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14.10.2014

Types of insomnia test, homeopathic remedies for depression - Try Out

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Typically, SSRIs are the first agents used to treat depression in clinical practice due to their safety and low incidence of serious side effects. Insomnia occurs because some antidepressants cause stimulation that can interfere with sleep. Not all patients taking antidepressants experience SSRI discontinuation syndrome, but for those who do the syndrome often presents with flu-like symptoms such as headache, diarrhea, nausea, vomiting, chills, dizziness, fatigue, and insomnia. Patients with a history of panic disorder (Table 3) or anxiety who are being treated with antidepressants should have a gradual escalation in dosage to minimize these side effects, typically seen during the initial days of treatment with antidepressants.
SSRIs may lead to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), characterized by hyponatremia, a potentially fatal condition that is typically asymptomatic until it becomes severe.
Understanding insomnia and how it can most effectively be treated continues to challenge psychiatrists and other clinicians. This column provides information on how and why insomnia develops, as well as on its treatment, focusing primarily on behavioral interventions.
Behavioral treatments for insomnia can be very effective for many patients, but there are substantial challenges to clinicians desiring to use these treatments. Age is a factor in development of insomnia, but not because we need less sleep as we age or even that sleep drive and sleep depth are reduced with age. Personality traits may also play a significant contributory role in the development of insomnia, based on this model.
A wide range of events and stimuli may precipitate an insomnia episode in susceptible individuals.
As a consequence of the development of insomnia, patients may make various changes in their habits and routines to try to compensate for their sleep loss and greater difficulties falling asleep. Understanding how insomnia develops may provide opportunities to treat insomnia at early stages and prevent progression to chronic insomnia. Understanding how insomnia develops is also important when insomnia has become established as a chronic condition. Various behavioral therapies have demonstrated efficacy in the treatment of chronic insomnia.9 Research supports the hypothesis that non-pharmacologic therapies can be very effective in the treatment of insomnia, and an effort should be made to include behavioral therapies in the treatment of every patient with insomnia.
Operationally, sleep restriction involves an initial limitation of time in bed to an amount close to the number of hours that the insomnia patient reports having slept.
Stimulus control therapy (SCT), originally described by Bootzin and colleagues,11 has become so widely utilized in the behavioral treatment of insomnia that many practitioners do not appreciate that it defines a specific and universal approach to the treatment of insomnia. CBT, demonstrated to be effective in the treatment of depression, has also demonstrated efficacy in multiple research studies as a treatment for insomnia.12-14 Typically, CBT attempts to address maladaptive behaviors and thought patterns that plague insomniac patients.
There are two types of free EMR programs: downloadable and installed on the local computer or server versus programs hosted online as a service.
Primary care physicians tend to choose for pharmacological treatment of insomnia,9although Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recognized as an effective alternative,7,10 causing a durable long-term improvement of the patient’s sleep, well beyond the termination of the treatment. Several models have been proposed to understand the development of chronic insomnia.14,15,16 Despite differences between the models, common aspects are a reciprocal interaction between nervous system arousal, cognitive and emotional activation, environmental aspects, dysfunctional cognitions and maladaptive behavior.
As the majority of insomniacs develop an irregular sleep pattern the first concern in CBT-I is to encourage patients to keep regular bedtimes and times of getting up. With that in mind a web-based system Somnio was developed for the evaluation, diagnosis and treatment of insomnia patients.
The sleep pattern in the apnea group without insomnia as comorbidity was different from the sleep pattern in the insomnia group. Insomniacs have different types of complaints and generally one of the complaints is predominant.
In this paper we showed that the prevalence of insomnia and comorbidities measured via internet is comparable to other studies.
The prevalence of insomnia is very high and sleep centers have not been able to offer effective treatment because CBT-I is difficult to offer. Patient information: See related handout on insomnia, written by the authors of this article.
Nausea typically begins within 1 week of starting treatment and often goes away on its own within a few weeks. Insomnia may be acute or chronic, but the majority of patients presenting for evaluation to treating physicians complain of chronic insomnia.


The origins of chronic insomnia are usually much more complex, with contributions from predisposing, precipitating, and perpetuating factors. It also recognizes that chronic insomnia is maintained (unintentionally) by maladaptive coping strategies (perpetuating factors). The presence of concomitant medical illnesses is the largest contributing factor to increased rates of insomnia seen with increased age. Insomnia patients are often anxious, and may develop fixations about the amount and quality of sleep that they obtain and the impact they believe it will have on daytime function.
For example, using the Spielman model,2-4 if physicians and therapists recognize that premorbid traits predisposing to development of insomnia exist, they may be more aggressive in treating stress and instructing patients on avoidance of key stressors capable of provoking insomnia.
Identification of elements that have contributed to the development of insomnia, and educating the patient about the roles that behavior and conditioning have played in this process, should help physicians and patients understand that behavioral therapies combined with pharmacologic interventions are useful treatment options.
Some of the elements from these specific therapies may also be incorporated in a more global approach to the treatment of insomnia using cognitive-behavioral therapy (CBT).
This restriction is based on assumption that most insomnia patients underestimate the amount of sleep that they have obtained. These disturbances develop over long periods of time, become an entrenched part of the insomniac’s thought and behavior patterns, and exacerbate insomnia severity. Assessment tools included Auditory Number Sequencing (repeating a series of numbers in order from lowest to highest), the Face Memory Test (selecting target computer-generated faces from ones intended to distract the patient), and the Tapping Speed Test (patients pressed a key as fast as possible for a given duration).
Harvey and colleagues found that patients with TRD performed significantly poorer than patients without the disorder on all cognitive assessment tools except two measures of the Set-Shifting Test, which gauged learning, executive function, and processing speed. This paper reports on our experience with the internet based method and on the effectiveness of online CBT-I for a subgroup of 62 verified insomnia patients. The overall improvement over the consecutive consults was tested with a repeated measures multivariate test. Interestingly the sleep pattern in the apnea group with comorbid insomnia was more similar to the sleep pattern of the insomnia group (Figure 1). This high prevalence is in agreement with what is found in the literature22,23 and may warrant more emphasis on the assessment of insomnia in apnea diagnosis. The high percentage of comorbidity of insomnia in apnea patients should be of concern to the sleep centers to also focus on insomnia.
Physicians may initiate treatment of insomnia at an initial visit; for patients with a clear acute stressor such as grief, no further evaluation may be indicated.
An approach to the evaluation and treatment of the patient with insomnia is shown in Figure 1. Effects of reboxetine on anxiety, agitation, and insomnia: results of a pooled evaluation of randomized clinical trials.
Most insomnia can be related, at least in part, to comorbid medical and psychiatric conditions, which may play a role in any of these three contributory realms. Thus, a person may be prone to insomnia due to trait characteristics, may experience a trenchant or short-term insomnia as a consequence of precipitating stresses, and may develop a persistent and chronic insomnia as a consequence of pathologic coping strategies and poor sleep hygiene. Thought processes of this sort clearly contribute to the development of insomnia, and are excellent targets for cognitive therapy as part of an overall treatment program. Parental demands, care-giving for a spouse or parent, or arousal related to a bed-partner’s sleep tendencies, schedule, or habits may all contribute to increased risk of developing insomnia.
Examples of disorders that could precipitate insomnia include arthritis flares, angina, prostatism, hyperthyroidism, and irritable bowel syndrome. If stressors are neutralized or insomnia symptoms are quickly and effectively treated, patients may revert to their pre-morbid, non-insomniac state. These disturbances tend to develop no matter how the insomnia originally developed, and include behavioral and cognitive elements that interfere with the patient’s ability to relax and fall asleep. Another common habit exhibited by insomniacs is a tendency to look at clocks when they have trouble sleeping. Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. The progress in the pharmacotherapy of insomnia over the last four decades have improved the hypnotic compounds in terms of a reduction of negative effects on the physiological sleep pattern and a reduction of side effects.


Cognitive behavioral therapy for insomnia (CBT-I) consists of a combination of several techniques addressing the various aspects of the development of chronic insomnia.
The 15 questions covered the major symptoms of insomnia, apnea, narcolepsy and limb movement disorders.
In addition the improvement after the 7th consult was compared to the baseline values of the first week, using the non-parametric Wilcoxon signed rank test. This was tested by classifying the patients in three groups: initiating sleep, maintaining sleep or a combination of both symptoms on the basis of their initial sleep profile. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.
NIH State-of-the-Science Conference statement on manifestations and management of chronic insomnia in adults. Cognitive Behavioral Therapy for Insomnia Enhances Depression Outcome in Patients with Comorbid Major Depressive Disorder and Insomnia. Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Frequency of insomnia report in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, if insomnia is severe or long-lasting, a thorough evaluation to uncover coexisting medical, neurologic, or psychiatric illness is warranted. They typically respond to analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), or to an ice pack on the headache area. If interventions are not made until perpetuating elements have developed, the insomnia condition is more likely to become chronic. Insomniacs will attempt to process the information provided by the clock in the middle of the night; this is always a negative phenomenon. As insomnia is one of the most prevalent psychological health problems affecting between 9% and 19% of the adult population, it also has a socioeconomic impact on society in general.
The rationale of the sleep restriction technique is to increase sleep time by consolidating the fragmented sleep of insomniacs in one solid block and by reducing the time the patient is awake in bed. The advantage of CBT for insomnia over the internet is the fact that that the therapy can be followed at home, so that it is independent of location. This is comparable to the values found in some recent studies on online self-administered insomnia treatment.19,20 These effects were found even though the patient group in this study consisted of patients with various insomnia complaints. Practice Parameters for the psychological and behavioral treatment of insomnia: an update. A more comprehensive evaluation should be pursued with nonresponders or if a comorbid condition is present or suspected.The evaluation of chronic insomnia should involve a detailed history and examination to detect any coexisting medical or psychiatric illness and may include an interview with a partner or caregiver.
Antidepressant-induced insomnia can be dealt with by giving the antidepressant with a sedating medication (eg, a benzodiazepine or trazodone) at bedtime.
These mediations can typically be used with great tolerance and benefit in the majority of depressed patients. The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia. Walsh and Engelhardt1 estimated the direct costs involved in the diagnosis and treatment of insomnia in 1995 in the USA as $14 billion. Indirect costs of insomnia may involve the loss of productivity and the occurrence of accidents.
The AASM practice parameters17 support the efficacy of the techniques for the treatment of insomnia. Exercise improves sleep as effectively as benzodiazepines in some studies and, given its other health benefits, is recommended for patients with insomnia.



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