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Review Article

Current Clinical Practice of Insomnia

Hee Yeon Choi, Weon-Jeong Lim
The Ewha Medical Journal 2013;36(2):84-92. Published online: September 26, 2013

Department of Psychiatry, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Weon-Jeong Lim. Department of Psychiatry, Ewha Womans University School of Medicine, 1091 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-5163, Fax: 82-2-2650-0984, psyweon@ewha.ac.kr
• Received: August 5, 2013   • Accepted: August 12, 2013

Copyright © 2013. Ewha Womans University School of Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.
  • Keywords: Behavior therapy; Cognitive therapy; Drug therapy; Insomnia
  • 1. Ellis JG, Perlis ML, Neale LF, Espie CA, Bastien CH. The natural history of insomnia: focus of prevalence and incidence of acute insomnia. J Psychiatr Res 2012;46:1278-1285.
  • 2. Terzano MG, Parrino L, Cirignotta F, Ferini-Strambi L, Gigli G, Rudelli G, et al. Insomnia in primary care, a survey conducted on the Italian population. Sleep Med 2004;5:67-75.
  • 3. Espie CA, Kyle SD, Hames P, Cyhlarova E, Benzeval M. The daytime impact of DSM-5 insomnia disorder: comparative analysis of insomnia subtypes from the Great British Sleep Survey. J Clin Psychiatry 2012;73:e1478-e1484.
  • 4. Leger D, Morin CM, Uchiyama M, Hakimi Z, Cure S, Walsh JK. Chronic insomnia, quality-of-life, and utility scores: comparison with good sleepers in a cross-sectional international survey. Sleep Med 2012;13:43-51.
  • 5. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011;135:10-19.
  • 6. Phillips B, Mannino DM. Do insomnia complaints cause hypertension or cardiovascular disease? J Clin Sleep Med 2007;3:489-494.
  • 7. Woo JM, Hyun SY, Lee SH, Kang SG, Lee JS, Kim L, et al. Productivity time lost by sleep disturbance among workers in Korea. J Korean Neuropsychiatr Assoc 2011;50:62-68.
  • 8. Walsh JK. Clinical and socioeconomic correlates of insomnia. J Clin Psychiatry 2004;65:Suppl 8. 13-19.
  • 9. American Psychiatric Association.Diagnostic and statistical manual of mental disorders; 5th ed. Washington, DC: American Psychiatric Association; 2013.
  • 10. American Academy of Sleep Medicine.The international classification of sleep disorders: diagnostic and coding manual; 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.
  • 11. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4:487-504.
  • 12. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update: an American Academy of Sleep Medicine. Sleep 2006;29:1415-1419.
  • 13. Kopta SM, Howard KI, Lowry JL, Beutler LE. Patterns of symptomatic recovery in psychotherapy. J Consult Clin Psychol 1994;62:1009-1016.
  • 14. Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systemic review. BMC Fam Pract 2012;13:40.
  • 15. Edinger JD, Sampson WS. A primary care "friendly" cognitive behavioral insomnia therapy. Sleep 2003;26:177-182.
  • 16. Siebern AT, Suh SY, Nowakowski S. Non-pharmacological treatment of insomnia. Neurotherapeutics 2012;9:717-727.
  • 17. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia: an American Academy of Sleep Medicine review. Sleep 1999;22:1134-1156.
  • 18. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's comprehensive textbook of psychiatry; 9th ed. Philadelphia: Lipppincott Williams and Wilkins; 2009 21502157.
  • 19. Buysse DJ, Strollo PJ Jr, Black JE, Zee PG, Winkelman JW. Sleep disorders. Hales RE, Yodifsky SC, Gabbard GO. The American Psychiatric Publishing textbook of psychiatry; 5th ed. Arlington, VA: American Psychiatric Publishing; 2008 921936.
  • 20. Stepanski EJ, Wyatt JK. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev 2003;7:215-225.
  • 21. Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ 2000;162:225-233.
  • 22. Roth T, Roehrs TA. A review of the safety profiles of benzodiazepine hypnotics. J Clin Psychiatry 1991;52:Suppl. 38-41.
  • 23. Mendelson WB. Clinical distinctions between long-acting and short-acting benzodiazepines. J Clin Psychiatry 1992;53:Suppl. 4-7.
  • 24. Roehrs T, Pedrosi B, Rosenthal L, Roth T. Hypnotic self administration and dose escalation. Psychopharmacology (Berl) 1996;127:150-154.
  • 25. Paterniti S, Dufouil C, Alperovitch A. Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. J Clin Psychopharmacol 2002;22:285-293.
  • 26. Allain H, Bentue-Ferrer D, Polard E, Akwa Y, Patat A. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging 2005;22:749-765.
  • 27. Cumming RG, Le Couteur DG. Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs 2003;17:825-837.
  • 28. Wilson S, Nutt D. Drug treatment of chronic insomnia: dawn at the end of a long night? J Psychopharmacol 2008;22:703-706.
  • 29. Walsh JK, Krystal AD, Amato DA, Rubens R, Caron J, Wessel TC, et al. Nightly treatment of primary insomnia with eszopiclone for 6 months: effect on sleep, quality of life, and work limitations. Sleep 2007;30:959-968.
  • 30. Krystal AD, Erman M, Zammit GK, Soubrane C, Roth T. ZOLONG Study GroupLong-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep 2008;31:79-90.
  • 31. Ancoli-Israel S, Richardson GS, Mangano RM, Jenkins L, Hall P, Jones WS. Long-term use of sedative hypnotics in older patients with insomnia. Sleep Med 2005;6:107-113.
  • 32. Morgenthaler TI, Silber MH. Amnestic sleep-related eating disorder associated with zolpidem. Sleep Med 2002;3:323-327.
  • 33. Ministry of Food and SafetyDrug safety communications: insomnia drugs containing zolpidem Seoul, Ministry of Food and Safety. 2013;cited 2013 Aug 10. Available from: http://www.mfds.go.kr/index.do?mid=57&seq=19505&cmd=v
  • 34. Hardeland R. New approaches in the management of insomnia: weighing the advantages of prolonged-release melatonin and synthetic melatoninergic agonists. Neuropsychiatr Dis Treat 2009;5:341-354.
  • 35. Roth T, Zee PC, Wang-Weigand S, Zhang J, Zee P. Effects of ramelteon on patient-reported sleep latency in older adults with chronic insomnia. Sleep Med 2006;7:312-318.
  • 36. Pandi-Perumal SR, Srinivasan V, Poeggeler B, Hardeland R, Cardinali DP. Drug insight: the use of melatonergic agonists for the treatment of insomnia-focus on ramelteon. Nat Clin Pract Neurol 2007;3:221-228.
  • 37. Roth T, Seiden D, Sainati S, Wang-Weigand S, Zhang J, Zee P. Effects of ramelteon on patient-reported sleep latency in older adults with chronic insomnia. Sleep Med 2006;7:312-318.
  • 38. Descamps A, Rousset C, Millan MJ, Spedding M, Delagrange P, Cespuglio R. Influence of the novel antidepressant and melatonin agonist/serotonin 2C receptor antagonist, agomelatine, on the rat sleep-wake cycle architecture. Psychopharmacology (Berl) 2009;205:93-106.
  • 39. Leproult R, Van Onderbergen A, L'hermite-Balériaux M, Van Cauter E, Copinschi G. Phase-shifts of 24-h rhythms of hormonal release and body temperature following early evening administration of the melatonin agonist agomelatine in healthy older men. Clin Endocrinol (Oxf) 2005;63:298-304.
  • 40. Krystal AD, Lankford A, Durrence HH, Ludington E, Jochelson P, Rogowski R, et al. Efficacy and safety of doxepin 3 and 6mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep 2011;34:1433-1442.
  • 41. Walsh JK, Erman M, Erwin CW, Jamieson A, Mahowald M, Regestein Q, et al. Subjective hypnotic efficacy of trazodone and zolpidem in DSM-III-R primary insomnia. Hum Psychopharmacol 1998;13:191-198.
  • 42. Aslan S, Isik E, Cosar B. The effects of mirtazapine on sleep: a placebo controlled, double-blind study in young healthy volunteers. Sleep 2002;25:677-679.
  • 43. Coe HV, Hong IS. Safety of low doses of quetiapine when used for insomnia. Ann Pharmacother 2012;46:718-722.
  • 44. Monti JM. Serotoinin control of sleep-wake behavior. Sleep Med Rev 2011;15:269-281.
  • 45. Hoever P, Hay J, Rad M, Cavallaro M, van Gerven JM, Dingemanse J. Tolerability, pharmacokinetics, and pharmacodynamics of single-dose almorexant, an orexin receptor antagonist, in healthy elderly subjects. J Clin Psychopharmacol 2013;33:363-370.
  • 46. Winrow CJ, Renger JJ. Discovery and development of orexin receptor antagonists as therapeutics for insomnia. Br J Pharmacol 2013;06 03 [Epub]. http://dx.doi.org/10.1111/bph.12261
Table 1
Diagnostic and Statistical Manual of Mental Disorder (DSM)-5 criteria of insomnia disorder

Adapted from American Psychiatric Association [9].

emj-36-84-i001.jpg
Table 2
Evaluation of insomnia [11]
emj-36-84-i002.jpg
Table 3
Medications used in the treatment of insomnia
emj-36-84-i003.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
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    Ewha Med J. 2013;36(2):84-92.   Published online September 26, 2013
    DOI: https://doi.org/10.12771/emj.2013.36.2.84
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    Current Clinical Practice of Insomnia
    Ewha Med J. 2013;36(2):84-92.   Published online September 26, 2013
    DOI: https://doi.org/10.12771/emj.2013.36.2.84
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    Current Clinical Practice of Insomnia
    Current Clinical Practice of Insomnia

    Diagnostic and Statistical Manual of Mental Disorder (DSM)-5 criteria of insomnia disorder

    Adapted from American Psychiatric Association [9].

    Evaluation of insomnia [11]

    Medications used in the treatment of insomnia
    Table 1 Diagnostic and Statistical Manual of Mental Disorder (DSM)-5 criteria of insomnia disorder

    Adapted from American Psychiatric Association [9].

    Table 2 Evaluation of insomnia [11]

    Table 3 Medications used in the treatment of insomnia

    Table 1

    Table 2

    Table 3

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