Abstract:
Insomnia is more common in older people. There are multiple causes of insomnia including medical and psychiatric illness, medications, specific sleep disorders, environmental and behavioural factors and age-related changes in sleep quality and sleep patterns.This article reviews the causes of insomnia, assessment issues and management approaches, to provide the reader with a practical approach to the problem. A comprehensive assessment often reveals reversible factors. Non pharmacological approaches include sleep hygiene measures, increasing sunlight exposure and acupuncture. Only after use of these approaches should short term hypnosedative treatment be commenced.With appropriate management, most older people with insomnia will experience improved sleep.Keywords:
Sleep hygiene
Sleep
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Obsessive-compulsive disorder frequently have insomnia, and those with acute insomnia who also have mental comorbidities without therapy, they are more likely to develop persistent insomnia. We present a case of OCD with acute insomnia that was successfully treated with early non-pharmacological sleep psychiatry intervention. Sleep is necessary for brain function and the maintenance of cognitive and emotional processes. Insomnia and anxiety problems are common, and they’re linked to a lot of damage and disability. In addition to being strongly comorbid with major depressive illness, there is evidence that sleeplessness and anxiety disorders frequently co-occur. The majority of insomnia psychological therapies include sleep hygiene. In terms of clinical practice, these instructions are a solid place to start. Obsessive-compulsive disorder is associated with sleep difficulties. Sleep difficulties are also common in people with obsessive-compulsive disorder, with up to 48% reporting them. Obsessive compulsive disorder research reveals a link between specific sleep habits and clinical factors such the severity of obsessive-compulsive symptoms, treatment resistance, and the age at which the disorder.
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Previous studies examining the associations between sleep hygiene practices and insomnia have produced inconsistent results. This study further investigates this issue by examining different domains of sleep hygiene separately. One hundred and six insomnia patients and 89 good sleepers participated in the study. Their sleep hygiene, sleep quality and insomnia severity were assessed with subjective rating scales. Among good sleepers, almost all domains of sleep hygiene correlated significantly with their sleep ratings. However, in insomnia patients, only the arousal-related behavior correlated with sleep ratings. The findings suggest that strategies in prevention and treatment of sleep disturbance may be different accordingly.
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Sleep disorders are especially common among elderly patients and may be the result of psychiatric illness, a medical problem, poor sleep habits, or a primary sleep disorder. Because a sleep complaint (especially insomnia) is only a symptom, the physician must undertake a careful evaluation in an attempt to identify a specific treatable cause. Although some patients may require referral to a psychiatrist or sleep disorders clinic, many patients may benefit from behavioral strategies, such as improved sleep hygiene. In general, hypnotics should be prescribed for only a limited period of time and should be combined with other therapeutic approaches in patients with chronic insomnia.
Sleep hygiene
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Sleep medicine
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Obsessive-compulsive disorder frequently have insomnia, and those with acute insomnia who also have mental comorbidities without therapy, they are more likely to develop persistent insomnia. We present a case of OCD with acute insomnia that was successfully treated with early non-pharmacological sleep psychiatry intervention. Sleep is necessary for brain function and the maintenance of cognitive and emotional processes. Insomnia and anxiety problems are common, and they’re linked to a lot of damage and disability. In addition to being strongly comorbid with major depressive illness, there is evidence that sleeplessness and anxiety disorders frequently co-occur. The majority of insomnia psychological therapies include sleep hygiene. In terms of clinical practice, these instructions are a solid place to start. Obsessive-compulsive disorder is associated with sleep difficulties. Sleep difficulties are also common in people with obsessive-compulsive disorder, with up to 48% reporting them. Obsessive compulsive disorder research reveals a link between specific sleep habits and clinical factors such the severity of obsessive-compulsive symptoms, treatment resistance, and the age at which the disorder.
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Sleep disturbances are common in adolescents. The etiologies include biological, environmental, and sociocultural factors. The structure of sleep changes during adolescence, and it is easy for adolescents to stay awake. Sleep deprivation causes psychiatric symptoms. On the other hand, many psychiatric disorders cause secondary insomnia. The primary care is sleep hygiene counselling and behavioural therapy. If the sleep disorder is secondary, treatment of the primary disorder is the most important help. The scientific data of pharmacological management of insomnia of adolescent is thin. Melatonin might be worth a try, since there is scientific data of its effectiveness and safety.
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Disturbance of sleep is a symptom of heterogeneous origin. Hypersomnia (excessive sleep during daytime) must be carefully distinguished from hyposomnia. Hypersomnic patients should be referred to a neurologist for further diagnostic workup; hypnotics may be dangerous in these patients. Medical, psychiatric and other cases of hyposomnia should be identified and treated as part of a comprehensive therapy plan. Counselling and application of the rules of sleep hygiene should be considered. When drug therapy is indicated, benzodiazepines are preferable. Because chronic insomnia causes serious impairment to the quality of life, prolonged treatment with hypnotics is sometimes unavoidable. However, their long term efficacy remains to be demonstrated.
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Chronic Insomnia
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Background: Poor sleep is a frequent complaint of persons with HIV infection. Objectives: To pilot test a tailored sleep promotion intervention protocol based on principles of sleep hygiene in a convenience sample of 30 HIV seropositive women. Methods: At baseline and 1 week after implementing the intervention, sleep was assessed by self-report measures and wrist actigraphy. Objective sleep measures include total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hr activity rhythm, and amount of sleep during the day. Results: Prior to the intervention, women averaged 6.4 hr (SD = 1.99) of sleep, and 67% (n = 20) of the sample napped more than 30 min per day. After allowing 1 week to implement sleep hygiene principles to promote healthy sleep behaviors, there was a significant improvement in their perception of sleep and a significant change in their 24-hr activity rhythm. This involved more activity and less napping during the day. Discussion: Although there was minimal change in objective measures of nighttime sleep for the group as a whole, those with initiation insomnia and maintenance insomnia benefited most from the intervention. These findings support the utility of a tailored sleep promotion intervention for women who are HIV positive to address their unique form of sleep disturbance.
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Sleep disturbance is common in psychiatry wards despite poor sleep worsening mental health. Contributory factors include the ward environment, frequent nightly checks on patients and sleep disorders including sleep apnoea. We evaluated the safety and feasibility of a package of measures to improve sleep across a mental health trust, including removing hourly checks when safe, sleep disorder screening and improving the ward environment.During the pilot there were no serious adverse events; 50% of in-patients were able to have protected overnight sleep. Hypnotic issuing decreased, and feedback from patients and staff was positive. It was possible to offer cognitive-behavioural therapy for insomnia to selected patients.Many psychiatry wards perform standardised, overnight checks, which are one cause of sleep disruption. A protected sleep period was safe and well-tolerated alongside education about sleep disturbance and mental health. Future research should evaluate personalised care rather than blanket observation policies.
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SummaryAlzheimer's disease (AD) is the most common form of late-life dementia. Significant sleep disturbance is an extremely common complaint in AD, affecting as much as half of clinic-based or community AD cases. Typically sleep disturbance in AD is multi-factorial. The major causes of sleep disruption in dementia include: (1) age-dependent physiological changes that arise as part of normal, 'non-pathological' aging; (2) sleep problems due to medical and psychiatric disorders, and their treatments; (3) primary sleep disorders; (4) poor sleep-related habits and behaviors, often collectively referred to as poor 'sleep hygiene'; or (5) some combination of these factors. The various causes of sleep disturbance in AD are reviewed and 'state-of-the-art' treatments for sleep disturbance in AD are described. Finally, a research agenda is proposed, describing the major research gaps that will need to be filled before a definitive guide to effectively treating sleep disturbances in AD can truly be developed.
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Sleep hygiene
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Zolpidem
Primary Insomnia
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