Maintenance insomnia treatment trial#

In all publications, impact of treatment on sleep maintenance parameters (wake time after sleep onset, number of awakenings) and measures of next-day functioning were evaluated, in addition to sleep onset parameters (sleep latency, time to sleep onset/induction) and sleep duration data (total sleep time). Relevant texts and other articles that evaluated side effect profiles of these agents were also included, one of which was published in January of 2005.

Maintenance insomnia treatment trial#

As only one randomized placebo-controlled trial evaluated trazodone use in primary insomnia, the trazodone search was expanded to include all clinical trials that evaluated trazodone use in insomnia. Sleep efficacy endpoints from randomized, placebo-controlled clinical trials in adult populations and key review articles published between 19 were included in this review. A literature search using the terms 'trazodone' and 'insomnia' was also performed, as this is the second-most commonly prescribed agent for treating insomnia. Per reviewer comments, the search criteria was later expanded to include lorazepam. When insomnia is recognized, considerable emphasis has been placed on improving sleep onset however, there is growing evidence that improving sleep maintenance is an equally important treatment goal.Ī MEDLINE literature search was performed using the search parameters 'insomnia,' 'zolpidem,' 'zaleplon,' 'flurazepam,' 'estazolam,' 'quazepam,' 'triazolam,' and 'temazepam,' as these agents are FDA-approved for the treatment of insomnia. 31Ĭontinuous positive airway pressure is the most effective treatment option for obstructive sleep apnea and is recommended in conjunction with weight loss.Although insomnia is highly prevalent, sleep disturbances often go unrecognized and untreated. Dopaminergic agonists should be used if there is inadequate response. Nonpharmacologic interventions are first-line treatment for restless legs syndrome, followed by the use of alpha-2-delta ligands. 23, 24Īmerican Academy of Sleep Medicine clinical practice guidelines and two randomized controlled trials One randomized controlled trial and a systematic review of good-quality studiesĪ sleep-wake schedule and melatonin or a bright-light therapy regimen is recommended for treatment of delayed sleep phase syndrome. 10, 12, 13, 15Ĭlinical guidelines from multiple organizations and large systematic review and meta-analysisĬognitive behavior therapy for insomnia can be administered effectively in a primary care setting to treat chronic insomnia. Treatment consists of positive airway pressure therapy while sleeping in conjunction with weight loss.Ĭognitive behavior therapy for insomnia is the first-line treatment for chronic insomnia. Obstructive sleep apnea may be diagnosed in patients with excessive snoring and witnessed apneas and can be diagnosed using overnight polysomnography.

Narcolepsy is treated with behavior modifications and medications such as stimulants, selective serotonin reuptake inhibitors, sodium oxybate, and pitolisant. Diagnosis is suggested by the history and can be confirmed with polysomnography and a multiple sleep latency test the following day. Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and sleep hallucinations. Restless legs syndrome is treated with gabapentin or dopamine agonists, depending on the severity. Restless legs syndrome is defined by an urge to move the legs that worsens when at rest.

Rapid eye movement sleep behavior disorder is diagnosed by polysomnography and treated with melatonin or clonazepam. Rapid eye movement sleep behavior disorder is characterized by increased muscle tone during rapid eye movement sleep, resulting in patients acting out their dreams with potentially harmful effects. Insomnia is diagnosed by history and is treated with cognitive behavior therapy, with or without medications. Insomnia, the most common sleep disorder, is defined by difficulty initiating sleep, maintaining sleep, or both, resulting in daytime consequences. Patients with sleep disorders can be categorized into three groups: people with problems falling asleep, people with behavior and movement disturbances during sleep, and people with excessive daytime sleepiness. Sleep disorders are common in the general adult population and are associated with adverse effects such as motor vehicle collisions, decreased quality of life, and increased mortality.