Posted by Chantel Martiromo, Article By Kyle J. Norton
Insomnia is a sign and symptom
of sleep disorder and defined as a condition in which a person has a
difficulty falling asleep and/or staying asleep or sleep of poor
quality that can lead to substantial impairments in the quality of life
and functional capacity of an individual. Most adults have experienced
insomnia sometimes in their life. According to statistic, more than 30%
of the population suffers from insomnia, one in three people suffer from
some form of insomnia during their lifetime and women suffer from
insomnia more often than men.
Treatments
A. Conventional medicine
Generally, treatment of insomnia includes Non-pharmacological non-pharmacologic pharmacologic
A. 1.Non-pharmacological treatments
Non-pharmacological treatments have been used more effectively without worrying about the withdrawal effects
after discontinued use of medication, including sleep hygiene,
stimulus control, behavioral interventions, sleep-restriction therapy,
paradoxical intention, patient education and relaxation therapy.
1. Sleep hygiene
Sleep
hygiene is the method used to treat insomnia by including all
behavioral and environmental factors that precede to sleep and may
interfere with sleep. In a study of Sleep hygiene and actigraphically
evaluated sleep characteristics in children with ADHD and chronic sleep
onset insomnia KRISTIAAN B . VAN DER HEIJDE, researchers concluded that
there were differences in sleep onset and sleep latency in ADHD children
with chronic SOI and those without insomnia; however, sleep hygiene
practices were similar and did not relate to sleep characteristics.
2. Stimulus control
The
purpose of stimulus control is to The use of conditioning techniques to
bring the target behavior of an individual under environmental control.
If a person behaviors can respond differentially to the environment
factors, he/or she are likely to fall to sleep under certain certain
conditions. the characteristics of stimulus control is to helps the
patient to behavior automatically when the conditioned stimulus is given
but not to others.
3. Behavioral intervention
The
purpose of behavioral intervention is to reinforce the positive
behavior and avoid bad behavior regardless the environment influence.
4. Sleep-restriction therapy
Sleep
restriction therapy base on the hypothesis that insomnia is caused
spending too much time in bed cause of insomnia. By restriction the time
in bed determine by the time a person normally asleep and schedule for
others such as time to wake up, same bed time every night, etc.
5. Paradoxical intention
Paradoxical
intention is a treatment of removing the psychological habit or thought
cause of insomnia by helping the patient to understand the
irrationality of the emotional reaction
6. Relaxation therapy
relaxation
therapy is a form of treatment by enhancing the person into a
relaxation stage quieting the mind to allow thoughts to flow in a
smooth and induce the relaxation response.
7. Etc.
A..2. Pharmacologic treaments
1. Benzodiazepines
a.
Benzodiazepines is used for patient with insomnia to initiate sleep
and increase sleep time, but they also decrease deep sleep and increase
light sleep.
b. Risk and side effects
b.1. Drowsiness and dizziness.
b.2. Stomach upset
b.3. Headache,
b.4. Confusion
b.5. Impaired coordination
b, 6. Fatigue
b.7. Memory loss
b.8. Trembling
b.9. Etc
2. Non-benzodiazepines
a.
Non-benzodiazepine is a sedative-hypnotic drugs used to treat insomnia
similar to those in the benzodiazepine class but with an advantage of
reducing the time for the patient to fall asleep.
b. Risks and side effects
b.1. morning sedation
b.2. Drowsiness
b.3. Dizziness
b.4.Fatigue
b.5. Headache
b.6. Diarrhea
b.7. Etc.
3. Antidepressants
a. According the article of Use
of Low-Dose Sedating Antidepressants vs Benzodiazepine Receptor Agonist
Hypnotics in Treating Insomnia by Thomas Roth, PhD, the author
concluded that Because the use of low-dose sedating antidepressants in
insomnia is a common practice, one can come to 2 conclusions. These
were formalized in the National Institutes of Health State of the
Science Conference on the Manifestations and Management of Chronic
Insomnia in Adults. First, there is a need for dose-response data on
the relationship with sleep, as well as long-term efficacy data.
Second, "all antidepressants have potentially significant adverse
effects raising concerns about the risk-benefit ratio."[11]
In summary, there is a wealth of data supporting the efficacy and
safety, with some concerns mentioned above, of the BZRAs for the
management of insomnia. In contrast, while the use of low-dose sedating
antidepressants for the management of insomnia is gaining in
popularity, as pointed out by the National Institutes of Health, the
wisdom of this use awaits further data on dose-related safety and
efficacy.
b. Risk and side effects
b.1. Bladder problems
b.2. Loss of libido
b.3. Dizziness and drowsiness
b.4. Inability to achieve an orgasm
b.5. Headaches
b.6. Nervousness
b.7. Etc.
4. Melatonin supplement
a. Melatonin supplements has been used treat
insomnia without altering the sleep pattern by inducing sleep and
regulating the sleep/waking cycle. In a study of Melatonin and zopiclone
as facilitators of early circadian sleep in operational air transport
crews. by Paul MA, Gray G, Sardana TM, Pigeau RA, researchers concluded
that melatonin and zopiclone, in the dosages we used, are equipotent
facilitators of early circadian sleep during transmeridian air transport
operations.
b. Risks and side effects
b.1. Daytime sleepiness and drowsiness
b.2. Dizziness
b.3. Headaches
b.4. Abdominal discomfort
b.5. Confusion
b. 6. Nightmares
b.7. Etc.
5. Melatonin agonist
In
a study of Melatonin agonist and insomnia by Ferguson SA, Rajaratnam
SM, Dawson D., researchers concluded that all appear to be efficacious
in the treatment of circadian rhythm sleep disorders and some types of
insomnia. However, further studies are required to understand the
mechanisms of action, particularly for insomnia. Clinical application
of the agonists requires a good understanding of their phase-dependent
properties. Long-term effects of melatonin should be evaluated in
large-scale, independent randomized controlled trials.
b. Risks and side effects
b.1. Daytime sleepiness
b.2. Dizziness
b.3. Headaches
b.4. Abdominal discomfort
b.5. Confusion
b. 6. Nightmares
b.7. Etc.
6. Etc.
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