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New Approaches in Managing Chronic Insomnia

Published online by Cambridge University Press:  07 November 2014

David N. Neubauer
David N. Neubauer*
Affiliation:
David N. Neubauer, MD, is assistant professor in the Department of Psychiatry at, Johns Hopkins University School of Medicineand medical director of the Psychiatry Mobile Treatment Services at Johns Hopkins Bayview Medical Center in Baltimore, Maryland. He is also associate director of the Johns Hopkins Sleep Disorders Center.
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Abstract

Despite a high prevalence in the United States, insomnia remains underdiagnosed and undertreated. Extensive research has identified several factors that contribute to the inadequate treatment of insomnia, including the failure of patients to report insomnia to physicians, limited physician training, and physician misconceptions about the risks associated with hypnotic medications. To achieve optimal patient outcomes, physicians differentiate acute from chronic insomnia and distinguish primary insomnia from sleep disorders that occur with comorbid conditions, most notably psychiatric illnesses such as circadian rhythm disturbances. In addition, they utilize sleep hygiene measures, behavioral therapy, and/or pharmacologic medications to improve sleep problems in patients with insomnia. Newer nonbenzodiazepine receptor agonists are effective with fewer side effects than older benzodiazepine agonists; however, in 2005 a National Institutes of Health panel on chronic insomnia management indicated that clinical trials are needed to establish the long-term benefits of the newer drugs. Since 2005, data from clinical trials lasting 6 months to 1 year have been published for hypnotics including eszopiclone, zaleplon, and zolpidem extended-release. As the result of potentially altered dosing and monitoring, elderly patients require special consideration.

Type
Research Article
Information
CNS Spectrums , Volume 11 , Issue S8 , 2006 , pp. 1 - 16
Copyright
Copyright © Cambridge University Press 2006

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