Sleep Initiation and Maintenance Disorders

Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. · Penn Sleep Centers, University of Pennsylvania Health System, Philadelphia, PA 19104, USA. · J Clin Sleep Med. · Pubmed #18853708 links to  free full text

Abstract: Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, "insomnia" refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.

Anonymous106236. · No affiliation provided · J Clin Sleep Med. · Pubmed #17564412 No free full text.

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Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, Coleman J, Kapur V, Lee-Chiong T, Owens J, Pancer J, Swick T, Anonymous00049. · Mayo Sleep Disorders Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. · Sleep. · Pubmed #17162987 No free full text.

Abstract: Insomnia is highly prevalent, has associated daytime consequences which impair job performance and quality of life, and is associated with increased risk of comorbidities including depression. These practice parameters provide recommendations regarding behavioral and psychological treatment approaches, which are often effective in primary and secondary insomnia. These recommendations replace or modify those published in the 1999 practice parameter paper produced by the American Sleep Disorders Association. A Task Force of content experts was appointed by the American Academy of Sleep Medicine to perform a comprehensive review of the scientific literature since 1999 and to grade the evidence regarding non-pharmacological treatments of insomnia. Recommendations were developed based on this review using evidence-based methods. These recommendations were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Psychological and behavioral interventions are effective in the treatment of both chronic primary insomnia (Standard) and secondary insomnia (Guideline). Stimulus control therapy, relaxation training, and cognitive behavior therapy are individually effective therapies in the treatment of chronic insomnia (Standard) and sleep restriction therapy, multicomponent therapy (without cognitive therapy), biofeedback and paradoxical intention are individually effective therapies in the treatment of chronic insomnia (Guideline). There was insufficient evidence to recommend sleep hygiene education, imagery training and cognitive therapy as single therapies or when added to other specific approaches. Psychological and behavioral interventions are effective in the treatment of insomnia in older adults and in the treatment of insomnia among chronic hypnotic users (Standard).

Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M. · Stanford University Center of Excellence for Sleep Disorders, Stanford, CA, USA. · Sleep. · Pubmed #16171294 No free full text.

Abstract: These practice parameters are an update of the previously-published recommendations regarding the indications for polysomnography and related procedures in the diagnosis of sleep disorders. Diagnostic categories include the following: sleep related breathing disorders, other respiratory disorders, narcolepsy, parasomnias, sleep related seizure disorders, restless legs syndrome, periodic limb movement sleep disorder, depression with insomnia, and circadian rhythm sleep disorders. Polysomnography is routinely indicated for the diagnosis of sleep related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep related breathing disorders; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep related symptoms; to assist in the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure related; in a presumed parasomnia or sleep related seizure disorder that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement sleep disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with seizures who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.

Littner M, Hirshkowitz M, Kramer M, Kapen S, Anderson WM, Bailey D, Berry RB, Davila D, Johnson S, Kushida C, Loube DI, Wise M, Woodson BT, Anonymous00013, Anonymous00014. · VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA. · Sleep. · Pubmed #14572131 No free full text.

Abstract: Insomnia is a common and clinically important problem. It may arise directly from a sleep-wake regulatory dysfunction and/or indirectly result from comorbid psychiatric, behavioral, medical, or neurological conditions. As an important public-health problem, insomnia requires accurate diagnosis and effective treatment. Insomnia is primarily diagnosed clinically with a detailed medical, psychiatric, and sleep history. Polysomnography is indicated when a sleep-related breathing disorder or periodic limb movement disorder is suspected, initial diagnosis is uncertain, treatment fails, or precipitous arousals occur with violent or injurious behavior. However, polysomnography is not indicated for the routine evaluation of transient insomnia, chronic insomnia, or insomnia associated with psychiatric disorders.

Chesson A, Hartse K, Anderson WM, Davila D, Johnson S, Littner M, Wise M, Rafecas J. · Neurology Department, Louisiana State University Medical Center, Shreveport, USA. · Sleep. · Pubmed #10737341 No free full text.

Abstract: Chronic insomnia is the most common sleep complaint which health care practitioners must confront. Most insomnia patients are not, however, seen by sleep physicians but rather by a variety of primary care physicians. There is little agreement concerning methods for effective assessment and subsequent differential diagnosis of this pervasive problem. The most common basis for diagnosis and subsequent treatment has been the practitioner's clinical impression from an unstructured interview. No systematic, evidence-based guidelines for diagnosis exist for chronic insomnia. This practice parameter paper presents recommendations for the evaluation of chronic insomnia based on the evidence in the accompanying review paper. We recommend use of these parameters by the sleep community, but even more importantly, hope the large number of primary care physicians providing this care can benefit from their use. Conclusions reached in these practice parameters include the following recommendations for the evaluation of chronic insomnia. Since the complaint of insomnia is so widespread and since patients may overlook the impact of poor sleep quality on daily functioning, the health care practitioner should screen for a history of sleep difficulty. This evaluation should include a sleep history focused on common sleep disorders to identify primary and secondary insomnias. Polysomnography, and the Multiple Sleep Latency Test (MSLT) should not be routinely used to screen or diagnose patients with insomnia complaints. However, the complaint of insomnia does not preclude the appropriate use of these tests for diagnosis of specific sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, and narcolepsy that may be present in patients with insomnia. There is insufficient evidence to suggest whether portable sleep studies, actigraphy, or other alternative assessment measures including static charge beds are effective in the evaluation of insomnia complaints. Instruments such as sleep logs, self-administered questionnaires, symptom checklist, or psychological screening tests may be of benefit to discriminate insomnia patients from normals, but these instruments have not been shown to differentiate subtypes of insomnia complaints.

Chesson AL, Anderson WM, Littner M, Davila D, Hartse K, Johnson S, Wise M, Rafecas J. · Neurology Department, Louisiana State University Medical Center, Shreveport, USA. · Sleep. · Pubmed #10617175 No free full text.

Abstract: Insomnia is the most common sleep complaint reported to physicians. Treatment has traditionally involved medication. Behavioral approaches have been available for decades, but lack of physician awareness and training, difficulty in obtaining reimbursements, and questions about efficacy have limited their use. These practice parameters review the current evidence with regards to a variety of nonpharmacologic treatments for insomnia. Using a companion paper which provides a background review, the available literature was analyzed. The evidence was graded by previously reported criteria of the American Academy of Sleep Medicine with references to American Psychological Association criteria. Treatments considered include: stimulus control, progressive muscle relaxation, paradoxical intention, biofeedback, sleep restriction, multicomponent cognitive behavioral therapy, sleep hygiene education, imagery training, and cognitive therapy. Improved experimental design has significantly advanced the process of evaluation of nonpharmacologic treatments for insomnia using guidelines outlined by the American Psychological Association (APA). Recommendations for individual therapies using the American Academy of Sleep Medicine recommendation levels for each are: Stimulus Control (Standard); Progressive Muscle Relaxation, Paradoxical Intention, and Biofeedback (Guidelines); Sleep Restriction, and Multicomponent Cognitive Behavioral Therapy (Options); Sleep Hygiene Education, Imagery Training, and Cognitive Therapy had insufficient evidence to be recommended as a single therapy. Optimal duration of therapy, who should perform the treatments, long term outcomes and safety concerns, and the effect of treatment on quality of life are questions in need of future research.

Kripke DF. · No affiliation provided · Sleep Med. · Pubmed #19269891 No free full text.

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Lipman AG. · No affiliation provided · J Pain Palliat Care Pharmacother. · Pubmed #19042848 No free full text.

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Lundberg U. · No affiliation provided · Int J Behav Med. · Pubmed #19005924 No free full text.

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Kéri S. · No affiliation provided · Neuropsychopharmacol Hung. · Pubmed #18956614 No free full text.

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Friedman GD. · No affiliation provided · J Sleep Res. · Pubmed #18844817 No free full text.

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Wilson S, Nutt D. · No affiliation provided · J Psychopharmacol. · Pubmed #18753272 No free full text.

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Vitiello MV. · No affiliation provided · J Am Geriatr Soc. · Pubmed #18691284 No free full text.

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Rosekind MR. · No affiliation provided · Sleep Med Rev. · Pubmed #18603217 No free full text.

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Saleh P, Shapiro CM. · No affiliation provided · J Psychosom Res. · Pubmed #18582605 No free full text.

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Ware JC. · No affiliation provided · Sleep Med. · Pubmed #18495535 No free full text.

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Roth T. · No affiliation provided · Sleep Med. · Pubmed #18346676 No free full text.

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Perils ML, Smith MT. · No affiliation provided · J Clin Sleep Med. · Pubmed #18350955 links to  free full text

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McKinstry B, Wilson P, Espie C. · No affiliation provided · Br J Gen Pract. · Pubmed #18307848 links to  free full text

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Roth T. · No affiliation provided · Sleep Med. · Pubmed #18032105 No free full text.

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Vitiello MV. · No affiliation provided · J Am Geriatr Soc. · Pubmed #17979904 No free full text.

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Culebras A. · Upstate Medical University, State University of New York, Syracuse, NY, USA. · Rev Neurol Dis. · Pubmed #17943066 No free full text.

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Ohayon MM. · No affiliation provided · J Psychiatr Res. · Pubmed #17709046 No free full text.

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Dolan-Sewell RT, Riley WT, Hunt CE. · No affiliation provided · J Clin Sleep Med. · Pubmed #17564396 No free full text.

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