Transcript Insomnia & Treatment Modalities

Insomnia
A Presentation By:
Jennifer Glover
Cathleen Gallagher
Margaret Gaines
Paul Garrett
Matthew Gayford
What Causes Us To Be Sleepy?
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If the average amount of sleep is not met, a sleep
debt is created.
All lost sleep accumulates progressively as a larger
and larger sleep indebtedness.
The size of your sleep debt is zero, sleep is
impossible.
If your sleep debt is very low, only a small amount of
stimulation is required to keep you awake.
If your sleep debt is very large, no amount of
stimulation can keep you awake (Dement, 2).
What is Insomnia?
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The perception of inadequate or poor-quality sleep
accompanied by significant distress or impaired
function.
Chronic if it occurs on most nights and lasts a month
or more (National Institute of Health).
You might suffer from insomnia if:
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It takes you more than 30 to 45 minutes to get to sleep
You wake up during the night
If you wake up early and cannot get back to sleep
You wake up feeling un-refreshed in the morning
You can only get to sleep with the aid of sleeping aids or
alcohol (Alpha Sleep, 1999)
What Causes Insomnia?
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Most reasons for insomnia are subtly woven into the
fabric of your life (Dryer, 17)
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Changes in sleep patterns because of different work hours or
travel.
Depression, anxiety, worries, or stress
Use of caffeine or other stimulants
Use of alcohol or other sedatives which are depressants of
the central nervous system but can alter normal sleep
patterns, especially if used long-term
Sleeping or napping during the day (Alpha Sleep, 1999)
Death of a loved one, job loss or failing in school (Kirkwood
Community College, 1).
Types of Insomnia
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There are five types of insomnia, including:
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Initial Insomnia, where an individual finds
difficulty in falling asleep
Mental Insomnia, where an individual wakes up
frequently from sleep
Terminal Insomnia, characterized by waking up
early and not being able to get back to sleep
Hypersomnia, where one has trouble staying
awake during the regular day
Parasomnia, shown through abnormal behaviors
occurring during sleep (Morin, 3)
Treatment Modalities
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Treatment of insomnia includes alleviating
any physical and emotional problems that are
contributing to the condition and exploring
changes in lifestyle that will improve the
situation (Barstow, 3).
There are a myriad of treatments available for
insomniacs, which fall into three major
categories
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Drug Therapy
Cognitive-Behavioral Therapy
Alternative Treatments
Treatments: Drug Therapy
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Sedative-Hypnotic Medications (aka Sleep-Meds)
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Benzodiazepines can be used on an “as-needed” basis
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These reduce the length of time to fall asleep
Medications include Dalmane, Doral, Halcion, Prosom, and
Restoril
These were formerly the most used treatments. Issues with
abuse, dependence, memory impairment, and a next-day
hangover have lead to cautions with prescription.
Non-benzodiazepines, such as benzodiazepine receptor
agonists
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Zoldipem, which is associated more with the effects that persist
later into the night
Zaleplon, which may be taken at bedtime or later, as long as
there are four hours of more time left to sleep (American
Insomnia Association.org)
Treatments: Prescription Drug
Therapy
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Sedative-Hypnotic Medications (Continued)
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Eszopiclone is a new drug that recently completed
testing at Duke University.
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It has displayed “improvement in the patients’ ability to
fall asleep, stay asleep, in the quality of their sleep,
without evidence of loss of effect over time.”
“The data further demonstrates that improvements in
sleep were associated with consistent improvements in
the patients’ ratings of their capacity to function well
during the day,” (Koepke, 1).
Treatments: Prescription Drug
Therapy
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Sedating Antidepressants are prescription
medications that have been developed for the
treatment of depression, but are known to have
sedative side effects.
The most common of these are
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Desyrel
Elavil
Sinequan
A major concern is the association with more
troubling, adverse effects than prescription sedativehypnotic medications
(AmericanInsomniaAssociation.org, 4).
Treatments: Over-the-Counter
Drugs
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Over-the-counter medications can be
purchased from a pharmacy without a
prescription.
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These include medications such as Nytol,
Sleep-Eze, Sominex, and Benadryl.
Undesirable side effects include vivid
dreams and next day “hang-over” effects
(AmericanInsomniaAssociation.org, 3).
Treatment: CognitiveBehavioral Therapies
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This component is aimed at achieving two goals:
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To strengthen the association between sleep behaviors and
such stimuli as the bed, bedtime, and the bedroom
surroundings (Sammons, 120).
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To consolidate sleep over shorter periods of time spent in
bed.
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This is designed to eliminate both overt and covert sleep—
incompatible activities.
This curtails the amount of time spent in bed. (Morin, 110)
Behavioral therapy can be an alternative to
medication for the treatment of persistent primary
insomnia, a sleep disorder that affects up to 5
percent of Americans (Koepke, 1).
Treatment: Alternative
Therapies
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Medicinal Herbs
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Valerian extracts cause both CNS depression and muscle
relaxation.
Ginseng has an inhibitory effect on the CNS and may
modulate neurotransmission.
Kava Kava possibly acts on GABA and benzodiazepine
binding sites in the brain.
Passion flower is associated with significantly prolonged
sleeping time in rats, and may be applicable to humans.
Hops, when infused in tea, are reported to have a calming
effect within 20-40 minutes of ingestion (Attele, 1-6).
Treatment: Alternative
Therapies
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Physiological Agents
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Melatonin increases sleep quality when compared with
baseline and placebo in night-shift workers
Tryptophans reduce sleep latency by increasing subjective
“sleepiness” and also decreasing waking time.
Other Approaches
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Acupuncture therapy can affect the regulation of sleep-wake
cycles and possibly reharmonize a disturbed sleep-wake
cycle.
Low energy emission therapy, in healthy volunteers, 15
minutes of LEET treatment induced EEG changes, and was
associated with objective and subjective feelings of
relaxation (Attele, 7).
Insomnia & College Students
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College students who have difficulty falling asleep are the
largest group of the growing community with sleep disorders
– 77 percent – according to a national study.
College students often face insomnia because of the varying
sleep schedules between weeknights and weekend nights.
Sunday is “insomnia night” and Mondays can be problematic
while the body is trying to readjust to the weekday sleep
schedule, he said. Wednesday is the most efficient day of the
week for sleeping (Hanek, 1).
Drinking coffee to improve alertness, taking naps to make up
for last sleep, and drinking alcohol to promote sleepiness are
common strategies students use to counter their varying
sleep schedules. These are poor sleep-hygiene practices
(Brown, 3).
Insomnia & College Students
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Solutions
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If you can’t sleep within 20 minutes, get up
and do something else.
Learn to work on difficult tasks when you
feel most productive and awake.
Allocate schedule to do things you enjoy.
Employ relaxation techniques.
Use down-time before bed (Maynard, 1).
Conclusion
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Insomnia is a growing problem with America,
especially across college students.
Insomnia can be problematic if not dealt with.
Although many treatments are available, few
people seek treatment.
Proper sleep hygiene is integral to daily life.
Bibliography
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Barstow, David. “Insomnia”. Main Search Index. Online. Internet
Explorer. 12 Nov. 2003. Available:
http://www.ehendrick.org/healthy/000764.htm
Dryer, Bernard, M.D., Ellen S. Kaplan. Inside Insomnia. Villard
Books. New York. 1986.
“Insomnia”. Alpha Sleep Diagnostic Centers. Online. Internet
Explorer. 26 Oct. 2003.
“Many College Students Suffer from Insomnia” The Daily Illini
Online. Online. Internet Explorer. 26 Oct. 2003. Available:
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http://dailyillini.com/apr01/apr10/news/stories/news07.shtml
“Treatment Options: Medication and Behavior Treatments”
Americans Insomnia Association. Online. Internet Explorer. 12
Nov. 2003. Available:
http://www.americansomniaassociation.org/treatment.htm
Bibliography
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“Insomnia rate highest amoung college students”. The Daily Illini
Online. Online. Internet Explorer. 12 Nov. 2003. Available:
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http://dailyillini.com/jan03/jan29/news/printer/campus01-printer.shtml
Sammons, Morgan T. and Norman B. Schmidt. Combined Treatments
for Mental Disorders. Washington DC: American Psychological
Association, 2001.
AmericanInsomniaAssociation.org.2002 11/12/2003.
http://www.americaninsomniaassociation.org/causes.htm
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Brown, Franklin C., Walter C. Buboltz Jr., and Barlow Soper.
“Relationships of Sleep Hygiene Awareness, Sleep Hyiene Practices,
and Sleep Quality in University Students.”Behavioral Medicine. 28.1
(2002):33. Academic Search Elite. EBSCOHost.11/01/03
“Sleepless at Stanford”. Stanford University of Excellence. Online .
Internet Explorer. Sept.1997.
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http://www.stanford.edu/~dement/sleepless.html
Bibliography
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“Insomnia: Are you lacking a good night’s sleep?” Kinkwood
Community College. Online. Internet Explorer.
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http://www.sleeping-tips.com/lacking-sleep-research-college.htm
Horin, Charles M. Insomnia: Psychological Assessment and
Management.New York. New York, The Guilford Press, 1993.
www.americansinsomniaassociation.org.”Medications,”2002.
11/12/03.
Attele, Anoja S.,DDS, Jing-Tian XIE, MD, and Chun-Su Yuan, MD,
PhD, “Treatment of Insomnia:An Alternative Approach.”
www.throne.com.11/12/03
Koepke, Tracey. “Behavioral Therapy Effective in Treatment of
Insomnia,” 4/11/2001. www.dukemednews.duke.edu 11/12/03
Koepke, Tracey. “New Drug Proves Helpful for Treating Long- Term
Insomnia,” 10/20/2003. www.dukemednews.duke.edu. 11/12/03