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Volume : 29 Issue : 3 Year : 2023
Turkish Journal of Neurology Indexed By
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Clinical Update on Epidemiology, Pathogenesis, and Nonpharmacological Treatment of Insomnia [Turk J Neurol]
Turk J Neurol. 2006; 12(2): 87-97
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Clinical Update on Epidemiology, Pathogenesis, and Nonpharmacological Treatment of InsomniaMustafa KahrimanDepartment Of Neurology, University Hospitals Of Cleveland, And Louis Stokes Va Medical Center, Cleveland, Ohio, Usa
Scientific background: Insomnia is by far the most common form of sleep disturbance. Most typically, insomnia has been defined as the symptom of difficulty initiating or maintaining sleep and more rarely as an inability to obtain restorative sleep. Insomnia disorders are most often classified as either primary or secondary to other sleep, psychiatric, or medical conditions, although it is often difficult in practice to determine true causality of insomnia or there may be more than one cause (comorbid conditions). Increasing age, female sex, and psychiatric and medical disorders are consistent risk factors for insomnia. Insomnia is associated with significant social, medical, and financial consequences including impaired social functioning and quality of life, increased risk for psychiatric disorders, and increased health care costs. The clinical assessment of insomnia is based on a careful clinical interview, often supplemented by sleep questionnaires, sleep logs, and psychological testing. Polysomnography is indicated only in selected cases when specific sleep pathologies are suspected. Assessment: A large proportion of insomnia sufferers go undiagnosed, and therefore untreated, by their doctors, and many of these patients incur considerable personal, vocational, and health-related consequences as a result. Insomnia can be triggered by a variety of precipitating events, but when it becomes a chronic problem, psychological and behavioral factors are almost always involved in perpetuating or exacerbating sleep disturbances over time. Psychological and behavioral therapies for primary insomnia include sleep restriction, stimulus control therapy, relaxation training, cognitive strategies, and a combination of those methods, referred to as cognitive behavior therapy of insomnia. Results of the controlled clinical trials indicate that 70% to 80% of patients with primary insomnia partially benefit from cognitive behavior therapy. Although only 20% to 30% of patients become completely symptom free and can be called as "good sleepers". The clinical studies showed that sleep improvements are well maintained up to 2 years after treatment completion. C o n c l u s i o n: Despite evidence showing psychological and behavioral approaches to be efficacious in the treatment of insomnia, in today’s clinical practice, such therapies are not readily available and are not widely used by doctors.
Mustafa Kahriman. Clinical Update on Epidemiology, Pathogenesis, and Nonpharmacological Treatment of Insomnia. Turk J Neurol. 2006; 12(2): 87-97
Corresponding Author: Mustafa Kahriman, United States |
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