![]() ![]() Temporary significant restriction of the amount of time spent in bed during the night to the average amount of sleep with subsequent adjustment of the amount of time spent in bed in the weekly rhythm. progressive muscle relaxation guided visualization) Methods of physical and mental relaxation (e.g. Information about “sleep hygiene rules“ and basic information about sleep and sleep disorders Medications can be used for short-term support in this case, they are similar to those used to treat symptomatic insomnia ( table 3). By contrast, sleeping pills are not recommended as the primary treatment option for insomnia ( 6, 7). Studies have been conducted to determine how many patients actually receive treatment according to expert estimates, it is only a minority of those affected ( 5, 7). The guidelines recommend psychotherapy specifically designed for sleep problems, so-called cognitive behavioral therapy for insomnia (CBT-I, core modules in Table 2), for which, on average, large effect sizes have been found ( 5– 6 e11), as demonstrated in meta-analyses with large effect sizes (improvement of the measured values by 0.5 to 1 standard deviation) and level Ia evidence ( e12). Insomnia is associated with a significant increase in consumption of health services, along with higher levels of absence from work and reduced work performance ( 4)Įpidemiological studies have found that sleep disorders are increasing in prevalence ( e11). Hence, sleep disorders and health are closely related in a bidirectional fashion. It is likely that insomnia is also a risk factor for dementia ( e8), anxiety disorders ( e9), and alcohol dependence ( e10). In addition, longitudinal studies have shown that insomnia is a risk factor for cardiovascular disease (risk ratio : 1.3–1.5), diabetes (RR: 1.5–1.8), depression (odds ratio : 2.1), and suicidality (RR: 1.9–3.0) ( e4– e7). Insomnia results in reduced quality of life ( e2) and limitations in performance ( e3). Women are one and a half times as likely to be affected as men and the condition is more prevalent among older people. Nonorganic insomnia takes a chronic course, with more than 70% of persons with insomnia still meeting the diagnostic criteria after one year ( e1). For sleep disorders with the other two main manifestations, specific drug therapy has been found to be beneficial.ĭisorders of initiating and maintaining sleep, which have a negative impact on performance or daytime wellbeing and which cannot be explained by other underlying medical issues, are referred to as nonorganic insomnia, a common condition, affecting 6% of the population in Western industrialized countries ( 3). ![]() Studies have shown marked improvement of sleep latency and sleep duration from short-term treatment with benzodiazepines and Z-drugs (non-benzodiazepine agonists such as zolpidem and zopiclone), but not without a risk of tolerance and dependence. These patients, like those suffering from secondary sleep disorders, can also benefit from drug treatment for a limited time. For patients suffering from insomnia as a primary sleep disorder, rather than a symptom of another disease, meta-analyses have shown the efficacy of cognitive behavioral therapy, with high average effect sizes. Some of these disorders can be treated by primary care physicians, while others call for referral to a neurologist or psychiatrist with special experience in sleep medicine. A pragmatic classification of sleep disorders by their three chief complaints-insomnia, daytime somnolence, and sleep-associated motor phenomena-enables tentative diagnoses that are often highly accurate.
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