Insomnia is one of the most common sleep disorders, which is leading to significant clinical distress and impairment of daytime functioning and decreasing quality of life. This article reviews the current clinical treatment options of insomnia. Non-pharmacological treatment including stimulus control, sleep restriction, cognitive therapy, relaxation training, and education of sleep hygiene should be considered first for treatment of insomnia. Psychological and behavioral interventions tend to have longer-lasting treatment benefits, while drugs show immediate improvement of sleep disturbance. In pharmacotherapy, benzodiazepine receptor agonist, melatonin receptor antagonist, and 'off-label' drugs to treat insomnia are reviewed.
Behavior Therapy ; Cognitive Therapy ; Drug Therapy ; Quality of Life ; Relaxation ; Sleep Initiation and Maintenance Disorders* ; Sleep Wake Disorders

The Cognitive-Behavioral Therapy for Insomnia (CBT-I) is an important and effective treatment for insomnia patients. However, it is not easy for most general practitioners to learn and practice CBT-I, and it is popular to prescribe sleeping pills to insomnia patients in clinical practice. In the case, we need to consider the factors which can influence the effect of sleeping pills to prescribe sleeping pills appropriately and safely with the lowest dosage. Age, gender, medical or psychiatric comorbid disease, workplace, or sleep environment may affect the patients' satisfaction with their sleeping pills. Physician should know about the mechanism of action of each sleeping pill and which type of sleeping pills needs to be prescribed to patients in each situation. Physician also needs to ask patients what time they took their sleeping pills and check whether patients followed physician's sleeping pills administration instruction or not. In this review, we want to discuss about optimizing the sleeping pills prescription to insomnia patients.
Drug Therapy ; General Practitioners ; Humans ; Hypnotics and Sedatives ; Prescriptions ; Sleep Initiation and Maintenance Disorders*

PURPOSE: This study is to determine the effects of Colorectal Neoplasms patients' stage, location of disease, functional status (physiological factor), mood (psychological factor), and social support (situational factor) on their symptom experience, and to verify the relationship between symptom experience and the quality of life. METHODS: The Theory of Unpleasant Symptoms was the framework for the study. A descriptive correlational design was used in analysis of data obtained from a sample of 113 Colorectal Neoplasms patients who were undergoing chemotherapy. RESULTS: Total mood disturbance and symptom experiences were negatively correlated with physical component score (PCS) and mental component score (MCS) of quality of life (r −.33 to r=−.51, p<.001; r=.40 to r=.50, p<.001). Multiple regression analysis revealed that the functional status and symptoms interference variables explained 29.2% of the variance in PCS of quality of life. Symptoms interference and age explained 30.6% of the variance in MCS of quality of life. CONCLUSION: Although overall depression levels were low in this sample, these findings suggest that insomnia and fatigue are related to depression and that depression is more closely associated with quality of life than are insomnia and fatigue.
Colorectal Neoplasms* ; Depression ; Drug Therapy ; Fatigue ; Humans ; Quality of Life* ; Sleep Initiation and Maintenance Disorders

BACKGROUND: To evaluate the efficacy of modified ventriculolumbar perfusion (VLP) chemotherapy with methotrexate on leptomeningeal carcinomatosis in terms of symptomatic response and side effects. METHODS: Previous infusion rate of 20 mL/h was reduced to 15 mL/h for the purpose of decreasing constitutional side effects of VLP such as nausea/vomiting, insomnia and confusion. The primary outcome was the response rate of increased intracranial pressure (ICP), and the secondary outcome was the occurrence of side effects compared to previous 20 mL/h trial. This interim analysis to validate the reduced infusion rate is not to affect the original effect of VLP chemotherapy. RESULTS: All forty-seven patients were enrolled including 22 patients with increased ICP. Thirteen patients out of these (59%) got normalized ICP after VLP chemotherapy. Moderate to severe (grade 2–3) confusion was observed in 3 patients (6%) and it was significantly reduced compared to those (23%) in the VLP 20 mL/h (p=0.017). Grade 2–3 nausea/vomiting was also reduced from 64% to 45% but failed to reach statistical significance (p=0.08). Median overall survival (OS) was 5.3 months (95% confidence interval, 3.55–7.05) and patients OS, who received maintenance VLP was significantly prolonged compared to patients who underwent induction VLP only (5.8 vs. 3.4 months, p=0.025). CONCLUSION: VLP of reduced perfusion rate (15 mL/h) showed compatible control rate of increased ICP at this interim analysis. Decreased moderate to severe side effects and prolonged OS in patients received maintenance VLP encourage us to evaluate the effectiveness of this trial further.
Drug Therapy ; Humans ; Infusions, Intraventricular ; Intracranial Pressure ; Meningeal Carcinomatosis ; Methotrexate ; Perfusion ; Sleep Initiation and Maintenance Disorders

In old people, the sleep pattern, prevalence of sleep disorders, and both pharmacokinetics and pharmacodynamics of drugs in the body are changed. The sleep disorders in elderly are regarded not as the result of changes in physiological sleep need but as the impairment in ability to maintain sleep. These impairments are thought to be the results of the changes in circadian rhythm, medical problems, drug use, common sleep disorders in the elderly, and the environmental factors which influence on sleep-wake cycle. Insomnia is not a simple homogenous disease entity, so exact diagnosis is essential for appropriate treatment. Especially, to treat sleep disorders in Elderly, it is necessary to make a careful diagnosis and prescription based on strict criteriae. Hypnotic medication takes simply a part among several treatment modalities of insomnia. For example, to certain patients, the behavioral modification and light therapy, rather than hypnotics, are effective. This paper reviews the characteristics of sleep pattern, common sleep disorders, indication of medication, and treatment guidelines of hypnotics in elderly.
Aged* ; Circadian Rhythm ; Diagnosis ; Drug Therapy ; Humans ; Hypnotics and Sedatives ; Pharmacokinetics ; Phototherapy ; Prescriptions ; Prevalence ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders

The consultation of personnel in relation to sleep disorders in Korea increased by 1.6 times between 2008 and 2012, and the related days of clinical practice increased by nearly 12 times during the same period. Among the sleep disorders, the most common diagnosis is insomnia, which is most commonly treated with medication. Medication is not only easy to access, but also effective immediately. However, the beneficial effect of hypnotic medication on sleep disorder for an extended period of time may be trivial. Tolerance is another barrier to treating chronic insomnia. In addition, such adverse effects as psychomotor slowing, memory loss, forgetfulness, and decreased sense of balance can heighten the risk of motor vehicle accidents and falling-related injuries. Recently, there have been reports about the association between the chronic use of sleeping pills and cancer mortality and dementia incidence. However, there are still many limitations to understanding whether it is the chronic use of hypnotics, or coexisting mental and physical illness, which increases the risk. Nevertheless, it is worthwhile to pay special attention to the abovementioned risks when using hypnotics and to consider alternative treatment options like cognitive behavioral therapy for insomnia.
Cognitive Therapy ; Dementia ; Diagnosis ; Drug Therapy* ; Hypnotics and Sedatives ; Incidence ; Korea ; Memory Disorders ; Mortality ; Motor Vehicles ; Sleep Initiation and Maintenance Disorders* ; Sleep Wake Disorders

Acupuncture Points ; Acupuncture Therapy ; Estazolam ; Humans ; Sleep Initiation and Maintenance Disorders/drug therapy* ; Treatment Outcome ; gamma-Aminobutyric Acid

OBJECTIVE: This study determined whether cognitive behavioral therapy for insomnia (CBT-i) decreased the need for sleep medications and produced better treatment outcomes than pharmacotherapy alone. METHODS: We reviewed data from patients with insomnia in the outpatient clinic of a general hospital between 2009 and 2015. We compared 41 patients who received five sessions of CBT-i with 100 age- and sex-matched patients who received pharmacotherapy only. We evaluated the change in prescription for sleep (i.e., antidepressants, hypnotics, and others) between the first and last visits using repeated measures analysis of variance (ANOVA). Clinical global impressions and completion status at the last visit were assessed using the chisquare test. RESULTS: We found a significant decrease in the prescription rate and the dosage of hypnotics among patients who received CBT-i when compared with control patients. There was no significant change in the dosage of antidepressants between the two groups. Achievement of case closure was better in the CBT-i group at the trend level. Clinical global impression at the last visit was not significantly different. CONCLUSION: These results show that CBT-i reduces the need for hypnotics among insomnia patients. Our results indicate that CBT-i offers additional benefits beyond improving sleep characteristics and thus provides another reason for recommending CBT-i as a first-line treatment for insomnia.
Ambulatory Care Facilities ; Antidepressive Agents ; Cognitive Therapy* ; Drug Therapy ; Hospitals, General ; Humans ; Hypnotics and Sedatives ; Prescriptions* ; Sleep Initiation and Maintenance Disorders*

PURPOSE: The combination of dexamethasone and granisetron provides effective prophylaxis in patients treated with high-dose cisplatin. We performed this study to evaluate the antiemetic effect of granisetron plus dexamethasone for the patients refractory to metoclo- pramide, dexamethasone, lorazepam (MDL) regimen. MATERIALS AND METHODS: From 1996 to 1998, we administered the MDL regimen in patients who received high-dose cisplatin (more than 60 mg/m/day) for the first time. The granisetron plus dexamethasone were administered in the subsequent cycle for the patients refractory to the MDL regimen during the first or the second cycle of chemotherapy. Efficacies of treatment were assessed daily from days 1 to 5. Complete response was defined as the absence of vomiting episodes and major response as 1 or 2 episodes per day. Complete or major responses were considered effective. RESULTS: Twenty patients received granisetron plus dexamethasone therapy. During the first 24 hours, complete and major responses were achieved in 75% and 15% respectively, thus it was effective in 90% of patients. For delayed vomiting (occurring during days 2 through 5), complete and major responses were achieved in 30% and 50% respectively, thus it was effective in 80%. Side effects included hiccups, headache, diarrhea, sedation, dizziness and insomnia, but discontinuation or dose adjustment was not needed. CONCLUSION: The granisetron plus dexamethasone regimen was an effective antiemetic regimen for the patients refractory to the MDL regimen.
Antiemetics* ; Cisplatin ; Dexamethasone* ; Diarrhea ; Dizziness ; Drug Therapy ; Granisetron* ; Headache ; Hiccup ; Humans ; Lorazepam* ; Metoclopramide* ; Sleep Initiation and Maintenance Disorders ; Vomiting

Huanglian Ejiao Decoction,firstly recorded in Treatise on Febrile Diseases,could be used to treat heat-conversion syndrome of Shaoyin. It has been identified that,the indications of Huanglian Ejiao Decoction include:(1)in modern medicine,it can be used to treat insomnia,arrhythmia,oral ulcer,Xiali,blood syndrome and other diseases;(2)in terms of symptoms and signs,it is mainly used for restlessness,ritability,insomnia,extremely difficult to fall asleep,palpitation,atrial premature beat,ventricular premature beat and other arrhythmias,stomach distension and stuffiness,stomach pain,vomiting,abdominal pain,cramps,lower edge,constipation,blush,red lips,easy bleeding,red tongue,thin or no coating,dry tongue surface,or light red tongue,or dark red,thin white tongue coating,and rapid pulse. It has been also identified that,(1)although the original statement of Huanglian Ejiao Decoction is very simple,it can not only be used according to irritability and insomnia;(2)tongue image is not the key to syndrome differentiation of this prescription;(3)the essence of Shaoyin syndrome is not completely heart kidney Yang deficiency,which is closest to shock in modern medicine,including septic shock,hypovolemic shock and cardiogenic shock;(4)the essential difference between Shaoyin cold and heat conversion syndrome of Shaoyin lies in the different types of shock,in which cardiogenic shock is the main cold type,while septic shock is the main heat shock;(5)heat-conversion syndrome of Shaoyin is more common in the late stage of septic shock,and part of it can be seen in the stage of heart failure combined with sympathetic activation;(6)Dioscoreae Rhizoma and Rehmanniae Radix are often used to replace egg yolk;(7)Huanglian Ejiao Decoction takes effect quickly and the course of treatment is short.
Drugs, Chinese Herbal/therapeutic use* ; Gelatin ; Humans ; Medicine, Chinese Traditional ; Sleep Initiation and Maintenance Disorders/drug therapy* ; Yang Deficiency