ^ van Straten A, van der Zweerde T, Kleiboer A, Cuijpers P, Morin CM, Lancee J (April 2018). "Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis" (PDF). Sleep Medicine Reviews. 38: 3–16. doi:10.1016/j.smrv.2017.02.001. hdl:1871.1/6fbbd685-d526-41ec-9961-437833035f53. PMID 28392168. S2CID 3359815.
  81. ^ "NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults". NIH Consensus and State-Of-The-Science Statements. 22 (2): 1–30. 2005. PMID 17308547.
  82. ^ Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (February 2017). "Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline". Journal of Clinical Sleep Medicine. 13 (2): 307–349. doi:10.5664/jcsm.6470. PMC 5263087. PMID 27998379.
  83. ^ Riemann D, Perlis ML (June 2009). "The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies". Sleep Medicine Reviews. 13 (3): 205–14. doi:10.1016/j.smrv.2008.06.001. PMID 19201632.
  84. ^ a b c Merrigan JM, Buysse DJ, Bird JC, Livingston EH (February 2013). "JAMA patient page. Insomnia". JAMA. 309 (7): 733. doi:10.1001/jama.2013.524. PMID 23423421.
  85. ^ "Sleep Statistics - Facts and Data About Sleep 2022". Sleep Foundation. 2021-10-25. Retrieved 2022-07-15.
  86. ^ Drake CL, Roehrs T, Roth T (December 2003). "Insomnia causes, consequences, and therapeutics: an overview". Depression and Anxiety. 18 (4): 163–76. doi:10.1002/da.10151. PMID 14661186. S2CID 19203612.
  87. ^ National Prescribing Service (1 February 2010). "Addressing hypnotic medicines use in primary care" 1 November 2013 at the Wayback Machine. NPS News, Vol. 67.
  88. ^ Kirkwood CK (1999). "Management of insomnia". Journal of the American Pharmaceutical Association. 39 (5): 688–96, quiz 713–14. doi:10.1016/s1086-5802(15)30354-5. PMID 10533351.
  89. ^ Jespersen KV, Pando-Naude V, Koenig J, Jennum P, Vuust P (August 2022). "Listening to music for insomnia in adults". The Cochrane Database of Systematic Reviews. 2022 (8): CD010459. doi:10.1002/14651858.CD010459.pub3. PMC 9400393. PMID 36000763.
  90. ^ Lake JA (2006). Textbook of Integrative Mental Health Care. Thieme Medical Publishers. p. 313. ISBN 978-1-58890-299-3.
  91. ^ van Straten A, Cuijpers P (February 2009). "Self-help therapy for insomnia: a meta-analysis". Sleep Medicine Reviews. 13 (1): 61–71. doi:10.1016/j.smrv.2008.04.006. PMID 18952469.
  92. ^ Lande RG, Gragnani C (December 2010). "Nonpharmacologic approaches to the management of insomnia". The Journal of the American Osteopathic Association. 110 (12): 695–701. PMID 21178150.
  93. ^ van Maanen A, Meijer AM, van der Heijden KB, Oort FJ (October 2016). "The effects of light therapy on sleep problems: A systematic review and meta-analysis". Sleep Med Rev. 29: 52–62. doi:10.1016/j.smrv.2015.08.009. PMID 26606319. S2CID 3410636.
  94. ^ Kierlin L (November 2008). "Sleeping without a pill: nonpharmacologic treatments for insomnia". Journal of Psychiatric Practice. 14 (6): 403–07. doi:10.1097/01.pra.0000341896.73926.6c. PMID 19057243. S2CID 22141056.
  95. ^ Ellis J, Hampson SE, Cropley M (May 2002). "Sleep hygiene or compensatory sleep practices: An examination of behaviours affecting sleep in older adults". Psychology, Health & Medicine. 7 (2): 156–161. doi:10.1080/13548500120116094. S2CID 143141307.
  96. ^ a b "Insomnia". The Lecturio Medical Concept Library. Retrieved 2021-06-24.
  97. ^ Mitchell MD, Gehrman P, Perlis M, Umscheid CA (May 2012). "Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review". BMC Family Practice. 13: 40. doi:10.1186/1471-2296-13-40. PMC 3481424. PMID 22631616.
  98. ^ Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW (September 2004). "Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison". Archives of Internal Medicine. 164 (17): 1888–96. doi:10.1001/archinte.164.17.1888. PMID 15451764.
  99. ^ Morin CM, Colecchi C, Stone J, Sood R, Brink D (March 1999). "Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial". JAMA. 281 (11): 991–99. doi:10.1001/jama.281.11.991. PMID 10086433.
  100. ^ Miller KE (2005). . American Family Physician. 72 (2): 330. Archived from the original on 6 June 2011.
  101. ^ Ramakrishnan K, Scheid DC (August 2007). "Treatment options for insomnia". American Family Physician. 76 (4): 517–526. PMID 17853625.
  102. ^ Krystal AD (August 2009). "A compendium of placebo-controlled trials of the risks/benefits of pharmacological treatments for insomnia: the empirical basis for U.S. clinical practice". Sleep Medicine Reviews. 13 (4): 265–74. doi:10.1016/j.smrv.2008.08.001. PMID 19153052.
  103. ^ Matthews EE, Arnedt JT, McCarthy MS, Cuddihy LJ, Aloia MS (December 2013). "Adherence to cognitive behavioral therapy for insomnia: a systematic review". Sleep Medicine Reviews. 17 (6): 453–64. doi:10.1016/j.smrv.2013.01.001. PMC 3720832. PMID 23602124.
  104. ^ Ong JC, Ulmer CS, Manber R (November 2012). "Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia". Behaviour Research and Therapy. 50 (11): 651–60. doi:10.1016/j.brat.2012.08.001. PMC 3466342. PMID 22975073.
  105. ^ a b Meadows, G. (2015) The sleep book: How to sleep well every night. London, UK: Orion Publishing Group, p.2-7
  106. ^ Salari, N., Khazaie, H., Hosseinian-Far, A. et al. The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC Neurol 20, 300 (2020). https://doi.org/10.1186/s12883-020-01883-1
  107. ^ Edinger JD, Means MK (July 2005). "Cognitive-behavioral therapy for primary insomnia". Clinical Psychology Review. 25 (5): 539–58. doi:10.1016/j.cpr.2005.04.003. PMID 15951083.
  108. ^ a b Fox S, Fallows D (5 October 2005). . Internet health resources. Washington, DC: Pew Internet & American Life Project. Archived from the original on 21 October 2005.
  109. ^ Rabasca L (2000). "Taking telehealth to the next step". Monitor on Psychology. 31: 36–37. doi:10.1037/e378852004-017. from the original on 30 December 2012.
  110. ^ Marks IM, Cavanagh K, Gega L (2007). Hands-on Help: Computer-Aided Psychotherapy. Hove, England and New York: Psychology Press. ISBN 978-1-84169-679-9.
  111. ^ a b Ritterband LM, Gonder-Frederick LA, Cox DJ, Clifton AD, West RW, Borowitz SM (2003). "Internet interventions: In review, in use, and into the future". Professional Psychology: Research and Practice. 34 (5): 527–34. doi:10.1037/0735-7028.34.5.527. S2CID 161666.
  112. ^ Cheng SK, Dizon J (2012). "Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis". Psychotherapy and Psychosomatics. 81 (4): 206–16. doi:10.1159/000335379. PMID 22585048. S2CID 10527276.
  113. ^ Charles J, Harrison C, Britt H (May 2009). (PDF). Australian Family Physician. 38 (5): 283. PMID 19458795. Archived from the original (PDF) on 12 March 2011.
  114. ^ Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD (July 2016). "Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians". Annals of Internal Medicine. 165 (2): 125–133. doi:10.7326/m15-2175. PMID 27136449.
  115. ^ "FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines". US Food and Drug Administration. 30 April 2019. Retrieved 2 May 2019.
  116. ^ Chong Y., Fryar, C.D., and Gu, Q. (2013). Prescription Sleep Aid Use Among Adults: United States, 2005–2010. Hyattsville, Md.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
  117. ^ Consumer Reports; Drug Effectiveness Review Project (January 2012). "Evaluating Newer Sleeping Pills Used to Treat: Insomnia. Comparing Effectiveness, Safety, and Price" (PDF). Best Buy Drugs: 3, 8, 11. (PDF) from the original on 9 December 2013. Retrieved 4 June 2013.
  118. ^ DrugBank: DB00366 (Doxylamine) 3 December 2009 at the Wayback Machine. Drugbank.ca. Retrieved on 20 November 2011.
  119. ^ Lie JD, Tu KN, Shen DD, Wong BM (November 2015). "Pharmacological Treatment of Insomnia". P & T. 40 (11): 759–771. PMC 4634348. PMID 26609210.
  120. ^ "Restless Legs Syndrome Fact Sheet | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. from the original on 28 July 2017. Retrieved 29 August 2017.
  121. ^ Bertschy G, Ragama-Pardos E, Muscionico M, Aït-Ameur A, Roth L, Osiek C, Ferrero F (January 2005). "Trazodone addition for insomnia in venlafaxine-treated, depressed inpatients: a semi-naturalistic study". Pharmacological Research. 51 (1): 79–84. doi:10.1016/j.phrs.2004.06.007. PMID 15519538.
  122. ^ Winokur A, DeMartinis NA, McNally DP, Gary EM, Cormier JL, Gary KA (October 2003). "Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia". The Journal of Clinical Psychiatry. 64 (10): 1224–29. doi:10.4088/JCP.v64n1013. PMID 14658972.
  123. ^ Schittecatte M, Dumont F, Machowski R, Cornil C, Lavergne F, Wilmotte J (2002). "Effects of mirtazapine on sleep polygraphic variables in major depression". Neuropsychobiology. 46 (4): 197–201. doi:10.1159/000067812. PMID 12566938. S2CID 25351993.
  124. ^ Le Strat Y, Gorwood P (September 2008). "Agomelatine, an innovative pharmacological response to unmet needs". Journal of Psychopharmacology. 22 (7 Suppl): 4–8. doi:10.1177/0269881108092593. PMID 18753276. S2CID 29745284.
  125. ^ "Summary of Product Characteristics" (PDF). European Medicine Agency. (PDF) from the original on 29 October 2014. Retrieved 14 October 2013.
  126. ^ "VALDOXAN® Product Information" (PDF). TGA eBusiness Services. Servier Laboratories Pty Ltd. 23 September 2013. from the original on 24 March 2017. Retrieved 14 October 2013.
  127. ^ Novartis drops future blockbuster agomelatine. 11 November 2011 at the Wayback Machine Scrip Intelligence, 25 October 2011 (retrieved 30 October 2011).
  128. ^ Bentham C (29 March 2006). . Servier UK. Archived from the original on 16 April 2009. Retrieved 15 May 2009.
  129. ^ Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, et al. (May 2018). "Antidepressants for insomnia in adults". The Cochrane Database of Systematic Reviews. 2018 (5): CD010753. doi:10.1002/14651858.CD010753.pub2. PMC 6494576. PMID 29761479.
  130. ^ a b c Brasure M, MacDonald R, Fuchs E, Olson CM, Carlyle M, Diem S, Koffel E, Khawaja IS, Ouellette J, Butler M, Kane RL, Wilt TJ (December 2015). "Management of Insomnia Disorder". AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID 26844312.
  131. ^ "Use of melatonin supplements rising among adults". National Institutes of Health (NIH). 2022-02-28. Retrieved 2022-06-29.
  132. ^ a b Conn DK, Madan R (2006). "Use of sleep-promoting medications in nursing home residents: risks versus benefits". Drugs & Aging. 23 (4): 271–87. doi:10.2165/00002512-200623040-00001. PMID 16732687. S2CID 38394552.
  133. ^ Lyseng-Williamson KA (November 2012). "Melatonin prolonged release: in the treatment of insomnia in patients aged ≥55 years". Drugs & Aging. 29 (11): 911–23. doi:10.1007/s40266-012-0018-z. PMID 23044640. S2CID 1403262.
  134. ^ Lemoine P, Zisapel N (April 2012). "Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia". Expert Opinion on Pharmacotherapy. 13 (6): 895–905. doi:10.1517/14656566.2012.667076. PMID 22429105. S2CID 23291045.
  135. ^ Sánchez-Barceló EJ, Mediavilla MD, Reiter RJ (2011). "Clinical uses of melatonin in pediatrics". International Journal of Pediatrics. 2011: 892624. doi:10.1155/2011/892624. PMC 3133850. PMID 21760817.
  136. ^ Temazepam 30 May 2013 at the Wayback Machine. Websters-online-dictionary.org. Retrieved on 20 November 2011.
  137. ^ a b Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M (September 2007). "The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs". Journal of General Internal Medicine. 22 (9): 1335–50. doi:10.1007/s11606-007-0251-z. PMC 2219774. PMID 17619935.
  138. ^ Ohayon MM, Caulet M (May 1995). "Insomnia and psychotropic drug consumption". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 19 (3): 421–31. doi:10.1016/0278-5846(94)00023-B. PMID 7624493. S2CID 20655328.
  139. ^ "What's wrong with prescribing hypnotics?". Drug and Therapeutics Bulletin. 42 (12): 89–93. December 2004. doi:10.1136/dtb.2004.421289. PMID 15587763. S2CID 40188442.
  140. ^ a b Kaufmann CN, Spira AP, Alexander GC, Rutkow L, Mojtabai R (June 2016). "Trends in prescribing of sedative-hypnotic medications in the USA: 1993–2010". Pharmacoepidemiology and Drug Safety. 25 (6): 637–45. doi:10.1002/pds.3951. PMC 4889508. PMID 26711081.
  141. ^ Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE (November 2005). "Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits". BMJ. 331 (7526): 1169. doi:10.1136/bmj.38623.768588.47. PMC 1285093. PMID 16284208.
  142. ^ Tsoi WF (March 1991). "Insomnia: drug treatment". Annals of the Academy of Medicine, Singapore. 20 (2): 269–72. PMID 1679317.
  143. ^ Montplaisir J (August 2000). "Treatment of primary insomnia". CMAJ. 163 (4): 389–91. PMC 80369. PMID 10976252.
  144. ^ Carlstedt RA (2009). Handbook of Integrative Clinical Psychology, Psychiatry, and Behavioral Medicine: Perspectives, Practices, and Research. Springer. pp. 128–30. ISBN 978-0-8261-1094-7.
  145. ^ Lader M, Cardinali DP, Pandi-Perumal SR (2006). Sleep and sleep disorders: a neuropsychopharmacological approach. Georgetown, Tex.: Landes Bioscience/Eurekah.com. p. 127. ISBN 978-0-387-27681-6.
  146. ^ Authier N, Boucher A, Lamaison D, Llorca PM, Descotes J, Eschalier A (2009). "Second meeting of the French CEIP (Centres d'Evaluation et d'Information sur la Pharmacodépendance). Part II: benzodiazepine withdrawal". Therapie. 64 (6): 365–70. doi:10.2515/therapie/2009051. PMID 20025839.
  147. ^ Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN (December 2012). "Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration". BMJ. 345: e8343. doi:10.1136/bmj.e8343. PMC 3544552. PMID 23248080.
  148. ^ Jacobson LH, Hoyer D, de Lecea L (January 2022). "Hypocretins (orexins): The ultimate translational neuropeptides". J Intern Med. 291 (5): 533–556. doi:10.1111/joim.13406. PMID 35043499. S2CID 248119793.
  149. ^ "Highlights of prescribing information" (PDF). (PDF) from the original on 12 September 2014.
  150. ^ a b Thompson W, Quay TA, Rojas-Fernandez C, Farrell B, Bjerre LM (June 2016). "Atypical antipsychotics for insomnia: a systematic review". Sleep Med. 22: 13–17. doi:10.1016/j.sleep.2016.04.003. PMID 27544830.
  151. ^ Morin AK (1 March 2014). "Off-label use of atypical antipsychotic agents for treatment of insomnia". Mental Health Clinician. 4 (2): 65–72. doi:10.9740/mhc.n190091. eISSN 2168-9709.
  152. ^ American Psychiatric Association (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Psychiatric Association, from the original on 3 December 2013, retrieved 30 December 2013, which cites
    • American Association of Clinical Endocrinologists; North American Association for the Study of Obesity (February 2004). "Consensus development conference on antipsychotic drugs and obesity and diabetes". Diabetes Care. 27 (2): 596–601. doi:10.2337/diacare.27.2.596. PMID 14747245.
    • Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, Roth B, Hilton L, Suttorp MJ, Ewing BA, Motala A, Perry T (Sep 2011). "Off-Label Use of Atypical Antipsychotics: An Update". AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID 22132426.
    • Nasrallah HA (January 2008). "Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles". Molecular Psychiatry. 13 (1): 27–35. doi:10.1038/sj.mp.4002066. PMID 17848919. S2CID 205678886.
  153. ^ Coe HV, Hong IS (May 2012). "Safety of low doses of quetiapine when used for insomnia". The Annals of Pharmacotherapy. 46 (5): 718–722. doi:10.1345/aph.1Q697. PMID 22510671. S2CID 9888209.
  154. ^ Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, Roth B, Hilton L, Suttorp MJ (2011). Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Reviews, No. 43. Rockville: Agency for Healthcare Research and Quality. PMID 22973576.
  155. ^ a b c d e f De Crescenzo F, D'Alò GL, Ostinelli EG, Ciabattini M, Di Franco V, Watanabe N, Kurtulmus A, Tomlinson A, Mitrova Z, Foti F, Del Giovane C, Quested DJ, Cowen PJ, Barbui C, Amato L, Efthimiou O, Cipriani A (July 2022). "Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis". Lancet. 400 (10347): 170–184. doi:10.1016/S0140-6736(22)00878-9. PMID 35843245. S2CID 250536370.
  156. ^ Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, et al. (January 2020). "Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis". The Lancet. Psychiatry. 7 (1): 64–77. doi:10.1016/s2215-0366(19)30416-x. PMC 7029416. PMID 31860457.
  157. ^ Yoshida K, Takeuchi H (March 2021). "Dose-dependent effects of antipsychotics on efficacy and adverse effects in schizophrenia". Behavioural Brain Research. 402: 113098. doi:10.1016/j.bbr.2020.113098. PMID 33417992. S2CID 230507941.
  158. ^ Højlund M, Andersen K, Ernst MT, Correll CU, Hallas J (October 2022). "Use of low-dose quetiapine increases the risk of major adverse cardiovascular events: results from a nationwide active comparator-controlled cohort study". World Psychiatry. 21 (3): 444–451. doi:10.1002/wps.21010. PMC 9453914. PMID 36073694.
  159. ^ Højlund M (2022-09-12). Low-dose Quetiapine: Utilization and Cardiometabolic Risk (Thesis). Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet. doi:10.21996/mr3m-1783.
  160. ^ Atkin T, Comai S, Gobbi G (April 2018). "Drugs for Insomnia beyond Benzodiazepines: Pharmacology, Clinical Applications, and Discovery". Pharmacol Rev. 70 (2): 197–245. doi:10.1124/pr.117.014381. PMID 29487083. S2CID 3578916.
  161. ^ "Review finds little evidence to support gabapentinoid use in bipolar disorder or insomnia". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 17 October 2022. doi:10.3310/nihrevidence_54173. S2CID 252983016.
  162. ^ Hong JS, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, et al. (March 2022). "Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale". Molecular Psychiatry. 27 (3): 1339–1349. doi:10.1038/s41380-021-01386-6. PMC 9095464. PMID 34819636.
  163. ^ Aschenbrenner DS, Venable SJ (2009). Drug Therapy in Nursing. Lippincott Williams & Wilkins. p. 277. ISBN 978-0-7817-6587-9.
  164. ^ a b Leach MJ, Page AT (December 2015). "Herbal medicine for insomnia: A systematic review and meta-analysis". Sleep Med Rev. 24: 1–12. doi:10.1016/j.smrv.2014.12.003. PMID 25644982.
  165. ^ a b Kim J, Lee SL, Kang I, Song YA, Ma J, Hong YS, Park S, Moon SI, Kim S, Jeong S, Kim JE (May 2018). "Natural Products from Single Plants as Sleep Aids: A Systematic Review". J Med Food. 21 (5): 433–444. doi:10.1089/jmf.2017.4064. PMID 29356580.
  166. ^ a b Meolie AL, Rosen C, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Townsend D, Claman D, Hoban T, Mahowald M (April 2005). "Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence". J Clin Sleep Med. 1 (2): 173–87. doi:10.5664/jcsm.26314. PMID 17561634.
  167. ^ a b Wheatley D (July 2005). "Medicinal plants for insomnia: a review of their pharmacology, efficacy and tolerability". J Psychopharmacol. 19 (4): 414–21. doi:10.1177/0269881105053309. PMID 15982998. S2CID 34484538.
  168. ^ Bhagavan C, Kung S, Doppen M, John M, Vakalalabure I, Oldfield K, Braithwaite I, Newton-Howes G (December 2020). "Cannabinoids in the Treatment of Insomnia Disorder: A Systematic Review and Meta-Analysis". CNS Drugs. 34 (12): 1217–1228. doi:10.1007/s40263-020-00773-x. PMID 33244728. S2CID 227174084.
  169. ^ Suraev AS, Marshall NS, Vandrey R, McCartney D, Benson MJ, McGregor IS, Grunstein RR, Hoyos CM (October 2020). "Cannabinoid therapies in the management of sleep disorders: A systematic review of preclinical and clinical studies". Sleep Med Rev. 53: 101339. doi:10.1016/j.smrv.2020.101339. PMID 32603954. S2CID 219452622.
  170. ^ Gates PJ, Albertella L, Copeland J (December 2014). "The effects of cannabinoid administration on sleep: a systematic review of human studies". Sleep Med Rev. 18 (6): 477–87. doi:10.1016/j.smrv.2014.02.005. PMID 24726015.
  171. ^ Cheuk DK, Yeung WF, Chung KF, Wong V (September 2012). "Acupuncture for insomnia". The Cochrane Database of Systematic Reviews. 9 (9): CD005472. doi:10.1002/14651858.CD005472.pub3. hdl:10722/198790. PMID 22972087.
  172. ^ a b c d Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (February 2002). "Mortality associated with sleep duration and insomnia". Archives of General Psychiatry. 59 (2): 131–36. doi:10.1001/archpsyc.59.2.131. PMID 11825133.
  173. ^ "What are Sleep Disorders?". Psychiatry.org.
  174. ^ Lamberg L (2007). "Several Sleep Disorders Reflect Gender Differences". Psychiatric News. 42 (8): 40. doi:10.1176/pn.42.10.0040.
  175. ^ Jiang XL, Zheng XY, Yang J, Ye CP, Chen YY, Zhang ZG, Xiao ZJ (December 2015). "A systematic review of studies on the prevalence of insomnia in university students". Public Health. 129 (12): 1579–84. doi:10.1016/j.puhe.2015.07.030. PMID 26298588.
  176. ^ Horne J (2016). Sleeplessness Assessing Sleep Need in Society Today. p. 114. ISBN 978-3-319-30572-1. Everyone sleeps and needs to do so
  177. ^ Horne J (2016). Sleeplessness Assessing Sleep Need in Society Today. p. 116. ISBN 978-3-319-30572-1.

External links

February 21, 2023
insomnia, this, article, about, sleeping, disorder, other, uses, disambiguation, trouble, sleeping, redirects, here, other, uses, trouble, sleeping, disambiguation, also, known, sleeplessness, sleep, disorder, which, people, have, trouble, sleeping, they, have. This article is about the sleeping disorder For other uses see Insomnia disambiguation Trouble sleeping redirects here For other uses see Trouble sleeping disambiguation Insomnia also known as sleeplessness is a sleep disorder in which people have trouble sleeping 1 They may have difficulty falling asleep or staying asleep for as long as desired 9 11 Insomnia is typically followed by daytime sleepiness low energy irritability and a depressed mood 1 It may result in an increased risk of motor vehicle collisions as well as problems focusing and learning 1 Insomnia can be short term lasting for days or weeks or long term lasting more than a month 1 The concept of the word insomnia has two possibilities insomnia disorder and insomnia symptoms and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to 12 InsomniaOther namesSleeplessness trouble sleepingDepiction of insomnia from the 14th century medical manuscript Tacuinum SanitatisPronunciation ɪ n ˈ s ɒ m n i e 1 SpecialtyPsychiatry sleep medicineSymptomsTrouble sleeping daytime sleepiness low energy irritability depressed mood 1 ComplicationsMotor vehicle collisions 1 CausesUnknown psychological stress chronic pain heart failure hyperthyroidism heartburn restless leg syndrome others 2 Diagnostic methodBased on symptoms sleep study 3 Differential diagnosisDelayed sleep phase disorder restless leg syndrome sleep apnea psychiatric disorder 4 TreatmentSleep hygiene cognitive behavioral therapy sleeping pills 5 6 7 Frequency 20 8 9 10 Insomnia can occur independently or as a result of another problem 2 Conditions that can result in insomnia include psychological stress chronic pain heart failure hyperthyroidism heartburn restless leg syndrome menopause certain medications and drugs such as caffeine nicotine and alcohol 2 8 Other risk factors include working night shifts and sleep apnea 9 Diagnosis is based on sleep habits and an examination to look for underlying causes 3 A sleep study may be done to look for underlying sleep disorders 3 Screening may be done with two questions do you experience difficulty sleeping and do you have difficulty falling or staying asleep 9 Although their efficacy as first line treatments is not unequivocally established 13 sleep hygiene and lifestyle changes are typically the first treatment for insomnia 5 7 Sleep hygiene includes a consistent bedtime a quiet and dark room exposure to sunlight during the day and regular exercise 7 Cognitive behavioral therapy may be added to this 6 14 While sleeping pills may help they are sometimes associated with injuries dementia and addiction 5 6 These medications are not recommended for more than four or five weeks 6 The effectiveness and safety of alternative medicine is unclear 5 6 Between 10 and 30 of adults have insomnia at any given point in time and up to half of people have insomnia in a given year 8 9 10 About 6 of people have insomnia that is not due to another problem and lasts for more than a month 9 People over the age of 65 are affected more often than younger people 7 Females are more often affected than males 8 Descriptions of insomnia occur at least as far back as ancient Greece 15 Contents 1 Signs and symptoms 1 1 Poor sleep quality 1 2 Subjectivity 2 Causes 2 1 Genetics 2 2 Substance induced 2 2 1 Alcohol induced 2 2 2 Benzodiazepine induced 2 2 3 Opioid induced 2 3 Risk factors 3 Mechanism 4 Diagnosis 4 1 DSM 5 criteria 4 2 Types 5 Prevention 6 Management 6 1 Non medication based 6 1 1 Sleep hygiene 6 1 2 Cognitive behavioral therapy 6 1 3 Acceptance and commitment therapy 6 1 4 Internet interventions 6 2 Medications 6 2 1 Antihistamines 6 2 2 Antidepressants 6 2 3 Melatonin agonists 6 2 4 Benzodiazepines 6 2 5 Z Drugs 6 2 6 Orexin antagonists 6 2 7 Antipsychotics 6 2 8 Other sedatives 6 2 9 Comparative effectiveness 6 3 Alternative medicine 7 Prognosis 8 Epidemiology 9 Society and culture 10 References 11 External linksSigns and symptoms Edit Potential complications of insomnia 16 Symptoms of insomnia 17 Difficulty falling asleep including difficulty finding a comfortable sleeping position Waking during the night being unable to return to sleep and waking up early Not able to focus on daily tasks difficulty in remembering Daytime sleepiness irritability depression or anxiety Feeling tired or having low energy during the day 18 Trouble concentrating Being irritable acting aggressive or impulsiveSleep onset insomnia is difficulty falling asleep at the beginning of the night often a symptom of anxiety disorders Delayed sleep phase disorder can be misdiagnosed as insomnia as sleep onset is delayed to much later than normal while awakening spills over into daylight hours 19 It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep Two thirds of these patients wake up in the middle of the night with more than half having trouble falling back to sleep after a middle of the night awakening 20 Early morning awakening is an awakening occurring earlier more than 30 minutes than desired with an inability to go back to sleep and before total sleep time reaches 6 5 hours Early morning awakening is often a characteristic of depression 21 Anxiety symptoms may well lead to insomnia Some of these symptoms include tension compulsive worrying about the future feeling overstimulated and overanalyzing past events 22 Poor sleep quality Edit Poor sleep quality can occur as a result of for example restless legs sleep apnea or major depression Poor sleep quality is defined as the individual not reaching stage 3 or delta sleep which has restorative properties 23 Major depression leads to alterations in the function of the hypothalamic pituitary adrenal axis causing excessive release of cortisol which can lead to poor sleep quality Nocturnal polyuria excessive night time urination can also result in a poor quality of sleep 24 Subjectivity Edit Main article Sleep state misperception Some cases of insomnia are not really insomnia in the traditional sense because people experiencing sleep state misperception often sleep for a normal amount of time 25 The problem is that despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss they do not feel like they have slept very much if at all 25 Because their perception of their sleep is incomplete they incorrectly believe it takes them an abnormally long time to fall asleep and they underestimate how long they stay asleep 25 Causes EditWhile insomnia can be caused by a number of conditions it can also occur without any identifiable cause This is known as Primary Insomnia 26 Primary Insomnia may also have an initial identifiable cause but continues after the cause is no longer present For example a bout of insomnia may be triggered by a stressful work or life event However the condition may continue after the stressful event has been resolved In such cases the insomnia is usually perpetuated by the anxiety or fear caused by the sleeplessness itself rather than any external factors 27 Symptoms of insomnia can be caused by or be associated with Sleep breathing disorders such as sleep apnea or upper airway resistance syndrome 28 Use of psychoactive drugs such as stimulants including certain medications herbs caffeine nicotine cocaine amphetamines methylphenidate aripiprazole MDMA modafinil or excessive alcohol intake 29 Use of or withdrawal from alcohol and other sedatives such as anti anxiety and sleep drugs like benzodiazepines 29 Use of or withdrawal from pain relievers such as opioids 29 Heart disease 30 Restless legs syndrome which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations 31 Periodic limb movement disorder PLMD which occurs during sleep and can cause arousals of which the sleeper is unaware 32 Pain 33 an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep and can also cause awakening Hormone shifts such as those that precede menstruation and those during menopause 34 Life events such as fear stress anxiety emotional or mental tension work problems financial stress birth of a child and bereavement 31 Gastrointestinal issues such as heartburn or constipation 35 Mental neurobehavioral or neurodevelopmental disorders such as bipolar disorder clinical depression generalized anxiety disorder post traumatic stress disorder schizophrenia obsessive compulsive disorder autism dementia 36 326 ADHD 37 and FASD Disturbances of the circadian rhythm such as shift work and jet lag can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day Chronic circadian rhythm disorders are characterized by similar symptoms 29 Certain neurological disorders such as brain lesions or a history of traumatic brain injury 38 Medical conditions such as hyperthyroidism 2 Abuse of over the counter or prescription sleep aids sedative or depressant drugs can produce rebound insomnia 29 Poor sleep hygiene e g noise or over consumption of caffeine 29 A rare genetic condition can cause a prion based permanent and eventually fatal form of insomnia called fatal familial insomnia 39 Physical exercise exercise induced insomnia is common in athletes in the form of prolonged sleep onset latency 40 Increased exposure to the blue light from artificial sources such as phones or computers 41 Chronic pain 42 43 Lower back pain 43 Asthma 43 Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated night time levels of circulating cortisol and adrenocorticotropic hormone 44 They also have an elevated metabolic rate which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study Studies of brain metabolism using positron emission tomography PET scans indicate that people with insomnia have higher metabolic rates by night and by day The question remains whether these changes are the causes or consequences of long term insomnia 45 Genetics Edit Heritability estimates of insomnia vary between 38 in males to 59 in females 46 A genome wide association study GWAS identified 3 genomic loci and 7 genes that influence the risk of insomnia and showed that insomnia is highly polygenic 47 In particular a strong positive association was observed for the MEIS1 gene in both males and females This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits It has been hypothesized that epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain stress response having an impact as well on the brain plasticity 48 Substance induced Edit Alcohol induced Edit Main article Alcohol use and sleep Alcohol is often used as a form of self treatment of insomnia to induce sleep However alcohol use to induce sleep can be a cause of insomnia Long term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation Frequent moving between sleep stages occurs with awakenings due to headaches the need to urinate dehydration and excessive sweating Glutamine rebound also plays a role as when someone is drinking alcohol inhibits glutamine one of the body s natural stimulants When the person stops drinking the body tries to make up for lost time by producing more glutamine than it needs The increase in glutamine levels stimulates the brain while the drinker is trying to sleep keeping him her from reaching the deepest levels of sleep 49 Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams During withdrawal REM sleep is typically exaggerated as part of a rebound effect 50 Benzodiazepine induced Edit Like alcohol benzodiazepines such as alprazolam clonazepam lorazepam and diazepam are commonly used to treat insomnia in the short term both prescribed and self medicated but worsen sleep in the long term While benzodiazepines can put people to sleep i e inhibit NREM stage 1 and 2 sleep while asleep the drugs disrupt sleep architecture decreasing sleep time delaying time to REM sleep and decreasing deep slow wave sleep the most restorative part of sleep for both energy and mood 51 52 53 Opioid induced Edit Opioid medications such as hydrocodone oxycodone and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects Opioids can fragment sleep and decrease REM and stage 2 sleep By producing analgesia and sedation opioids may be appropriate in carefully selected patients with pain associated insomnia 33 However dependence on opioids can lead to long term sleep disturbances 54 Risk factors Edit Insomnia affects people of all age groups but people in the following groups have a higher chance of acquiring insomnia 55 Individuals older than 60 History of mental health disorder including depression etc Emotional stress Working late night shifts Traveling through different time zones 11 Having chronic diseases such as diabetes kidney disease lung disease Alzheimer s or heart disease 56 Alcohol or drug use disorders Gastrointestinal reflux disease Heavy smoking Work stress 57 Mechanism EditTwo main models exists as to the mechanism of insomnia cognitive and physiological The cognitive model suggests rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia The physiological model is based upon three major findings in people with insomnia firstly increased urinary cortisol and catecholamines have been found suggesting increased activity of the HPA axis and arousal second increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia and lastly increased full body metabolism and heart rate in those with insomnia All these findings taken together suggest a deregulation of the arousal system cognitive system and HPA axis all contributing to insomnia 9 58 However it is unknown if the hyperarousal is a result of or cause of insomnia Altered levels of the inhibitory neurotransmitter GABA have been found but the results have been inconsistent and the implications of altered levels of such a ubiquitous neurotransmitter are unknown Studies on whether insomnia is driven by circadian control over sleep or a wake dependent process have shown inconsistent results but some literature suggests a deregulation of the circadian rhythm based on core temperature 59 Increased beta activity and decreased delta wave activity has been observed on electroencephalograms however the implication of this is unknown 60 Around half of post menopausal women experience sleep disturbances and generally sleep disturbance is about twice as common in women as men this appears to be due in part but not completely to changes in hormone levels especially in and post menopause 34 61 Changes in sex hormones in both men and women as they age may account in part for increased prevalence of sleep disorders in older people 62 Diagnosis EditIn medicine insomnia is widely measured using the Athens insomnia scale 63 It is measured using eight different parameters related to sleep finally represented as an overall scale which assesses an individual s sleep pattern A qualified sleep specialist should be consulted for the diagnosis of any sleep disorder so the appropriate measures can be taken Past medical history and a physical examination need to be done to eliminate other conditions that could be the cause of insomnia After all other conditions are ruled out a comprehensive sleep history should be taken The sleep history should include sleep habits medications prescription and non prescription alcohol consumption nicotine and caffeine intake co morbid illnesses and sleep environment 64 A sleep diary can be used to keep track of the individual s sleep patterns The diary should include time to bed total sleep time time to sleep onset number of awakenings use of medications time of awakening and subjective feelings in the morning 64 The sleep diary can be replaced or validated by the use of out patient actigraphy for a week or more using a non invasive device that measures movement 65 Workers who complain of insomnia should not routinely have polysomnography to screen for sleep disorders 66 This test may be indicated for patients with symptoms in addition to insomnia including sleep apnea obesity a thick neck diameter or high risk fullness of the flesh in the oropharynx 66 Usually the test is not needed to make a diagnosis and insomnia especially for working people can often be treated by changing a job schedule to make time for sufficient sleep and by improving sleep hygiene 66 Some patients may need to do an overnight sleep study to determine if insomnia is present Such a study will commonly involve assessment tools including a polysomnogram and the multiple sleep latency test Specialists in sleep medicine are qualified to diagnose disorders within the according to the ICSD 81 major sleep disorder diagnostic categories 67 Patients with some disorders including delayed sleep phase disorder are often mis diagnosed with primary insomnia when a person has trouble getting to sleep and awakening at desired times but has a normal sleep pattern once asleep a circadian rhythm disorder is a likely cause In many cases insomnia is co morbid with another disease side effects from medications or a psychological problem Approximately half of all diagnosed insomnia is related to psychiatric disorders 68 For those who have depression insomnia should be regarded as a co morbid condition rather than as a secondary one insomnia typically predates psychiatric symptoms 68 In fact it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder 9 Insomnia occurs in between 60 and 80 of people with depression 69 This may partly be due to treatment used for depression 69 Determination of causation is not necessary for a diagnosis 68 DSM 5 criteria Edit The DSM 5 criteria for insomnia include the following 70 Predominant complaint of dissatisfaction with sleep quantity or quality associated with one or more of the following symptoms Difficulty initiating sleep In children this may manifest as difficulty initiating sleep without caregiver intervention Difficulty maintaining sleep characterized by frequent awakenings or problems returning to sleep after awakenings In children this may manifest as difficulty returning to sleep without caregiver intervention Early morning awakening with inability to return to sleep In addition The sleep disturbance causes clinically significant distress or impairment in social occupational educational academic behavioral or other important areas of functioning The sleep difficulty occurs at least three nights per week The sleep difficulty is present for at least three months The sleep difficulty occurs despite adequate opportunity for sleep The insomnia is not better explained by and does not occur exclusively during the course of another sleep wake disorder e g narcolepsy a breathing related sleep disorder a circadian rhythm sleep wake disorder a parasomnia The insomnia is not attributable to the physiological effects of a substance e g a drug of abuse a medication Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia Types Edit Insomnia can be classified as transient acute or chronic Transient insomnia lasts for less than a week It can be caused by another disorder by changes in the sleep environment by the timing of sleep severe depression or by stress Its consequences sleepiness and impaired psychomotor performance are similar to those of sleep deprivation 71 Acute insomnia is the inability to consistently sleep well for a period of less than a month Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non refreshing or of poor quality These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function 72 Acute insomnia is also known as short term insomnia or stress related insomnia 73 Chronic insomnia lasts for longer than a month It can be caused by another disorder or it can be a primary disorder Common causes of chronic insomnia include persistent stress trauma work schedules poor sleep habits medications and other mental health disorders 74 People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia 75 Its effects can vary according to its causes They might include muscular weariness hallucinations and or mental fatigue 71 Prevention EditPrevention and treatment of insomnia may require a combination of cognitive behavioral therapy 14 medications 76 and lifestyle changes 77 Among lifestyle practices going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia 11 Avoidance of vigorous exercise and caffeinated drinks a few hours before going to sleep is recommended while exercise earlier in the day may be beneficial 77 Other practices to improve sleep hygiene may include 77 78 Avoiding or limiting naps Treating pain at bedtime Avoiding large meals beverages alcohol and nicotine before bedtime Finding soothing ways to relax into sleep including use of white noise Making the bedroom suitable for sleep by keeping it dark cool and free of devices such as clocks cell phones or televisions Maintain regular exercise Try relaxing activities before sleepingManagement EditIt is recommended to rule out medical and psychological causes before deciding on the treatment for insomnia 79 Cognitive behavioral therapy is generally the first line treatment once this has been done 80 It has been found to be effective for chronic insomnia 14 The beneficial effects in contrast to those produced by medications may last well beyond the stopping of therapy 81 Medications have been used mainly to reduce symptoms in insomnia of short duration their role in the management of chronic insomnia remains unclear 8 Several different types of medications may be used 82 83 76 Many doctors do not recommend relying on prescription sleeping pills for long term use 77 It is also important to identify and treat other medical conditions that may be contributing to insomnia such as depression breathing problems and chronic pain 77 84 As of 2022 many people with insomnia were reported as not receiving overall sufficient sleep or treatment for insomnia 85 86 Non medication based Edit Non medication based strategies have comparable efficacy to hypnotic medication for insomnia and they may have longer lasting effects Hypnotic medication is only recommended for short term use because dependence with rebound withdrawal effects upon discontinuation or tolerance can develop 87 Non medication based strategies provide long lasting improvements to insomnia and are recommended as a first line and long term strategy of management Behavioral sleep medicine BSM tries to address insomnia with non pharmacological treatments The BSM strategies used to address chronic insomnia include attention to sleep hygiene stimulus control behavioral interventions sleep restriction therapy paradoxical intention patient education and relaxation therapy 88 Some examples are keeping a journal restricting the time spent awake in bed practicing relaxation techniques and maintaining a regular sleep schedule and a wake up time 84 Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation Behavioral therapy may include learning healthy sleep habits to promote sleep relaxation undergoing light therapy to help with worry reduction strategies and regulating the circadian clock 84 Music may improve insomnia in adults see music and sleep 89 EEG biofeedback has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as quality of sleep 90 Self help therapy defined as a psychological therapy that can be worked through on one s own may improve sleep quality for adults with insomnia to a small or moderate degree 91 Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed or sleep in general with a negative response As stimulus control therapy involves taking steps to control the sleep environment it is sometimes referred interchangeably with the concept of sleep hygiene Examples of such environmental modifications include using the bed for sleep and sex only not for activities such as reading or watching television waking up at the same time every morning including on weekends going to bed only when sleepy and when there is a high likelihood that sleep will occur leaving the bed and beginning an activity in another location if sleep does not occur in a reasonably brief period of time after getting into bed commonly 20 min reducing the subjective effort and energy expended trying to fall asleep avoiding exposure to bright light during night time hours and eliminating daytime naps 92 A component of stimulus control therapy is sleep restriction a technique that aims to match the time spent in bed with actual time spent asleep This technique involves maintaining a strict sleep wake schedule sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average and then if capable i e when sleep efficiency improves slowly increasing this amount 15 min by going to bed earlier as the body attempts to reset its internal sleep clock Bright light therapy may be effective for insomnia 93 Paradoxical intention is a cognitive reframing technique where the insomniac instead of attempting to fall asleep at night makes every effort to stay awake i e essentially stops trying to fall asleep One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep it relieves the performance anxiety that arises from the need or requirement to fall asleep which is meant to be a passive act This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep onset latency and overestimation of the sleep deficit a quality found in many insomniacs 94 Sleep hygiene Edit Sleep hygiene is a common term for all of the behaviors which relate to the promotion of good sleep They include habits which provide a good foundation for sleep and help to prevent insomnia However sleep hygiene alone may not be adequate to address chronic insomnia 65 Sleep hygiene recommendations are typically included as one component of cognitive behavioral therapy for insomnia CBT I 65 6 Recommendations include reducing caffeine nicotine and alcohol consumption maximizing the regularity and efficiency of sleep episodes minimizing medication usage and daytime napping the promotion of regular exercise and the facilitation of a positive sleep environment 95 The creation of a positive sleep environment may also be helpful in reducing the symptoms of insomnia 96 On the other hand a systematic review by the AASM concluded that clinicians should not prescribe sleep hygiene for insomnia due to the evidence of absence of its efficacy and potential delaying of adequate treatment recommending instead that effective therapies such as CBT i should be preferred 13 Cognitive behavioral therapy Edit Main article Cognitive behavioral therapy for insomnia There is some evidence that cognitive behavioral therapy for insomnia CBT I is superior in the long term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia 97 In this therapy patients are taught improved sleep habits and relieved of counter productive assumptions about sleep Common misconceptions and expectations that can be modified include Unrealistic sleep expectations Misconceptions about insomnia causes Amplifying the consequences of insomnia Performance anxiety after trying for so long to have a good night s sleep by controlling the sleep process Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and the relaxation therapies Hypnotic medications are equally effective in the short term treatment of insomnia but their effects wear off over time due to tolerance The effects of CBT I have sustained and lasting effects on treating insomnia long after therapy has been discontinued 98 99 The addition of hypnotic medications with CBT I adds no benefit in insomnia The long lasting benefits of a course of CBT I shows superiority over pharmacological hypnotic drugs Even in the short term when compared to short term hypnotic medication such as zolpidem CBT I still shows significant superiority Thus CBT I is recommended as a first line treatment for insomnia 100 Common forms of CBT I treatments include stimulus control therapy sleep restriction sleep hygiene improved sleeping environments relaxation training paradoxical intention and biofeedback 101 CBT is the well accepted form of therapy for insomnia since it has no known adverse effects whereas taking medications to alleviate insomnia symptoms have been shown to have adverse side effects 102 Nevertheless the downside of CBT is that it may take a lot of time and motivation 103 Acceptance and commitment therapy Edit Treatments based on the principles of acceptance and commitment therapy ACT and metacognition have emerged as alternative approaches to treating insomnia 104 ACT rejects the idea that behavioral changes can help insomniacs achieve better sleep since they require sleep efforts actions which create more struggle and arouse the nervous system leading to hyperarousal 105 The ACT approach posits that acceptance of the negative feelings associated with insomnia can in time create the right conditions for sleep Mindfulness practice is a key feature of this approach although mindfulness is not practised to induce sleep this in itself is a sleep effort to be avoided but rather as a longer term activity to help calm the nervous system and create the internal conditions from which sleep can emerge A key distinction between CBT i and ACT lies in the divergent approaches to time spent awake in bed Proponents of CBT i advocate minimizing time spent awake in bed on the basis that this creates cognitive association between being in bed and wakefulness The ACT approach proposes that avoiding time in bed may increase the pressure to sleep and arouse the nervous system further 105 Research has shown that ACT has a significant effect on primary and comorbid insomnia and sleep quality and can be used as an appropriate treatment method to control and improve insomnia 106 Internet interventions Edit Despite the therapeutic effectiveness and proven success of CBT treatment availability is significantly limited by a lack of trained clinicians poor geographical distribution of knowledgeable professionals and expense 107 One way to potentially overcome these barriers is to use the Internet to deliver treatment making this effective intervention more accessible and less costly The Internet has already become a critical source of health care and medical information 108 Although the vast majority of health websites provide general information 108 109 there is growing research literature on the development and evaluation of Internet interventions 110 111 These online programs are typically behaviorally based treatments that have been operationalized and transformed for delivery via the Internet They are usually highly structured automated or human supported based on effective face to face treatment personalized to the user interactive enhanced by graphics animations audio and possibly video and tailored to provide follow up and feedback 111 There is good evidence for the use of computer based CBT for insomnia 112 Medications Edit Many people with insomnia use sleeping tablets and other sedatives In some places medications are prescribed in over 95 of cases 113 They however are a second line treatment 114 In 2019 the US Food and Drug Administration stated it is going to require warnings for eszopiclone zaleplon and zolpidem due to concerns about serious injuries resulting from abnormal sleep behaviors including sleepwalking or driving a vehicle while asleep 115 The percentage of adults using a prescription sleep aid increases with age During 2005 2010 about 4 of U S adults aged 20 and over reported that they took prescription sleep aids in the past 30 days Rates of use were lowest among the youngest age group those aged 20 39 at about 2 increased to 6 among those aged 50 59 and reached 7 among those aged 80 and over More adult women 5 reported using prescription sleep aids than adult men 3 Non Hispanic white adults reported higher use of sleep aids 5 than non Hispanic black 3 and Mexican American 2 adults No difference was shown between non Hispanic black adults and Mexican American adults in use of prescription sleep aids 116 Antihistamines Edit As an alternative to taking prescription drugs some evidence shows that an average person seeking short term help may find relief by taking over the counter antihistamines such as diphenhydramine or doxylamine 117 Diphenhydramine and doxylamine are widely used in nonprescription sleep aids They are the most effective over the counter sedatives currently available at least in much of Europe Canada Australia and the United States and are more sedating than some prescription hypnotics 118 Antihistamine effectiveness for sleep may decrease over time and anticholinergic side effects such as dry mouth may also be a drawback with these particular drugs While addiction does not seem to be an issue with this class of drugs they can induce dependence and rebound effects upon abrupt cessation of use 119 However people whose insomnia is caused by restless legs syndrome may have worsened symptoms with antihistamines 120 Antidepressants Edit While insomnia is a common symptom of depression antidepressants are effective for treating sleep problems whether or not they are associated with depression While all antidepressants help regulate sleep some antidepressants such as amitriptyline doxepin mirtazapine trazodone and trimipramine can have an immediate sedative effect and are prescribed to treat insomnia 121 Amitriptyline doxepin and trimipramine all have antihistaminergic anticholinergic antiadrenergic and antiserotonergic properties which contribute to both their therapeutic effects and side effect profiles while mirtazapine s actions are primarily antihistaminergic and antiserotonergic and trazodone s effects are primarily antiadrenergic and antiserotonergic Mirtazapine is known to decrease sleep latency i e the time it takes to fall asleep promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia 122 123 Agomelatine a melatonergic antidepressant with claimed sleep improving qualities that does not cause daytime drowsiness 124 is approved for the treatment of depression though not sleep conditions in the European Union 125 and Australia 126 After trials in the United States its development for use there was discontinued in October 2011 127 by Novartis who had bought the rights to market it there from the European pharmaceutical company Servier 128 A 2018 Cochrane review found the safety of taking antidepressants for insomnia to be uncertain with no evidence supporting long term use 129 Melatonin agonists Edit Melatonin receptor agonists such as melatonin and ramelteon are used in the treatment of insomnia The evidence for melatonin in treating insomnia is generally poor 130 There is low quality evidence that it may speed the onset of sleep by 6 minutes 130 Ramelteon does not appear to speed the onset of sleep or the amount of sleep a person gets 130 Usage of melatonin as a treatment for insomnia in adults has increased from 0 4 between 1999 and 2000 to nearly 2 1 between 2017 and 2018 131 Most melatonin agonists have not been tested for longitudinal side effects 132 Prolonged release melatonin may improve quality of sleep in older people with minimal side effects 133 134 Studies have also shown that children who are on the autism spectrum or have learning disabilities attention deficit hyperactivity disorder ADHD or related neurological diseases can benefit from the use of melatonin This is because they often have trouble sleeping due to their disorders For example children with ADHD tend to have trouble falling asleep because of their hyperactivity and as a result tend to be tired during most of the day Another cause of insomnia in children with ADHD is the use of stimulants used to treat their disorder Children who have ADHD then as well as the other disorders mentioned may be given melatonin before bedtime in order to help them sleep 135 Benzodiazepines Edit Normison temazepam is a benzodiazepine commonly prescribed for insomnia and other sleep disorders 136 The most commonly used class of hypnotics for insomnia are the benzodiazepines 36 363 Benzodiazepines are not significantly better for insomnia than antidepressants 137 Chronic users of hypnotic medications for insomnia do not have better sleep than chronic insomniacs not taking medications In fact chronic users of hypnotic medications have more regular night time awakenings than insomniacs not taking hypnotic medications 138 Many have concluded that these drugs cause an unjustifiable risk to the individual and to public health and lack evidence of long term effectiveness It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible especially in the elderly 139 Between 1993 and 2010 the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24 to 11 in the US coinciding with the first release of nonbenzodiazepines 140 The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side effects such as day time fatigue motor vehicle crashes and other accidents cognitive impairments and falls and fractures Elderly people are more sensitive to these side effects 141 Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to tolerance physical dependence benzodiazepine withdrawal syndrome upon discontinuation and long term worsening of sleep especially after consistent usage over long periods of time Benzodiazepines while inducing unconsciousness actually worsen sleep as like alcohol they promote light sleep while decreasing time spent in deep sleep 142 A further problem is with regular use of short acting sleep aids for insomnia daytime rebound anxiety can emerge 143 Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm prescriptions have continued to increase 144 This is likely due to their addictive nature both due to misuse and because through their rapid action tolerance and withdrawal they can trick insomniacs into thinking they are helping with sleep There is a general awareness that long term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the long term use of benzodiazepines and is recommended whenever possible 145 146 Benzodiazepines all bind unselectively to the GABAA receptor 137 Some theorize that certain benzodiazepines hypnotic benzodiazepines have significantly higher activity at the a1 subunit of the GABAA receptor compared to other benzodiazepines for example triazolam and temazepam have significantly higher activity at the a1 subunit compared to alprazolam and diazepam making them superior sedative hypnotics alprazolam and diazepam in turn have higher activity at the a2 subunit compared to triazolam and temazepam making them superior anxiolytic agents Modulation of the a1 subunit is associated with sedation motor impairment respiratory depression amnesia ataxia and reinforcing behavior drug seeking behavior Modulation of the a2 subunit is associated with anxiolytic activity and disinhibition For this reason certain benzodiazepines may be better suited to treat insomnia than others 96 Z Drugs Edit Nonbenzodiazepine or Z drug sedative hypnotic drugs such as zolpidem zaleplon zopiclone and eszopiclone are a class of hypnotic medications that are similar to benzodiazepines in their mechanism of action and indicated for mild to moderate insomnia Their effectiveness at improving time to sleeping is slight and they have similar though potentially less severe side effect profiles compared to benzodiazepines 147 Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992 from 2 3 in 1993 among individuals with sleep disorders to 13 7 in 2010 140 Orexin antagonists Edit Orexin receptor antagonists are a more recently introduced class of sleep medications and include suvorexant lemborexant and daridorexant all of which are FDA approved for treatment of insomnia characterized by difficulties with sleep onset and or sleep maintenance 148 149 Antipsychotics Edit Certain atypical antipsychotics particularly quetiapine olanzapine and risperidone are used in the treatment of insomnia 150 151 However while common use of antipsychotics for this indication is not recommended as the evidence does not demonstrate a benefit and the risk of adverse effects are significant 150 152 153 154 A major 2022 systematic review and network meta analysis of medications for insomnia in adults found that quetiapine did not demonstrate any short term benefits for insomnia 155 Some of the more serious adverse effects may also occur at the low doses used such as dyslipidemia and neutropenia 156 157 Such concerns of risks at low doses are supported by Danish observational studies that showed an association of use of low dose quetiapine excluding prescriptions filled for tablet strengths gt 50 mg with an increased risk of major cardiovascular events as compared to use of Z drugs with most of the risk being driven by cardiovascular death 158 Laboratory data from an unpublished analysis of the same cohort also support the lack of dose dependency of metabolic side effects as new use of low dose quetiapine was associated with a risk of increased fasting triglycerides at 1 year follow up 159 Concerns regarding side effects are greater in the elderly 132 Other sedatives Edit Gabapentinoids like gabapentin and pregabalin have sleep promoting effects but are not commonly used for treatment of insomnia 160 Gabapentin is not effective in helping alcohol related insomnia 161 162 Barbiturates while once used are no longer recommended for insomnia due to the risk of addiction and other side effects 163 Comparative effectiveness Edit A major systematic review and network meta analysis of medications for the treatment of insomnia was published in 2022 155 It found a wide range of effect sizes standardized mean difference SMD in terms of efficacy for insomnia 155 The assessed medications included benzodiazepines SMDs 0 58 to 0 83 Z drugs SMDs 0 03 to 0 63 sedative antidepressants and antihistamines SMDs 0 30 to 0 55 quetiapine SMD 0 07 orexin receptor antagonists SMDs 0 23 to 0 44 and melatonin receptor agonists SMDs 0 00 to 0 13 155 The certainty of evidence varied and ranged from high to very low depending on the medication 155 The meta analysis concluded that the orexin antagonist lemborexant and the Z drug eszopiclone had the best profiles overall in terms of efficacy tolerability and acceptability 155 Alternative medicine Edit Herbal products such as valerian kava chamomile and lavender have been used to treat insomnia 164 165 166 167 However there is no quality evidence that they are effective and safe 164 165 166 167 The same is true for cannabis and cannabinoids 168 169 170 It is likewise unclear if acupuncture is useful in the treatment of insomnia 171 Prognosis Edit Disability adjusted life year for insomnia per 100 000 inhabitants in 2004 no data less than 25 25 30 25 30 25 36 36 41 5 41 5 47 47 52 5 52 5 58 58 63 5 63 5 69 69 74 5 74 5 80 more than 80 A survey of 1 1 million residents in the United States found that those that reported sleeping about 7 hours per night had the lowest rates of mortality whereas those that slept for fewer than 6 hours or more than 8 hours had higher mortality rates Getting 8 5 or more hours of sleep per night was associated with a 15 higher mortality rate Severe insomnia sleeping less than 3 5 hours in women and 4 5 hours in men is associated with a 15 increase in mortality 172 With this technique it is difficult to distinguish lack of sleep caused by a disorder which is also a cause of premature death versus a disorder which causes a lack of sleep and the lack of sleep causing premature death Most of the increase in mortality from severe insomnia was discounted after controlling for associated disorders After controlling for sleep duration and insomnia use of sleeping pills was also found to be associated with an increased mortality rate 172 The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night Even sleeping only 4 5 hours per night is associated with very little increase in mortality Thus mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on mortality 172 It is unclear why sleeping longer than 7 5 hours is associated with excess mortality 172 Epidemiology EditBetween 10 and 30 of adults have insomnia at any given point in time and up to half of people have insomnia in a given year making it the most common sleep disorder 9 8 10 173 About 6 of people have insomnia that is not due to another problem and lasts for more than a month 9 People over the age of 65 are affected more often than younger people 7 Females are more often affected than males 8 Insomnia is 40 more common in women than in men 174 There are higher rates of insomnia reported among university students compared to the general population 175 Society and culture EditThe word insomnia is from Latin in somnus without sleep and ia as a nominalizing suffix The popular press have published stories about people who supposedly never sleep such as that of Thai Ngọc and Al Herpin 176 Horne writes everybody sleeps and needs to do so and generally this appears true However he also relates from contemporary accounts the case of Paul Kern who was shot in wartime and then never slept again until his death in 1943 177 Kern appears to be a completely isolated unique case References Edit a b c d e f g What Is Insomnia NHLBI 13 December 2011 Archived from the original on 28 July 2016 Retrieved 9 August 2016 a b c d What Causes Insomnia NHLBI 13 December 2011 Archived from the original on 28 July 2016 Retrieved 9 August 2016 a b c How Is Insomnia Diagnosed NHLBI 13 December 2011 Archived from the original on 11 August 2016 Retrieved 9 August 2016 Watson NF Vaughn BV 2006 Clinician s Guide to Sleep Disorders CRC Press p 10 ISBN 978 0 8493 7449 4 a b c d How Is Insomnia Treated NHLBI 13 December 2011 Archived from the original on 28 July 2016 Retrieved 9 August 2016 a b c d e f Qaseem A Kansagara D Forciea MA Cooke M Denberg TD July 2016 Management of Chronic Insomnia Disorder in Adults A Clinical Practice Guideline From the American College of Physicians Annals of Internal Medicine 165 2 125 133 doi 10 7326 M15 2175 PMID 27136449 a b c d e Wilson JF January 2008 In the clinic Insomnia Annals of Internal Medicine 148 1 ITC13 1 ITC13 16 doi 10 7326 0003 4819 148 1 200801010 01001 PMID 18166757 S2CID 42686046 a b c d e f g Dyssomnias PDF WHO pp 7 11 Archived PDF from the original on 18 March 2009 Retrieved 25 January 2009 a b c d e f g h i j Roth T August 2007 Insomnia definition prevalence etiology and consequences Journal of Clinical Sleep Medicine 3 5 Suppl S7 10 doi 10 5664 jcsm 26929 PMC 1978319 PMID 17824495 a b c Tasman A Kay J Lieberman JA First MB Riba M 2015 Psychiatry 2 Volume Set 4 ed John Wiley amp Sons p 4253 ISBN 978 1 118 75336 1 a b c Punnoose AR Golub RM Burke AE June 2012 JAMA patient page Insomnia JAMA 307 24 2653 doi 10 1001 jama 2012 6219 PMID 22735439 Banno M Tsujimoto Y Kohmura K Dohi E Taito S Someko H Kataoka Y September 2022 Unclear Insomnia Concept in Randomized Controlled Trials and Systematic Reviews A Meta Epidemiological Study International Journal of Environmental Research and Public Health 19 19 12261 doi 10 3390 ijerph191912261 PMC 9566752 PMID 36231555 a b Edinger JD Arnedt JT Bertisch SM Carney CE Harrington JJ Lichstein KL et al February 2021 Behavioral and psychological treatments for chronic insomnia disorder in adults an American Academy of Sleep Medicine systematic review meta analysis and GRADE assessment Journal of Clinical Sleep Medicine 17 2 263 298 doi 10 5664 jcsm 8988 PMC 7853211 PMID 33164741 a b c Trauer JM Qian MY Doyle JS Rajaratnam SM Cunnington D August 2015 Cognitive Behavioral Therapy for Chronic Insomnia A Systematic Review and Meta analysis Annals of Internal Medicine 163 3 191 204 doi 10 7326 M14 2841 PMID 26054060 S2CID 21617330 Attarian HP 2003 chapter 1 Clinical Handbook of Insomnia Springer Science amp Business Media ISBN 978 1 59259 662 1 Insomnia gt Complications Archived 8 February 2009 at the Wayback Machine Mayo Clinic Retrieved on 5 May 2009 Consumer Reports Drug Effectiveness Review Project January 2012 Evaluating New Sleeping Pills Used to Treat Insomnia Comparing Effectiveness Safety and Price PDF Best Buy Drugs Consumer Reports 4 Archived PDF from the original on 9 December 2013 Retrieved 4 June 2013 Symptoms Retrieved 15 April 2019 Kertesz RS Cote KA 2011 Event related potentials during the transition to sleep for individuals with sleep onset insomnia Behavioral Sleep Medicine 9 2 68 85 doi 10 1080 15402002 2011 557989 PMID 21491230 S2CID 30439961 Doghramji K 2007 Clinical Management of Insomnia Caddo OK Professional Communications Inc p 28 ISBN 978 1 932610 14 7 Morin C 2003 Insomnia A Clinician s Guide to Assessment and Treatment New York Kluwer Academic Plenum Publishers p 16 ISBN 978 0 306 47750 8 What Causes Insomnia Retrieved 24 April 2019 What Happens When You Sleep 22 December 2009 Archived from the original on 5 March 2017 Retrieved 24 February 2017 Adler CH Thorpy MJ June 2005 Sleep issues in Parkinson s disease Neurology 64 12 Suppl 3 S12 20 doi 10 1212 WNL 64 12 suppl 3 S12 PMID 15994219 S2CID 24024570 a b c Harvey AG Tang NK January 2012 Mis perception of sleep in insomnia a puzzle and a resolution Psychological Bulletin 138 1 77 101 doi 10 1037 a0025730 PMC 3277880 PMID 21967449 Moawad H 2020 Primary insomnia A lifelong problem Psychiatric Times Available at https www psychiatrictimes com view primary insomnia lifelong problem Accessed December 29 2022 Meadows G 2015 The sleep book How to sleep well every night London UK Orion Publishing Group p 21 Edinger JD 2013 Insomnia An Issue of Sleep Medicine Clinics Elsevier Health Sciences p 389 ISBN 978 0 323 18872 2 a b c d e f Insomnia University of Maryland Medical Center Archived from the original on 3 July 2013 Retrieved 11 July 2013 Taylor DJ Mallory LJ Lichstein KL Durrence HH Riedel BW Bush AJ February 2007 Comorbidity of chronic insomnia with medical problems Sleep 30 2 213 18 doi 10 1093 sleep 30 2 213 PMID 17326547 a b Insomnia Causes Mayo Clinic Archived from the original on 21 October 2013 Retrieved 11 July 2013 Restless Legs Syndrome Periodic Limb Movement Disorder National Heart Lung and Blood Institute Archived from the original on 3 August 2013 Retrieved 11 July 2013 a b Ramakrishnan K Scheid DC August 2007 Treatment options for insomnia American Family Physician 76 4 517 26 PMID 17853625 a b Santoro N Epperson CN Mathews SB September 2015 Menopausal Symptoms and Their Management Endocrinology and Metabolism Clinics of North America 44 3 497 515 doi 10 1016 j ecl 2015 05 001 PMC 4890704 PMID 26316239 What causes insomnia National Heart Lung and Blood Institute Archived from the original on 3 July 2013 Retrieved 11 July 2013 a b Geddes J Price J McKnight R Gelder M Mayou R 2012 Psychiatry 4th ed Oxford Oxford University Press ISBN 978 0 19 923396 0 Bendz LM Scates AC January 2010 Melatonin treatment for insomnia in pediatric patients with attention deficit hyperactivity disorder The Annals of Pharmacotherapy 44 1 185 91 doi 10 1345 aph 1M365 PMID 20028959 S2CID 207263711 Ouellet MC Beaulieu Bonneau S Morin CM 2006 Insomnia in patients with traumatic brain injury frequency characteristics and risk factors The Journal of Head Trauma Rehabilitation 21 3 199 212 doi 10 1097 00001199 200605000 00001 PMID 16717498 S2CID 28255648 Schenkein J Montagna P September 2006 Self management of fatal familial insomnia Part 1 what is FFI MedGenMed 8 3 65 PMC 1781306 PMID 17406188 The epidemiological survey of exercise induced insomnia in chinese athletes Archived 9 September 2009 at the Wayback Machine Youqi Shi Zhihong Zhou Ke Ning Jianhong LIU Athens 2004 Pre Olympic Congress Schmerler J Q amp A Why Is Blue Light before Bedtime Bad for Sleep Scientific American Retrieved 19 October 2018 Roth T August 2007 Insomnia definition prevalence etiology and consequences Journal of Clinical Sleep Medicine 3 5 Suppl S7 10 doi 10 5664 jcsm 26929 PMC 1978319 PMID 17824495 a b c What Causes Insomnia Sleep Foundation Sleep Foundation 2021 Retrieved 26 February 2021 Hirotsu C Tufik S Andersen ML November 2015 Interactions between sleep stress and metabolism From physiological to pathological conditions Sleep Science 8 3 143 152 doi 10 1016 j slsci 2015 09 002 PMC 4688585 PMID 26779321 Mendelson WB 2008 New Research on Insomnia Sleep Disorders May Precede or Exacerbate Psychiatric Conditions Psychiatric Times 25 7 Archived from the original on 19 October 2009 Lind MJ Aggen SH Kirkpatrick RM Kendler KS Amstadter AB September 2015 A Longitudinal Twin Study of Insomnia Symptoms in Adults Sleep 38 9 1423 30 doi 10 5665 sleep 4982 PMC 4531410 PMID 26132482 Hammerschlag AR Stringer S de Leeuw CA Sniekers S Taskesen E Watanabe K Blanken TF Dekker K Te Lindert BH Wassing R Jonsdottir I Thorleifsson G Stefansson H Gislason T Berger K Schormair B Wellmann J Winkelmann J Stefansson K Oexle K Van Someren EJ Posthuma D November 2017 Genome wide association analysis of insomnia complaints identifies risk genes and genetic overlap with psychiatric and metabolic traits Nature Genetics 49 11 1584 92 doi 10 1038 ng 3888 PMC 5600256 PMID 28604731 Palagini L Biber K Riemann D June 2014 The genetics of insomnia evidence for epigenetic mechanisms Sleep Medicine Reviews 18 3 225 35 doi 10 1016 j smrv 2013 05 002 PMID 23932332 Perry L 12 October 2004 How Hangovers Work HowStuffWorks Archived from the original on 15 March 2010 Retrieved 20 November 2011 Lee chiong T 24 April 2008 Sleep Medicine Essentials and Review Oxford University Press p 105 ISBN 978 0 19 530659 0 Ashton H May 2005 The diagnosis and management of benzodiazepine dependence Current Opinion in Psychiatry 18 3 249 55 doi 10 1097 01 yco 0000165594 60434 84 PMID 16639148 S2CID 1709063 Morin CM Belanger L Bastien C Vallieres A January 2005 Long term outcome after discontinuation of benzodiazepines for insomnia a survival analysis of relapse Behaviour Research and Therapy 43 1 1 14 doi 10 1016 j brat 2003 12 002 PMID 15531349 Poyares D Guilleminault C Ohayon MM Tufik S 1 June 2004 Chronic benzodiazepine usage and withdrawal in insomnia patients Journal of Psychiatric Research 38 3 327 34 doi 10 1016 j jpsychires 2003 10 003 PMID 15003439 Asaad TA Ghanem MH Samee AM El Habiby MM 2011 Sleep Profile in Patients with Chronic Opioid Abuse Addictive Disorders amp Their Treatment 10 21 28 doi 10 1097 ADT 0b013e3181fb2847 S2CID 76376646 Insomnia Symptoms and causes Mayo Clinic Retrieved 5 February 2018 Risk Factors For Insomnia Retrieved 14 April 2019 Lichstein K L Taylor D J McCrae C S amp Petrov M 2010 Insomnia Epidemiology and Risk Factors Principles and Practice of Sleep Medicine Fifth Edition 827 37 doi 10 1016 B978 1 4160 6645 3 00076 1 Bonnet MH April 2009 Evidence for the pathophysiology of insomnia Sleep 32 4 441 42 doi 10 1093 sleep 32 4 441 PMC 2663857 PMID 19413138 Levenson JC Kay DB Buysse DJ April 2015 The pathophysiology of insomnia Chest 147 4 1179 92 doi 10 1378 chest 14 1617 PMC 4388122 PMID 25846534 Mai E Buysse DJ 1 January 2008 Insomnia Prevalence Impact Pathogenesis Differential Diagnosis and Evaluation Sleep Medicine Clinics 3 2 167 74 doi 10 1016 j jsmc 2008 02 001 PMC 2504337 PMID 19122760 Shaver JL Woods NF August 2015 Sleep and menopause a narrative review Menopause 22 8 899 915 doi 10 1097 GME 0000000000000499 PMID 26154276 S2CID 23937236 Lord C Sekerovic Z Carrier J October 2014 Sleep regulation and sex hormones exposure in men and women across adulthood Pathologie Biologie 62 5 302 10 doi 10 1016 j patbio 2014 07 005 PMID 25218407 Soldatos CR Dikeos DG Paparrigopoulos TJ June 2000 Athens Insomnia Scale validation of an instrument based on ICD 10 criteria Journal of Psychosomatic Research 48 6 555 60 doi 10 1016 S0022 3999 00 00095 7 PMID 11033374 a b Passarella S Duong M Diagnosis and treatment of insomnia 2008 a b c Schutte Rodin S Broch L Buysse D Dorsey C Sateia M October 2008 Clinical guideline for the evaluation and management of chronic insomnia in adults PDF Journal of Clinical Sleep Medicine 4 5 487 504 doi 10 5664 jcsm 27286 PMC 2576317 PMID 18853708 Archived PDF from the original on 9 February 2015 Retrieved 30 July 2015 Actigraphy is indicated as a method to characterize circadian patterns or sleep disturbances in individuals with insomnia a b c American College of Occupational and Environmental Medicine February 2014 Five Things Physicians and Patients Should Question Choosing Wisely an initiative of the ABIM Foundation American College of Occupational and Environmental Medicine archived from the original on 11 September 2014 retrieved 24 February 2014 Thorpy MJ October 2012 Classification of sleep disorders Neurotherapeutics 9 4 687 701 doi 10 1007 s13311 012 0145 6 PMC 3480567 PMID 22976557 a b c Wilson SJ Nutt DJ Alford C Argyropoulos SV Baldwin DS Bateson AN et al November 2010 British Association for Psychopharmacology consensus statement on evidence based treatment of insomnia parasomnias and circadian rhythm disorders Journal of Psychopharmacology 24 11 1577 1601 doi 10 1177 0269881110379307 PMID 20813762 S2CID 16823040 a b Luca A Luca M Calandra C 2013 Sleep disorders and depression brief review of the literature case report and nonpharmacologic interventions for depression Clinical Interventions in Aging 8 1033 39 doi 10 2147 CIA S47230 PMC 3760296 PMID 24019746 Sleep Wake Disorders Diagnostic and statistical manual of mental disorders DSM 5 Washington D C American Psychiatric Association 2013 a b Roth T Roehrs T 2003 Insomnia epidemiology characteristics and consequences Clinical Cornerstone 5 3 5 15 doi 10 1016 S1098 3597 03 90031 7 PMID 14626537 Insomnia sleeplessness chronic insomnia acute insomnia mental Archived from the original on 29 March 2008 Retrieved 29 April 2008 Acute Insomnia What is Acute Insomnia Sleepdisorders about com Archived from the original on 29 March 2013 Retrieved 10 March 2013 Types of Insomnia Sleep Foundation 2020 08 31 Retrieved 2022 07 15 Simon H In Depth Report Causes of Chronic Insomnia The New York Times Archived from the original on 8 November 2011 Retrieved 4 November 2011 a b Abad VC Guilleminault C September 2018 Insomnia in Elderly Patients Recommendations for Pharmacological Management Drugs amp Aging 35 9 791 817 doi 10 1007 s40266 018 0569 8 PMID 30058034 S2CID 51866276 a b c d e Insomnia Diagnosis and treatment Mayo Clinic 15 October 2016 Retrieved 11 October 2018 Pathak N 17 January 2017 Insomnia Acute amp Chronic Symptoms Causes and Treatment WebMD Retrieved 11 October 2018 Wortelboer U Cohrs S Rodenbeck A Ruther E 2002 Tolerability of hypnosedatives in older patients Drugs amp Aging 19 7 529 39 doi 10 2165 00002512 200219070 00006 PMID 12182689 S2CID 38910586 van Straten A van der Zweerde T Kleiboer A Cuijpers P Morin CM Lancee J April 2018 Cognitive and behavioral therapies in the treatment of insomnia A meta analysis PDF Sleep Medicine Reviews 38 3 16 doi 10 1016 j smrv 2017 02 001 hdl 1871 1 6fbbd685 d526 41ec 9961 437833035f53 PMID 28392168 S2CID 3359815 NIH State of the Science Conference Statement on manifestations and management of chronic insomnia in adults NIH Consensus and State Of The Science Statements 22 2 1 30 2005 PMID 17308547 Sateia MJ Buysse DJ Krystal AD Neubauer DN Heald JL February 2017 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults An American Academy of Sleep Medicine Clinical Practice Guideline Journal of Clinical Sleep Medicine 13 2 307 349 doi 10 5664 jcsm 6470 PMC 5263087 PMID 27998379 Riemann D Perlis ML June 2009 The treatments of chronic insomnia a review of benzodiazepine receptor agonists and psychological and behavioral therapies Sleep Medicine Reviews 13 3 205 14 doi 10 1016 j smrv 2008 06 001 PMID 19201632 a b c Merrigan JM Buysse DJ Bird JC Livingston EH February 2013 JAMA patient page Insomnia JAMA 309 7 733 doi 10 1001 jama 2013 524 PMID 23423421 Sleep Statistics Facts and Data About Sleep 2022 Sleep Foundation 2021 10 25 Retrieved 2022 07 15 Drake CL Roehrs T Roth T December 2003 Insomnia causes consequences and therapeutics an overview Depression and Anxiety 18 4 163 76 doi 10 1002 da 10151 PMID 14661186 S2CID 19203612 National Prescribing Service 1 February 2010 Addressing hypnotic medicines use in primary care Archived 1 November 2013 at the Wayback Machine NPS News Vol 67 Kirkwood CK 1999 Management of insomnia Journal of the American Pharmaceutical Association 39 5 688 96 quiz 713 14 doi 10 1016 s1086 5802 15 30354 5 PMID 10533351 Jespersen KV Pando Naude V Koenig J Jennum P Vuust P August 2022 Listening to music for insomnia in adults The Cochrane Database of Systematic Reviews 2022 8 CD010459 doi 10 1002 14651858 CD010459 pub3 PMC 9400393 PMID 36000763 Lake JA 2006 Textbook of Integrative Mental Health Care Thieme Medical Publishers p 313 ISBN 978 1 58890 299 3 van Straten A Cuijpers P February 2009 Self help therapy for insomnia a meta analysis Sleep Medicine Reviews 13 1 61 71 doi 10 1016 j smrv 2008 04 006 PMID 18952469 Lande RG Gragnani C December 2010 Nonpharmacologic approaches to the management of insomnia The Journal of the American Osteopathic Association 110 12 695 701 PMID 21178150 van Maanen A Meijer AM van der Heijden KB Oort FJ October 2016 The effects of light therapy on sleep problems A systematic review and meta analysis Sleep Med Rev 29 52 62 doi 10 1016 j smrv 2015 08 009 PMID 26606319 S2CID 3410636 Kierlin L November 2008 Sleeping without a pill nonpharmacologic treatments for insomnia Journal of Psychiatric Practice 14 6 403 07 doi 10 1097 01 pra 0000341896 73926 6c PMID 19057243 S2CID 22141056 Ellis J Hampson SE Cropley M May 2002 Sleep hygiene or compensatory sleep practices An examination of behaviours affecting sleep in older adults Psychology Health amp Medicine 7 2 156 161 doi 10 1080 13548500120116094 S2CID 143141307 a b Insomnia The Lecturio Medical Concept Library Retrieved 2021 06 24 Mitchell MD Gehrman P Perlis M Umscheid CA May 2012 Comparative effectiveness of cognitive behavioral therapy for insomnia a systematic review BMC Family Practice 13 40 doi 10 1186 1471 2296 13 40 PMC 3481424 PMID 22631616 Jacobs GD Pace Schott EF Stickgold R Otto MW September 2004 Cognitive behavior therapy and pharmacotherapy for insomnia a randomized controlled trial and direct comparison Archives of Internal Medicine 164 17 1888 96 doi 10 1001 archinte 164 17 1888 PMID 15451764 Morin CM Colecchi C Stone J Sood R Brink D March 1999 Behavioral and pharmacological therapies for late life insomnia a randomized controlled trial JAMA 281 11 991 99 doi 10 1001 jama 281 11 991 PMID 10086433 Miller KE 2005 Cognitive Behavior Therapy vs Pharmacotherapy for Insomnia American Family Physician 72 2 330 Archived from the original on 6 June 2011 Ramakrishnan K Scheid DC August 2007 Treatment options for insomnia American Family Physician 76 4 517 526 PMID 17853625 Krystal AD August 2009 A compendium of placebo controlled trials of the risks benefits of pharmacological treatments for insomnia the empirical basis for U S clinical practice Sleep Medicine Reviews 13 4 265 74 doi 10 1016 j smrv 2008 08 001 PMID 19153052 Matthews EE Arnedt JT McCarthy MS Cuddihy LJ Aloia MS December 2013 Adherence to cognitive behavioral therapy for insomnia a systematic review Sleep Medicine Reviews 17 6 453 64 doi 10 1016 j smrv 2013 01 001 PMC 3720832 PMID 23602124 Ong JC Ulmer CS Manber R November 2012 Improving sleep with mindfulness and acceptance a metacognitive model of insomnia Behaviour Research and Therapy 50 11 651 60 doi 10 1016 j brat 2012 08 001 PMC 3466342 PMID 22975073 a b Meadows G 2015 The sleep book How to sleep well every night London UK Orion Publishing Group p 2 7 Salari N Khazaie H Hosseinian Far A et al The effect of acceptance and commitment therapy on insomnia and sleep quality A systematic review BMC Neurol 20 300 2020 https doi org 10 1186 s12883 020 01883 1 Edinger JD Means MK July 2005 Cognitive behavioral therapy for primary insomnia Clinical Psychology Review 25 5 539 58 doi 10 1016 j cpr 2005 04 003 PMID 15951083 a b Fox S Fallows D 5 October 2005 Digital Divisions Internet health resources Washington DC Pew Internet amp American Life Project Archived from the original on 21 October 2005 Rabasca L 2000 Taking telehealth to the next step Monitor on Psychology 31 36 37 doi 10 1037 e378852004 017 Archived from the original on 30 December 2012 Marks IM Cavanagh K Gega L 2007 Hands on Help Computer Aided Psychotherapy Hove England and New York Psychology Press ISBN 978 1 84169 679 9 a b Ritterband LM Gonder Frederick LA Cox DJ Clifton AD West RW Borowitz SM 2003 Internet interventions In review in use and into the future Professional Psychology Research and Practice 34 5 527 34 doi 10 1037 0735 7028 34 5 527 S2CID 161666 Cheng SK Dizon J 2012 Computerised cognitive behavioural therapy for insomnia a systematic review and meta analysis Psychotherapy and Psychosomatics 81 4 206 16 doi 10 1159 000335379 PMID 22585048 S2CID 10527276 Charles J Harrison C Britt H May 2009 Insomnia PDF Australian Family Physician 38 5 283 PMID 19458795 Archived from the original PDF on 12 March 2011 Qaseem A Kansagara D Forciea MA Cooke M Denberg TD July 2016 Management of Chronic Insomnia Disorder in Adults A Clinical Practice Guideline From the American College of Physicians Annals of Internal Medicine 165 2 125 133 doi 10 7326 m15 2175 PMID 27136449 FDA adds Boxed Warning for risk of serious injuries caused by sleepwalking with certain prescription insomnia medicines US Food and Drug Administration 30 April 2019 Retrieved 2 May 2019 Chong Y Fryar C D and Gu Q 2013 Prescription Sleep Aid Use Among Adults United States 2005 2010 Hyattsville Md U S Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics Consumer Reports Drug Effectiveness Review Project January 2012 Evaluating Newer Sleeping Pills Used to Treat Insomnia Comparing Effectiveness Safety and Price PDF Best Buy Drugs 3 8 11 Archived PDF from the original on 9 December 2013 Retrieved 4 June 2013 DrugBank DB00366 Doxylamine Archived 3 December 2009 at the Wayback Machine Drugbank ca Retrieved on 20 November 2011 Lie JD Tu KN Shen DD Wong BM November 2015 Pharmacological Treatment of Insomnia P amp T 40 11 759 771 PMC 4634348 PMID 26609210 Restless Legs Syndrome Fact Sheet National Institute of Neurological Disorders and Stroke www ninds nih gov Archived from the original on 28 July 2017 Retrieved 29 August 2017 Bertschy G Ragama Pardos E Muscionico M Ait Ameur A Roth L Osiek C Ferrero F January 2005 Trazodone addition for insomnia in venlafaxine treated depressed inpatients a semi naturalistic study Pharmacological Research 51 1 79 84 doi 10 1016 j phrs 2004 06 007 PMID 15519538 Winokur A DeMartinis NA McNally DP Gary EM Cormier JL Gary KA October 2003 Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia The Journal of Clinical Psychiatry 64 10 1224 29 doi 10 4088 JCP v64n1013 PMID 14658972 Schittecatte M Dumont F Machowski R Cornil C Lavergne F Wilmotte J 2002 Effects of mirtazapine on sleep polygraphic variables in major depression Neuropsychobiology 46 4 197 201 doi 10 1159 000067812 PMID 12566938 S2CID 25351993 Le Strat Y Gorwood P September 2008 Agomelatine an innovative pharmacological response to unmet needs Journal of Psychopharmacology 22 7 Suppl 4 8 doi 10 1177 0269881108092593 PMID 18753276 S2CID 29745284 Summary of Product Characteristics PDF European Medicine Agency Archived PDF from the original on 29 October 2014 Retrieved 14 October 2013 VALDOXAN Product Information PDF TGA eBusiness Services Servier Laboratories Pty Ltd 23 September 2013 Archived from the original on 24 March 2017 Retrieved 14 October 2013 Novartis drops future blockbuster agomelatine Archived 11 November 2011 at the Wayback Machine Scrip Intelligence 25 October 2011 retrieved 30 October 2011 Bentham C 29 March 2006 Servier and Novartis sign licensing agreement for agomelatine a novel treatment for depression Servier UK Archived from the original on 16 April 2009 Retrieved 15 May 2009 Everitt H Baldwin DS Stuart B Lipinska G Mayers A Malizia AL et al May 2018 Antidepressants for insomnia in adults The Cochrane Database of Systematic Reviews 2018 5 CD010753 doi 10 1002 14651858 CD010753 pub2 PMC 6494576 PMID 29761479 a b c Brasure M MacDonald R Fuchs E Olson CM Carlyle M Diem S Koffel E Khawaja IS Ouellette J Butler M Kane RL Wilt TJ December 2015 Management of Insomnia Disorder AHRQ Comparative Effectiveness Reviews Rockville MD Agency for Healthcare Research and Quality US PMID 26844312 Use of melatonin supplements rising among adults National Institutes of Health NIH 2022 02 28 Retrieved 2022 06 29 a b Conn DK Madan R 2006 Use of sleep promoting medications in nursing home residents risks versus benefits Drugs amp Aging 23 4 271 87 doi 10 2165 00002512 200623040 00001 PMID 16732687 S2CID 38394552 Lyseng Williamson KA November 2012 Melatonin prolonged release in the treatment of insomnia in patients aged 55 years Drugs amp Aging 29 11 911 23 doi 10 1007 s40266 012 0018 z PMID 23044640 S2CID 1403262 Lemoine P Zisapel N April 2012 Prolonged release formulation of melatonin Circadin for the treatment of insomnia Expert Opinion on Pharmacotherapy 13 6 895 905 doi 10 1517 14656566 2012 667076 PMID 22429105 S2CID 23291045 Sanchez Barcelo EJ Mediavilla MD Reiter RJ 2011 Clinical uses of melatonin in pediatrics International Journal of Pediatrics 2011 892624 doi 10 1155 2011 892624 PMC 3133850 PMID 21760817 Temazepam Archived 30 May 2013 at the Wayback Machine Websters online dictionary org Retrieved on 20 November 2011 a b Buscemi N Vandermeer B Friesen C Bialy L Tubman M Ospina M Klassen TP Witmans M September 2007 The efficacy and safety of drug treatments for chronic insomnia in adults a meta analysis of RCTs Journal of General Internal Medicine 22 9 1335 50 doi 10 1007 s11606 007 0251 z PMC 2219774 PMID 17619935 Ohayon MM Caulet M May 1995 Insomnia and psychotropic drug consumption Progress in Neuro Psychopharmacology amp Biological Psychiatry 19 3 421 31 doi 10 1016 0278 5846 94 00023 B PMID 7624493 S2CID 20655328 What s wrong with prescribing hypnotics Drug and Therapeutics Bulletin 42 12 89 93 December 2004 doi 10 1136 dtb 2004 421289 PMID 15587763 S2CID 40188442 a b Kaufmann CN Spira AP Alexander GC Rutkow L Mojtabai R June 2016 Trends in prescribing of sedative hypnotic medications in the USA 1993 2010 Pharmacoepidemiology and Drug Safety 25 6 637 45 doi 10 1002 pds 3951 PMC 4889508 PMID 26711081 Glass J Lanctot KL Herrmann N Sproule BA Busto UE November 2005 Sedative hypnotics in older people with insomnia meta analysis of risks and benefits BMJ 331 7526 1169 doi 10 1136 bmj 38623 768588 47 PMC 1285093 PMID 16284208 Tsoi WF March 1991 Insomnia drug treatment Annals of the Academy of Medicine Singapore 20 2 269 72 PMID 1679317 Montplaisir J August 2000 Treatment of primary insomnia CMAJ 163 4 389 91 PMC 80369 PMID 10976252 Carlstedt RA 2009 Handbook of Integrative Clinical Psychology Psychiatry and Behavioral Medicine Perspectives Practices and Research Springer pp 128 30 ISBN 978 0 8261 1094 7 Lader M Cardinali DP Pandi Perumal SR 2006 Sleep and sleep disorders a neuropsychopharmacological approach Georgetown Tex Landes Bioscience Eurekah com p 127 ISBN 978 0 387 27681 6 Authier N Boucher A Lamaison D Llorca PM Descotes J Eschalier A 2009 Second meeting of the French CEIP Centres d Evaluation et d Information sur la Pharmacodependance Part II benzodiazepine withdrawal Therapie 64 6 365 70 doi 10 2515 therapie 2009051 PMID 20025839 Huedo Medina TB Kirsch I Middlemass J Klonizakis M Siriwardena AN December 2012 Effectiveness of non benzodiazepine hypnotics in treatment of adult insomnia meta analysis of data submitted to the Food and Drug Administration BMJ 345 e8343 doi 10 1136 bmj e8343 PMC 3544552 PMID 23248080 Jacobson LH Hoyer D de Lecea L January 2022 Hypocretins orexins The ultimate translational neuropeptides J Intern Med 291 5 533 556 doi 10 1111 joim 13406 PMID 35043499 S2CID 248119793 Highlights of prescribing information PDF Archived PDF from the original on 12 September 2014 a b Thompson W Quay TA Rojas Fernandez C Farrell B Bjerre LM June 2016 Atypical antipsychotics for insomnia a systematic review Sleep Med 22 13 17 doi 10 1016 j sleep 2016 04 003 PMID 27544830 Morin AK 1 March 2014 Off label use of atypical antipsychotic agents for treatment of insomnia Mental Health Clinician 4 2 65 72 doi 10 9740 mhc n190091 eISSN 2168 9709 American Psychiatric Association September 2013 Five Things Physicians and Patients Should Question Choosing Wisely an initiative of the ABIM Foundation American Psychiatric Association archived from the original on 3 December 2013 retrieved 30 December 2013 which cites American Association of Clinical Endocrinologists North American Association for the Study of Obesity February 2004 Consensus development conference on antipsychotic drugs and obesity and diabetes Diabetes Care 27 2 596 601 doi 10 2337 diacare 27 2 596 PMID 14747245 Maglione M Maher AR Hu J Wang Z Shanman R Shekelle PG Roth B Hilton L Suttorp MJ Ewing BA Motala A Perry T Sep 2011 Off Label Use of Atypical Antipsychotics An Update AHRQ Comparative Effectiveness Reviews Rockville MD Agency for Healthcare Research and Quality US PMID 22132426 Nasrallah HA January 2008 Atypical antipsychotic induced metabolic side effects insights from receptor binding profiles Molecular Psychiatry 13 1 27 35 doi 10 1038 sj mp 4002066 PMID 17848919 S2CID 205678886 Coe HV Hong IS May 2012 Safety of low doses of quetiapine when used for insomnia The Annals of Pharmacotherapy 46 5 718 722 doi 10 1345 aph 1Q697 PMID 22510671 S2CID 9888209 Maglione M Maher AR Hu J Wang Z Shanman R Shekelle PG Roth B Hilton L Suttorp MJ 2011 Off Label Use of Atypical Antipsychotics An Update Comparative Effectiveness Reviews No 43 Rockville Agency for Healthcare Research and Quality PMID 22973576 a b c d e f De Crescenzo F D Alo GL Ostinelli EG Ciabattini M Di Franco V Watanabe N Kurtulmus A Tomlinson A Mitrova Z Foti F Del Giovane C Quested DJ Cowen PJ Barbui C Amato L Efthimiou O Cipriani A July 2022 Comparative effects of pharmacological interventions for the acute and long term management of insomnia disorder in adults a systematic review and network meta analysis Lancet 400 10347 170 184 doi 10 1016 S0140 6736 22 00878 9 PMID 35843245 S2CID 250536370 Pillinger T McCutcheon RA Vano L Mizuno Y Arumuham A Hindley G et al January 2020 Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia predictors of metabolic dysregulation and association with psychopathology a systematic review and network meta analysis The Lancet Psychiatry 7 1 64 77 doi 10 1016 s2215 0366 19 30416 x PMC 7029416 PMID 31860457 Yoshida K Takeuchi H March 2021 Dose dependent effects of antipsychotics on efficacy and adverse effects in schizophrenia Behavioural Brain Research 402 113098 doi 10 1016 j bbr 2020 113098 PMID 33417992 S2CID 230507941 Hojlund M Andersen K Ernst MT Correll CU Hallas J October 2022 Use of low dose quetiapine increases the risk of major adverse cardiovascular events results from a nationwide active comparator controlled cohort study World Psychiatry 21 3 444 451 doi 10 1002 wps 21010 PMC 9453914 PMID 36073694 Hojlund M 2022 09 12 Low dose Quetiapine Utilization and Cardiometabolic Risk Thesis Syddansk Universitet Det Sundhedsvidenskabelige Fakultet doi 10 21996 mr3m 1783 Atkin T Comai S Gobbi G April 2018 Drugs for Insomnia beyond Benzodiazepines Pharmacology Clinical Applications and Discovery Pharmacol Rev 70 2 197 245 doi 10 1124 pr 117 014381 PMID 29487083 S2CID 3578916 Review finds little evidence to support gabapentinoid use in bipolar disorder or insomnia NIHR Evidence Plain English summary National Institute for Health and Care Research 17 October 2022 doi 10 3310 nihrevidence 54173 S2CID 252983016 Hong JS Atkinson LZ Al Juffali N Awad A Geddes JR Tunbridge EM et al March 2022 Gabapentin and pregabalin in bipolar disorder anxiety states and insomnia Systematic review meta analysis and rationale Molecular Psychiatry 27 3 1339 1349 doi 10 1038 s41380 021 01386 6 PMC 9095464 PMID 34819636 Aschenbrenner DS Venable SJ 2009 Drug Therapy in Nursing Lippincott Williams amp Wilkins p 277 ISBN 978 0 7817 6587 9 a b Leach MJ Page AT December 2015 Herbal medicine for insomnia A systematic review and meta analysis Sleep Med Rev 24 1 12 doi 10 1016 j smrv 2014 12 003 PMID 25644982 a b Kim J Lee SL Kang I Song YA Ma J Hong YS Park S Moon SI Kim S Jeong S Kim JE May 2018 Natural Products from Single Plants as Sleep Aids A Systematic Review J Med Food 21 5 433 444 doi 10 1089 jmf 2017 4064 PMID 29356580 a b Meolie AL Rosen C Kristo D Kohrman M Gooneratne N Aguillard RN Fayle R Troell R Townsend D Claman D Hoban T Mahowald M April 2005 Oral nonprescription treatment for insomnia an evaluation of products with limited evidence J Clin Sleep Med 1 2 173 87 doi 10 5664 jcsm 26314 PMID 17561634 a b Wheatley D July 2005 Medicinal plants for insomnia a review of their pharmacology efficacy and tolerability J Psychopharmacol 19 4 414 21 doi 10 1177 0269881105053309 PMID 15982998 S2CID 34484538 Bhagavan C Kung S Doppen M John M Vakalalabure I Oldfield K Braithwaite I Newton Howes G December 2020 Cannabinoids in the Treatment of Insomnia Disorder A Systematic Review and Meta Analysis CNS Drugs 34 12 1217 1228 doi 10 1007 s40263 020 00773 x PMID 33244728 S2CID 227174084 Suraev AS Marshall NS Vandrey R McCartney D Benson MJ McGregor IS Grunstein RR Hoyos CM October 2020 Cannabinoid therapies in the management of sleep disorders A systematic review of preclinical and clinical studies Sleep Med Rev 53 101339 doi 10 1016 j smrv 2020 101339 PMID 32603954 S2CID 219452622 Gates PJ Albertella L Copeland J December 2014 The effects of cannabinoid administration on sleep a systematic review of human studies Sleep Med Rev 18 6 477 87 doi 10 1016 j smrv 2014 02 005 PMID 24726015 Cheuk DK Yeung WF Chung KF Wong V September 2012 Acupuncture for insomnia The Cochrane Database of Systematic Reviews 9 9 CD005472 doi 10 1002 14651858 CD005472 pub3 hdl 10722 198790 PMID 22972087 a b c d Kripke DF Garfinkel L Wingard DL Klauber MR Marler MR February 2002 Mortality associated with sleep duration and insomnia Archives of General Psychiatry 59 2 131 36 doi 10 1001 archpsyc 59 2 131 PMID 11825133 What are Sleep Disorders Psychiatry org Lamberg L 2007 Several Sleep Disorders Reflect Gender Differences Psychiatric News 42 8 40 doi 10 1176 pn 42 10 0040 Jiang XL Zheng XY Yang J Ye CP Chen YY Zhang ZG Xiao ZJ December 2015 A systematic review of studies on the prevalence of insomnia in university students Public Health 129 12 1579 84 doi 10 1016 j puhe 2015 07 030 PMID 26298588 Horne J 2016 Sleeplessness Assessing Sleep Need in Society Today p 114 ISBN 978 3 319 30572 1 Everyone sleeps and needs to do so Horne J 2016 Sleeplessness Assessing Sleep Need in Society Today p 116 ISBN 978 3 319 30572 1 External links Edit Retrieved from https en wikipedia org w index php title Insomnia amp oldid 1139252133, wikipedia, wiki, book, books, library,

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