8-10 There is often overlap among these 4 pathways. Initially, insomnia patients navigate through 4 common pathways: no discernible treatment, over-the-counter sleep aids, 5, 6 substances or alcohol at bedtime, 6, 7 and basic sleep hygiene instructions obtained through various media or from primary care providers and educators. Prim Care Companion J Clin Psychiatry 2010 12(4):e1-e10Ĭhronic insomnia is a common complaint in the general population as well as in various subpopulations such as the elderly, 1 psychiatric patients, 2, 3 and shift workers 4 however, longitudinal data are lacking on their long-term treatment course. These findings support FDA and AASM guidelines to reassess chronic insomnia patients who manifest residual symptoms despite nightly use of prescription medication for sleep. Both groups exhibited high rates of objectively diagnosed obstructive sleep apnea, a medical condition associated with pervasive sleep fragmentation. 22).Ĭonclusions: In this treatment-seeking sample of patients regularly taking sleep medications, residual insomnia was widespread, and patients with psychiatric insomnia may have perceived their condition as more problematic than a control group of insomnia patients without mental health complaints. The mean Apnea-Hypopnea Index score was 19.5 events/hour, yielding an obstructive sleep apnea diagnosis in 75% of patients per conservative AASM nosology (79% in the insomnia group and 74% in the psychiatric insomnia group, P =. Subjective perception of insomnia severity was worse in the psychiatric insomnia group, which also reported significantly more insomnia-related interference in daily functioning, symptoms of sleep maintenance insomnia, and a trend toward greater daytime fatigue. Only a few differences were noted between groups. As evaluated by self-report and polysomnography, these patients exhibited moderately severe insomnia across most measures. Although 100% of the sample used nightly sleep drugs, only 20% believed medication was the best solution for their condition. Results: The average patient reported insomnia for a decade and took prescription medication for sleep for a mean of 4.5 years. To assess the role of psychiatric influences on insomnia symptoms, our sample (N = 218) was divided into 2 subgroups: a group with a history of psychiatric complaints (psychiatric insomnia, n = 189) and a control group of no psychiatric complaints (insomnia, n = 29).
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Method: A retrospective chart review examined a consecutive series of chronic insomnia patients with persistent insomnia complaints despite current nightly use of prescription medication from May 2005 to February 2008. The US Food and Drug Administration (FDA) and the American Academy of Sleep Medicine (AASM) recommend reevaluation of this type of patient to assess for potential psychiatric or medical causes to explain this “failure for insomnia to remit.” Romero, BSīackground: Some chronic insomnia patients who take nightly prescription medication achieve less than optimal results. Patients With Treatment-Resistant Insomnia Taking Nightly Prescription Medications for Sleep: A Retrospective Assessment of Diagnostic and Treatment Variablesīarry Krakow, MD Victor A.
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