THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Insomnia: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83153-X 1. Insomnia-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of insomnia.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to insomnia. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to insomnia, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Narcolepsy
·
The Official Patient's Sourcebook on Restless Legs Syndrome
·
The Official Patient's Sourcebook on Sleep Apnea
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON INSOMNIA: GUIDELINES ................. 9
Overview............................................................................................................... 9 What Is Insomnia?.............................................................................................. 12 What Causes Insomnia? ..................................................................................... 12 Who Gets Insomnia? .......................................................................................... 13 How Is Insomnia Diagnosed?............................................................................. 14 How Is Insomnia Treated? ................................................................................. 14 For More Information......................................................................................... 16 More Guideline Sources ..................................................................................... 16 Vocabulary Builder............................................................................................. 21
CHAPTER 2. SEEKING GUIDANCE ....................................................... 23
Overview............................................................................................................. 23 Associations and Insomnia ................................................................................. 23 Finding More Associations................................................................................. 28 Finding Doctors.................................................................................................. 30 Selecting Your Doctor ........................................................................................ 31 Working with Your Doctor ................................................................................ 32 Broader Health-Related Resources ..................................................................... 33 Vocabulary Builder............................................................................................. 34
CHAPTER 3. CLINICAL TRIALS AND INSOMNIA .................................. 35
Overview............................................................................................................. 35 Recent Trials on Insomnia.................................................................................. 38 Benefits and Risks............................................................................................... 41 Keeping Current on Clinical Trials.................................................................... 44 General References.............................................................................................. 45 Vocabulary Builder............................................................................................. 46
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 49 CHAPTER 4. STUDIES ON INSOMNIA ................................................... 51
Overview............................................................................................................. 51 The Combined Health Information Database ..................................................... 51 Federally-Funded Research on Insomnia............................................................ 52 E-Journals: PubMed Central .............................................................................. 67
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The National Library of Medicine: PubMed ...................................................... 68 Vocabulary Builder............................................................................................. 77
CHAPTER 5. PATENTS ON INSOMNIA .................................................. 81
Overview............................................................................................................. 81 Patents on Insomnia ........................................................................................... 82 Patent Applications on Insomnia ....................................................................... 92 Keeping Current ................................................................................................. 94 Vocabulary Builder............................................................................................. 95
CHAPTER 6. BOOKS ON INSOMNIA ..................................................... 97
Overview............................................................................................................. 97 Book Summaries: Federal Agencies .................................................................... 97 Book Summaries: Online Booksellers ................................................................. 98 The National Library of Medicine Book Index ................................................. 102 Chapters on Insomnia....................................................................................... 106 General Home References ................................................................................. 108 Vocabulary Builder........................................................................................... 108
CHAPTER 7. MULTIMEDIA ON INSOMNIA ......................................... 113
Overview........................................................................................................... 113 Bibliography: Multimedia on Insomnia ........................................................... 113 Vocabulary Builder........................................................................................... 115
CHAPTER 8. PERIODICALS AND NEWS ON INSOMNIA ...................... 117
Overview........................................................................................................... 117 News Services & Press Releases ....................................................................... 117 Newsletter Articles ........................................................................................... 125 Academic Periodicals covering Insomnia ......................................................... 126 Vocabulary Builder........................................................................................... 128
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 129
Overview........................................................................................................... 129 NIH Guidelines................................................................................................. 129 NIH Databases.................................................................................................. 131 Other Commercial Databases ........................................................................... 135 The Genome Project and Insomnia................................................................... 136 Specialized References....................................................................................... 140
CHAPTER 10. DISSERTATIONS ON INSOMNIA ................................... 143
Overview........................................................................................................... 143 Dissertations on Insomnia................................................................................ 143 Keeping Current ............................................................................................... 145
PART III. APPENDICES .................................................. 147 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 149
Overview........................................................................................................... 149 Your Medications: The Basics .......................................................................... 150 Learning More about Your Medications .......................................................... 151
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Commercial Databases...................................................................................... 154 Contraindications and Interactions (Hidden Dangers) ................................... 167 A Final Warning .............................................................................................. 168 General References............................................................................................ 168 Vocabulary Builder........................................................................................... 169
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 177
Overview........................................................................................................... 177 What Is CAM? ................................................................................................. 177 What Are the Domains of Alternative Medicine?............................................ 178 Can Alternatives Affect My Treatment? ......................................................... 181 Finding CAM References on Insomnia ............................................................ 182 Additional Web Resources................................................................................ 195 General References............................................................................................ 221
APPENDIX C. RESEARCHING NUTRITION ......................................... 223
Overview........................................................................................................... 223 Food and Nutrition: General Principles........................................................... 224 Finding Studies on Insomnia ........................................................................... 228 Federal Resources on Nutrition........................................................................ 232 Additional Web Resources................................................................................ 232 Vocabulary Builder........................................................................................... 238
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 239
Overview........................................................................................................... 239 Preparation ....................................................................................................... 239 Finding a Local Medical Library ...................................................................... 240 Medical Libraries Open to the Public............................................................... 240
APPENDIX E. NIH CONSENSUS STATEMENT ON THE TREATMENT OF SLEEP DISORDERS OF OLDER PEOPLE ............................................... 247
Overview........................................................................................................... 247 Abstract ............................................................................................................ 248 What Is the Treatment of Sleep Disorders of Older People? ............................ 248 Sleep and Wakefulness of Older People ............................................................ 250 Diagnostic Evaluation ...................................................................................... 252 Treatment of Sleep Disorders ........................................................................... 254 Common Medical Practices .............................................................................. 255 Good Sleep Hygiene and Treatment ................................................................. 257 Future Research ................................................................................................ 259 Conclusions and Recommendations ................................................................. 260
APPENDIX F. MORE ON PROBLEM SLEEPINESS ................................. 263
Overview........................................................................................................... 263 What Causes Problem Sleepiness? ................................................................... 263 Sleep Disorders ................................................................................................. 264 Medical Conditions/Drugs ............................................................................... 265 Problem Sleepiness and Adolescents ................................................................ 266 What Can Help? ............................................................................................... 267
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ONLINE GLOSSARIES.................................................... 271 Online Dictionary Directories.......................................................................... 273
INSOMNIA GLOSSARY ................................................. 274 General Dictionaries and Glossaries ................................................................ 293
INDEX................................................................................... 295
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
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Insomnia
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Insomnia has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to insomnia, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on insomnia. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on insomnia should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching insomnia (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to insomnia. It also gives you sources of information that can help you find a doctor in your local area specializing in treating insomnia. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with insomnia. Part II moves on to advanced research dedicated to insomnia. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on insomnia. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with insomnia or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with insomnia. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with insomnia.
Scope While this sourcebook covers insomnia, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that insomnia is often considered a synonym or a condition closely related to the following: ·
Disorders of Initiating and Maintaining Sleep
·
Sleeplessness
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Insomnia
In addition to synonyms and related conditions, physicians may refer to insomnia using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for insomnia:4 ·
780.50 sleep disturbance, unspecified
·
780.51 insomnia with sleep apnea
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780.52 other insomnia
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to insomnia. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with insomnia will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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the smallest fraction of information dealing with insomnia is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of insomnia, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on insomnia. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of insomnia to you or even given you a pamphlet or brochure describing insomnia. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Seeking Guidance
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CHAPTER 1. THE ESSENTIALS ON INSOMNIA: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on insomnia. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on insomnia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on insomnia. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with insomnia and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Heart, Lung, and Blood Institute (NHLBI); guidelines at http://www.nhlbi.nih.gov/guidelines/index.htm
Among these, the National Heart, Lung, and Blood Institute (NHLBI) is particularly noteworthy. The NHLBI provides leadership for a national program in diseases of the heart, blood vessels, lung, and blood; blood resources; and sleep disorders.6 Since October 1997, the NHLBI has also had administrative responsibility for the NIH Woman’s Health Initiative. The Institute plans, conducts, fosters, and supports an integrated and coordinated program of basic research, clinical investigations and trials, observational studies, and demonstration and education projects. Research is related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The NHLBI plans and directs research in development and evaluation of interventions and devices related to prevention, treatment, and rehabilitation of patients suffering from such diseases and disorders. It also supports research on clinical use of blood and all aspects of the management of blood resources. Research is conducted in the Institute’s own laboratories and by scientific institutions and individuals supported by research grants and contracts. For health professionals and the public, the NHLBI conducts educational activities, including development and dissemination of materials in the above areas, with an emphasis on prevention. Within the NHLBI, the National Center on Sleep Disorders Research (NCSDR) was established in 1993 to combat a serious public health concern.7 6 This paragraph has been adapted from the NHLBI: http://www.nhlbi.nih.gov/about/org/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 7 This paragraph has been adapted from the NCSDR: http://www.nhlbisupport.com/sleep/about/about.htm.
Seeking Guidance 11
About 70 million Americans suffer from sleep problems; among them, nearly 60 percent have a chronic disorder. Each year, sleep disorders, sleep deprivation, and sleepiness add an estimated $15.9 billion to the national healthcare bill. Additional costs to society for related health problems, lost worker productivity, and accidents have not been calculated. Sleep disorders and disturbances of sleep comprise a broad range of problems, including sleep apnea, narcolepsy, insomnia, parasomnia, jet-lag syndrome, and disturbed biological and circadian rhythms. The Center seeks to fulfill its goal of improving the health of Americans by serving four key functions: research, training, technology transfer, and coordination. ·
Research: Sleep disorders span many medical fields, requiring multidisciplinary approaches not only to treatment, but also to basic research. The Center works with neuroscientists, cellular and molecular biologists, geneticists, physiologists, neuropsychiatrists, immunologists, pulmonary specialists, cardiologists, epidemiologists, behavioral scientists, and other experts. Ongoing research is supported by the NIH and other Federal agencies.
·
Training: Training researchers in sleep disorders is rigorous and timeconsuming. The Center seeks to support and promote formal training programs on the doctoral and postdoctoral levels. It also plans to expand existing career development paths and create new training programs for scientists in sleep disorders research.
·
Technology Transfer: The Center seeks to ensure that research results lead to health benefits. It works towards this goal by educating health care professionals about sleep disorders and research findings, encouraging medical schools to add sleep disorders to their curricula, working with leading experts to develop clinical guidelines, and sponsoring continuing medical education programs.
·
Coordination: The Center coordinates the Federal Government’s efforts on sleep disorders and works closely with other public, private, and nonprofit groups. The Center works to share information among these groups and encourage their cooperation, especially in crosscutting areas. It also seeks to improve communication among scientists, policymakers, and health care professionals.
The following patient guideline was recently published by the NHLBI and the NCSDR on insomnia.
12 Insomnia
What Is Insomnia?8 Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following: ·
Difficulty falling asleep
·
Waking up frequently during the night with difficulty returning to sleep
·
Waking up too early in the morning
·
Unrefreshing sleep
Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability. Insomnia can be classified as transient (short term), intermittent (on and off), and chronic (constant). Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more.
What Causes Insomnia? Certain conditions seem to make individuals more likely to experience insomnia. Examples of these conditions include: ·
Advanced age (insomnia occurs more frequently in those over age 60)
·
Female gender
·
A history of depression
If other conditions (such as stress, anxiety, a medical problem, or the use of certain medications) occur along with the above conditions, insomnia is more likely. There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following: Adapted from the National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/public/sleep/insomnia.txt.
8
Seeking Guidance 13
·
Stress
·
Environmental noise
·
Extreme temperatures
·
Change in the surrounding environment
·
Sleep/wake schedule problems such as those due to jet lag
·
Medication side effects
Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress. In addition, the following behaviors have been shown to perpetuate insomnia in some people: ·
Expecting to have difficulty sleeping and worrying about it
·
Ingesting excessive amounts of caffeine
·
Drinking alcohol before bedtime
·
Smoking cigarettes before bedtime
·
Excessive napping in the afternoon or evening
·
Irregular or continually disrupted sleep/wake schedules
These behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place. Stopping these behaviors may eliminate the insomnia altogether.
Who Gets Insomnia? Insomnia is found in males and females of all age groups, although it seems to be more common in females (especially after menopause) and in the elderly. The ability to sleep, rather than the need for sleep, appears to decrease with advancing age.
14 Insomnia
How Is Insomnia Diagnosed? Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient’s bed partner concerning the quantity and quality of the patient’s sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea or narcolepsy.
How Is Insomnia Treated? Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person’s biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia. Treatment for chronic insomnia consists of: ·
First, diagnosing and treating underlying medical or psychological problems.
·
Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
·
Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.
·
Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.
Seeking Guidance 15
Relaxation Therapy There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person’s mind is able to stop “racing,” the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation. Sleep Restriction Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night’s sleep is achieved.
Reconditioning Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person’s body will be conditioned to associate the bed and bedtime with sleep.
National Center on Sleep Disorders Research (NCSDR) The mission of the NCSDR is to support research, training, and education about sleep disorders. The center is located within the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. The NHLBI supports a variety of research and training programs focusing on cardiopulmonary disorders in sleep, designed to fill critical gaps in the understanding of the causes, diagnosis, treatment, and prevention of sleepdisordered breathing.
16 Insomnia
For More Information Talk to your doctor if you are having trouble getting good, refreshing sleep each night. Together, you can identify possible reasons for your sleeping difficulty and then try appropriate measures to correct the problem. For additional information on sleep and sleep disorders, contact the following offices of the National Heart, Lung, and Blood Institute of the National Institutes of Health: National Center on Sleep Disorders Research (NCSDR) Two Rockledge Centre Suite 7024 6701 Rockledge Drive, MSC 7920 Bethesda, MD 20892-7920 (301 ) 435-0199 (301) 480-3451 (FAX) The NCSDR, located within the National Heart, Lung, and Blood Institute, supports research, scientist training, dissemination of health information, and other activities on sleep disorders and related concerns. The NCSDR also coordinates sleep research activities with other Federal agencies and with public and nonprofit organizations. National Heart, Lung, and Blood Institute Information Center P.O. Box 30105 Bethesda, MD 20824-0105 (301) 592-8573 (301) 592-8563 (FAX) The Information Center acquires, analyzes, promotes, maintains, and disseminates programmatic and educational information related to sleep disorders and sleep-disordered breathing. Write for a list of available publications or to order additional copies of this fact sheet.
More Guideline Sources The guideline above on insomnia is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to insomnia. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with insomnia. Due to space limitations these sources are listed in a concise manner. Do not
Seeking Guidance 17
hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on insomnia and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Nature of Sleep and Its Disorders Source: Washington, DC: National Sleep Foundation. 12 p.
18 Insomnia
Contact: Available from National Sleep Foundation. 1367 Connecticut Avenue NW, Suite 200, Washington, DC 20036. (202) 785-2300; FAX (202) 785-2880. PRICE: Free. Summary: This brochure presents general information about the physiology of sleep and describes the onset and characteristics of the following types of sleep disorders: insomnia, sleep apnea, narcolepsy, restless legs syndrome, and parasomnias. The use of sleeping pills and when to seek medical attention for a sleep disorder are briefly discussed. The role of the National Sleep Foundation also is described. ·
The Benefits of Regular Exercise Source: Boston, MA: IRSA, The Association of Quality Clubs, 12p., 1991. Contact: IRSA, The Association of Quality Clubs, 253 Summer Street, Boston, MA 02210. (617) 951-0055. Summary: This brochure provides advice and information on the benefits of regular exercise. It begins with a review of the physical benefits of exercise, including health promotion and the prevention of diseases, such as breast cancer, high blood pressure, osteoporosis, insomnia. These benefits are listed according to categories of individuals, such as those over 40, women, children, and the general public. The mental health benefits of regular exercise are also reviewed.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “insomnia” or synonyms. The following was recently posted: ·
Practice parameters for the evaluation of chronic insomnia. Source: American Academy of Sleep Medicine.; 1999; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1502&sSearch_string=insomnia
Seeking Guidance 19
·
Practice parameters for the nonpharmacologic treatment of chronic insomnia. Source: American Academy of Sleep Medicine.; 1999; 6 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1501&sSearch_string=insomnia
·
Practice parameters for the use of polysomnography in the evaluation of insomnia. Source: American Academy of Sleep Medicine.; 1995 (reviewed 2000); 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0898&sSearch_string=insomnia
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Diseases & Conditions: Internet Resources for Alternative Medicine Summary: Follow these links for information online related to alternative treatment options for this select group of diseases and disorders -HIV/AIDS, asthma, cancer, epilepsy, headache, herpes, and insomnia. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3983
·
Facts About Insomnia Summary: This four-page brochure discusses insomnia -- inadequate or poor quality sleep because of difficulty falling asleep, and how it is treated. Source: National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=410
20 Insomnia
·
Test Your Sleep I.Q. Summary: This true-false quiz tests what you know about sleep. Questions cover topics on snoring, narcolepsy, insomnia, restless legs syndrome, and other issues. Source: National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2384
·
Tossing and Turning No More: How to Get a Good Night's Sleep Summary: This consumer health information article discusses sleep disorders -- insomnia, sleep apnea (snoring) -- and the effectiveness of various treatment methods including, melatonin. Source: Office of Consumer Affairs, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3587
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to insomnia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Seeking Guidance 21
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdominal: Pertaining to the abdomen. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Carbohydrates: A nutrient that supplies 4 calories/gram. They may be simple or complex. Simple carbohydrates are called sugars, and complex carbohydrates are called starch and fiber (cellulose). An organic compound—containing carbon, hydrogen, and oxygen—that is formed by photosynthesis in plants. Carbohydrates are heat producing and are classified as monosaccharides, disaccharides, or polysaccharides. [NIH] Cardiopulmonary: Pertaining to the heart and lungs. [EU]
22 Insomnia
Chronic: Of long duration; frequently recurring. [NIH] Constipation: Infrequent or difficult evacuation of the feces. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperthyroidism: 1. excessive functional activity of the thyroid gland. 2. the abnormal condition resulting from hyperthyroidism marked by increased metabolic rate, enlargement of the thyroid gland, rapid heart rate, high blood pressure, and various secondary symptoms. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Menopause: The cessation of menstruation in the human female, which begins at about the age of 50. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Pulmonary: Relating to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Seeking Guidance 23
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with insomnia. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.9 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with insomnia. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Insomnia As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.10 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 10 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 9
24 Insomnia
your expectations, and how well you cope with your condition can all influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Sleep Disorders Association Address: American Sleep Disorders Association 1610 14th Street NW, Suite 300, Rochester, MN 55901 Telephone: (507) 287-6006 Fax: (507) 287-6008 Email:
[email protected] Background: Established in 1975, the American Sleep Disorders Association (ASDA) is a voluntary, not-for-profit, medical and scientific society dedicated to quality medical care for individuals with sleep disorders and service to its individual and center members through education, research, and the development of practice standards related to the field of sleep medicine. The Association is committed to fostering professional education through meetings, courses, publications, and educational materials; defining, developing, distributing, and updating standards, guidelines, and policies that result in optimal access to and delivery of care for all patients with sleep disorders; and fostering basic and clinical sleep research. The Association is also dedicated to promoting training programs for practitioners of sleep medicine; representing the field to all government and private agencies involved in research, training, policy, practice, and healthcare delivery issues that affect the field; and educating the public about sleep disorders and related conditions. The Association offers a variety of educational and support materials including an educational slide series; manuals for physicians, healthcare professionals, medical students, sleep specialists, and other professionals, CD-ROM and computer-based information resources for professionals; an interdisciplinary medical journal entitled 'Sleep'; and patient education pamphlets. Relevant area(s) of interest: Insomnia, Narcolepsy
Seeking Guidance 25
·
National Center on Sleep Disorders Research National Heart Lung and Blood Institute National Institutes of Health Address: 6701 Rockledge Drive, MSC 7920 Bethesda, MD 20892-7920 Two Rockledge Centre, Suite 10038 Telephone: (301) 435-0199 Fax: (301) 480-3451 Email:
[email protected] Web Site: http://www.nhlbi.nih.gov/about/ncsdr/index.htm Background: The National Center on Sleep Disorders Research (NCSDR), located within the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), was established in 1993 to combat a serious public health concern. About 70 million Americans suffer from sleep problems; among them, nearly 60 percent have a chronic disorder. Each year, sleep disorders, sleep deprivation, and sleepiness add billiions of dollars to the national health care bill. Additional costs to society for related health problems, lost worker productivity, and accidents have not been calculated. Sleep disorders and disturbances of sleep comprise a broad range of problems, including sleep apnea, narcolepsy, insomnia, parasomnia, jet-lag syndrome, and disturbed biological and circadian rhythms. The Center seeks to fulfill its goal of improving the health of Americans by serving four key functions: research, training, technology transfer, and coordination. Some publications and videos are available to the public. Relevant area(s) of interest: Circadian rhythm; Insomnia; Sleep apnea; Sleep disorders
·
National Sleep Foundation Address: National Sleep Foundation 729 15th Street, N.W., 4th Floor, Washington, D.C. 20005 Telephone: (202) 347-3471 Fax: (202) 347-3472 Email:
[email protected] Web Site: http://www.sleepfoundation.or Background: The National Sleep Foundation (NSF) is a not-for-profit organization dedicated to improving the quality of life for those who are affected by sleep disorders (e.g., Sleep Apnea, Narcolepsy, Restless Legs Syndrome, and Periodic Limb Movement Disorder) and preventing accidents related to sleep deprivation or sleep disorders. Established in 1991, the National Sleep Foundation increases public awareness of sleep
26 Insomnia
disorders through all forms of media; encourages the development of patient services, community resources, and support groups for affected individuals; and creates partnerships with business and government to extend its educational reach. The National Sleep Foundation also provides referrals to regional sleep disorder centers; conducts symposia for physicians across the United States; and provides research grants and fellowships. The Foundation offers a variety of educational and supportive information through its database, brochures and pamphlets designed for physicians and the general public, a regular newsletter for physicians entitled 'Sleep Medicine Alert,' and 'NSF Connection,' a newsletter for the public. Relevant area(s) of interest: Insomnia, Narcolepsy ·
School of Medicine Sleep Disorders Clinic and Research Center Stanford University Address: 701 Welch Rd., Suite 2226 Palo Alto, CA 94304 Telephone: (415) 723-3181 Web Site: http://www.med.stanford.edu/school/psychiatry/coe/ Background: Partially sponsored by the National Institutes of Health and private foundations, the Sleep Disorders Clinic and Research Center of Stanford University School of Medicine is accredited by the Association of Sleep Disorders Centers. The Center chief focus is on sleep disorders, including narcolepsy, sleep apnea, and other related sleep/awake problems; and canine narcolepsy. The Clinic provides diagnostic, evaluation, consulting, and some treatment services for a fee, and makes referrals to other appropriate sources for diagnosis or treatment. Patients are seen on referral of a physician. Polysomnograph services are available to patients as part of the diagnostic procedure. General information on sleep problems and complaints is also available. Publication(s): The Center is the editorial office for the quarterly journal Sleep. Technical reports; books; journal articles; state-of-the-art reviews; standards; critical reviews; abstracts; indexes; research summaries; bibliographies; reprints. Relevant area(s) of interest: bioassay for the study of sleep and circadian rhythms (using; Circadian rhythms; Dogs (mammals); Facilities include the only canine narcolepsy colony in the; Holdings; Insomnia; Narcolepsy; rhythms in the United States; and SCORE (TM), the largest online; rodent models).; Sleep apnea; Sleep disorders; world; a temporal isolation facility for the study of circadian
Seeking Guidance 27
·
Sleep Disorders Center University of California at Los Angeles Address: 24-221 CHS Box 957069 Los Angeles, CA 90095-7069 Telephone: (310) 206-8005 Web Site: http://www.programs.healthcare.ucla.edu Background: Chief concerns of the Sleep Disonders Center include sleep, sleep disorders, narcolepsy, sleep apnea, insomnia, myoclonus, circadian rhythm disturbance, and nocturnal seizures. The Center answers inquiries, provides advisory and current-awareness services, provides information on research in progress, conducts seminars, evaluates data, and makes referrals to other sources of information. Fees are charged for consultations and testing. Relevant area(s) of interest: Circadian rhythms; Insomnia; Myoclonus; Narcolepsy; Sleep; Sleep apnea; Sleep disorders
·
Sleep/Wake Disorders Canada Address: Sleep/Wake Disorders Canada 3080 Yonge Street, Suite 5055, Toronto, Ontario, M4N 3N1, Canada Telephone: (416) 483-9654 Toll-free: (800) 387-9253 Fax: (416) 483-7081 Email:
[email protected] Web Site: http://www.geocities.com/~sleepwake Background: Sleep/Wake Disorders Canada (SWDC) is a national notfor-profit self-help organization of volunteers dedicated to providing information, practical support, and resources to Canadians with sleep/wake disorders. Such disorders include difficulties falling or staying asleep (insomnia); sleep apnea, a disorder in which breathing periodically ceases during sleep; narcolepsy, which is characterized by excessive daytime sleepiness, recurrent episodes of sleep during the day, and, in some cases, sudden loss of muscle tone (hypotonia) without loss of consciousness (cataplexy); and restless legs syndrome, a disorder characterized by unusual, unpleasant sensations deep in the legs, an overwhelming desire to move the legs to relieve such sensations, motor restlessness, and occurrence of such symptoms most frequently during the evening or early part of the night and while at rest. Established in 1981 and currently consisting of approximately 1,000 members, Sleep/Wake Disorders Canada has self-help chapters and contact representatives across Canada to provide local access for affected individuals and family members who seek information and peer support. The organization is committed to providing accurate and timely
28 Insomnia
information on sleep/wake disorders to affected individuals and health care professionals; promoting awareness among affected families, medical professionals, and the general public concerning the implications of sleep/wake disorders in the home environment, the workplace, and the community; and promoting and supporting research on the underlying causes of such disorders to improve prevention, diagnosis, and disease management efforts. Sleep/Wake Disorders Canada has a register of sleep laboratories and sleep specialists from across Canada, holds regular group meetings, conducts an annual conference to bring together volunteers and medical professionals in order to review the current state of sleep/wake research and to plan initiatives for the organization, and conducts National Sleep Awareness week activities to raise public awareness. Sleep/Wake Disorders Canada also offers a wide range of educational materials including informational brochures on insomnia, sleep apnea, narcolepsy, restless legs syndrome, and other sleep disorders; several books on sleep/wake disorders; 'Sleep Solutions,' a 10-volume informational booklet series for general practitioners; and a regular newsletter entitled 'Good Night/Good Day' that provides updates on research and chapter activities and enables affected individuals from across Canada to exchange information and mutual support. Relevant area(s) of interest: Insomnia, Narcolepsy
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about insomnia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
Seeking Guidance 29
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “insomnia” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “insomnia”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “insomnia” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with insomnia. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “insomnia” (or a synonym) in the search box. Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site:
30 Insomnia
http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet links may be of particular interest: ·
Pillow Talk - Insomnia Discussion Board www.insomniacure.com/sleep1_toc.htm
·
Sleeping Problems : Patient UK www.patient.co.uk/illness/s/sleep_problems.htm
·
SupportPath.com www.support-group.com
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with insomnia must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:11 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: · 11
Check with the associations listed earlier in this chapter. This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 31
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 12 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about insomnia?
·
Really listen to my questions?
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12
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·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for insomnia?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
14
Seeking Guidance 33
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
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·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Consciousness: Sense of awareness of self and of the environment. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Hypotonia: A condition of diminished tone of the skeletal muscles; diminished resistance of muscles to passive stretching. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Progressive: Increasing in severity. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Respiratory: Pertaining to respiration. [EU] Scrapie: A fatal disease of the nervous system in sheep and goats, characterized by pruritus, debility, and locomotor incoordination. It is caused by proteinaceous infectious particles called prions. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH]
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CHAPTER 3. CLINICAL TRIALS AND INSOMNIA Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning insomnia.
What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for insomnia is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
16
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What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
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Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on insomnia.
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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for insomnia compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on insomnia carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on insomnia. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
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treatment, like a placebo, has no effect on insomnia and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how insomnia develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for insomnia. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Insomnia The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to insomnia.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Behavioral Insomnia Therapy for Fibromyalgia Condition(s): Fibromyalgia; Insomnia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This study tests the effectiveness of a nondrug treatment for the insomnia that often occurs in people with fibromyalgia. The treatment is a type of psychotherapy called cognitive-behavioral therapy. Cognitive-behavioral therapy combines cognitive therapy, which can modify or eliminate thought patterns contributing to the person's symptoms, and behavioral therapy, which aims to help the person change his or her behavior. Phase(s): Phase II Study Type: Interventional
17
These are listed at www.ClinicalTrials.gov.
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Contact(s): Jack D Edinger, Ph.D. 919-286-0411
[email protected]; North Carolina; Duke University Medical Center, Durham, North Carolina, 27710, United States; Recruiting; William K Wohlgemuth, Ph.D. 919-684-4368. Study chairs or principal investigators: Jack D. Edinger, Ph.D., Principal Investigator; VA Medical Center-Brooklyn Web Site: http://clinicaltrials.gov/ct/gui/c/w2b/show/NCT00000397 ·
Yoga as a Treatment for Insomnia Condition(s): Insomnia Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this study is to evaluate the effectiveness of a daily, 8-week yoga treatment for insomnia in a randomized controlled clinical trial. Phase(s): Phase II Study Type: Interventional Contact(s): Sat Bir Singh Khalsa, PhD (617) 732-7994
[email protected]; Massachusetts; Brigham and Women's Hospital Division of Sleep Medicine, Boston, Massachusetts, 02115, United States; Recruiting. Study chairs or principal investigators: Sat Bir Singh Khalsa, PhD, Principal Investigator; Brigham and Women's Hospital Web Site: http://clinicaltrials.gov/ct/gui/c/w2b/show/NCT00033865
·
Effect of Activity on Sleep of Cognitively-Impaired Veterans Condition(s): Alzheimer's Disease; Sleep Disorders Study Status: This study is no longer recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service; Central Arkansas Veterans Healthcare System; University of Arkansas Purpose - Excerpt: Sleep-activity rhythm disturbance is a highly prevalent, disabling symptom in cognitively-impaired (CI) elders. Their nocturnal sleep is light and inefficient with frequent arousals and awakenings. Multiple short daytime napping episodes interfere with daytime activity and functioning. Furthermore, daytime disruptive behaviors, such as pacing, hitting, and cursing, are related significantly to sleep-activity rhythm disturbance. Interventions for sleep-activity rhythm
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disturbance consist primarily of pharmacological agents. Medical treatment for sleep and behavior disturbances with benzodiazepines or antipsychotic medications has proven only minimally effective and has serious side effects such as impairments in cognition, memory, coordination, and balance; tolerance and severe rebound insomnia; and tardive dyskinesia. Feasible, cost-effective nonpharmacological interventions that address the precipitating causes of sleep-activity rhythm disturbance require testing. Activity is proposed as one nonpharmacological intervention for nocturnal sleep disturbance, but no one has tested its efficacy. The degree of daytime sleepiness in elders may reflect a reduction in the purposive physical, cognitive, and affective activities that previously sustained daytime alertness and promoted psychological well-being. For some institutionalized elders, living in a physically, cognitively, and emotionally understimulating setting may induce excessive napping during the day with a subsequent adverse impact on circadian sleep-wake patterns. Concrete, reality-based activities may counter napping by keeping residents with dementia involved in the world around them and helping them meet important psychological, physical, and social needs. Our pilot study with five nursing home residents demonstrated that activities timed to occur during usual naptime and tailored to residents? interests and their remaining abilities improved nocturnal sleep. Our other research has shown that engaging residents in meaningful activity improved their psychological well-being and decreased certain types of disruptive behaviors. Therefore, we are testing the effect of an Individualized Activity Intervention timed to occur when the resident usually naps in the daytime on nocturnal sleep as measured by actigraphy in 90 CI nursing home residents who demonstrate sleep-activity rhythm disturbance. Examples of individualized activities include objects for tactile and visual stimulation, arts and crafts, and games. We also are testing the effect of the intervention on psychological well-being and disruptive behavior. After the collection of baseline sleep, disruptive behavior, and psychological well-being data for five days, residents are randomly assigned to the Individualized Activity Intervention or to a control condition for 21 days. On days 17-21, the research assistant repeats the outcome measures. Study Type: Interventional Contact(s): Arkansas; Central Arkansas Veterans Healthcare System, No Little Rock, Arkansas, 72114-1706, United States; Kathleen C. Richards, PhD, RN 501-257-2044
[email protected] Web Site: http://clinicaltrials.gov/ct/gui/c/w2b/show/NCT00013182
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·
Pharmacological and Behavioral Treatment of Insomnia Condition(s): Lung Diseases; Sleep; Sleep initiation and maintenance disorders Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: to develop the maximally effective treatment strategy for chronic sleep-onset insomnia and to reduce its impact on psychological functioning, health, and economic sequelae. Study Type: Behavioral Medicine, Longitudinal Human Study Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2b/show/NCT00005753
Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for insomnia. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with insomnia. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members.
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 18
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The Informed Consent Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient. What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.
What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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·
Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for insomnia? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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·
What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “insomnia” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The
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following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] EKG: Measurement of electrical activity during heartbeats. [NIH] Electrocardiogram:
Measurement of electrical activity during heartbeats.
[NIH]
Hepatitis: Inflammation of the liver. [EU] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Metastasis: 1. the transfer of disease from one organ or part to another not
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directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Palpitation: The sensation of rapid heartbeats. [NIH] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Placebos: Any dummy medication or treatment. Although placebos originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on insomnia. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on insomnia. In Part II, as in Part I, our objective is not to interpret the latest advances on insomnia or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with insomnia is suggested.
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CHAPTER 4. STUDIES ON INSOMNIA Overview Every year, academic studies are published on insomnia or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on insomnia. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on insomnia and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and insomnia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “insomnia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia Source: Journal of the American Medical Association. 276(4):313- 318; July 24/31, 1996. Summary: This journal article for health professionals presents a draft statement on the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia that was developed by a nonfederal, nonadvocate, 12-member panel of health professionals. The statement addressed issues concerning the behavioral and relaxation approaches currently used for conditions such as chronic pain and insomnia, the way in which these approaches work and their effectiveness, barriers to the appropriate integration of these approaches into health care, and significant issues for future research and applications. The panel concluded that several well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, relaxation and biofeedback produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant. 1 figure. (AA-M).
Federally-Funded Research on Insomnia The U.S. Government supports a variety of research studies relating to insomnia and associated conditions. These studies are tracked by the Office
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of Extramural Research at the National Institutes of Health.19 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to insomnia and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore insomnia and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for insomnia: ·
Project Title: Autonomic Dysregulation in Primary Insomnia Principal Investigator & Institution: Richardson, Gary S.; Senior Research Scientist; Case Western Reserve Univ-Henry Ford Hsc Henry Ford Health Science Ctr Detroit, Mi 48202 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2006 Summary: (provided by applicant) Chronic insomnia is a disorder afflicting as many as 10 percent of adults in the US, a substantial proportion of whom have no identifiable underlying cause for the sleep complaint, i.e. primary insomnia (PI). Several lines of evidence implicate central sympathetic nervous system (SNS) dysregulation in the pathogenesis of PI. First, patients with this disorder show evidence of SNS arousal, including increased basal metabolic rates, elevated circulating catecholamines, and increased daytime alertness relative to the degree of nocturnal sleep disruption. Along with the SNS, the hypothalamic pituitary adrenal (HPA) axis is also hyperactive in insomnia, implicating a central mechanism common to both axes. Second, epidemiological studies establish a strong link between patients with PI and patients with major depressive disorder (MDD), also characterized by central activation of the SNS and HPA axes. Third, corticotropic releasing factor (CRF), a link between the SNS and HPA axes implicated
19 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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in the pathogenesis of MDD, causes sleep disruption and hyper-arousal when centrally administered in animal models. In this proposal, we present a model of primary insomnia in which the pathogenic mechanism of this disorder is hypothesized to be dysregulation of central CRF neurons, specifically the delayed restoration of normal CRF levels following stress. This model provides a conceptual foundation for 1) the temporal (intermittent) pattern of manifest sleep disruption in patients with underlying tendency to P1; 2) the link between insomnia and stress; 3) the epidemiological link between MDD and P1; and 4) the hyperarousal in PI with activation of SNS and HPA axes. It also provides a focus for future therapeutic efforts for this important disorder, suggesting that antagonists of CRF may be useful in reversing insomnia, and in blocking the processes that eventuate in MDD. We propose three experiments to test the CRF model and some of its predictions. In the first experiment, we will examine the status of the SNS and HPA axes in patients with P1, and the clinical correlates of SNS-HPA activation in this population. Second, we will assess the role of the CRF-SNS response in perpetuating insomnia by comparing the effects of sleep disruption (audio tones) in patients with P1 and normal controls, using sleep continuity, urinary catecholamines, daytime function, and subsequent sleep as dependent measures. Finally, we will use a new measure of central CRF function, the DEX-sleep latency test, to test the hypothesis that central CRF tone is higher in patients with P1. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Behavioral and Pharmacological Treatment for Insomnia Principal Investigator & Institution: Morin, Charles M.; Associate Professor; Laval University Cite Universitaire Quebec, Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2006 Summary: (Adapted from the Applicant's Abstract): Insomnia is a prevalent health complaint which is often associated with functional impairments, reduced quality of life, and increased health-care costs. The specific aims of the proposed study are to (a) evaluate the short- and long-term effects of cognitive -behavior therapy (CBT), alone and in combination with medication, for chronic insomnia, (b) compare the efficacy of different maintenance strategies for combining drug and nondrug therapies to optimize long-term outcomes, and (c) examine the clinical impact of treatment on daytime functioning and psychological well-being. One hundred and fifty (150) adults meeting criteria for chronic insomnia will be randomly assigned to CBT or CBT plus medication. After the acute treatment phase, which will last eight weeks,
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patients will be entered into an extended treatment lasting six months. Of those treated with CBT alone initially, responders will be entered into an extended CBT or no treatment. Of those receiving the combined CBT plus medication (used on an as needed schedule) or CBT alone (plus medication tapering). Outcome will be evaluated across measures of sleep, clinical ratings, and several indices of daytime functioning. The measures will be administered at baseline, at the end of the acute and extended treatment phases, and at 6-, 12-, and 24-month follow-ups. The main research questions are: (a) Is CBT in conjunction with medication more effective than CBT alone for the acute treatment of insomnia? (b) When combining CBT and drug therapy, is it best to discontinue medication after the initial acute treatment or to continue using it on an intermittent (as needed) schedule in order to foster long-term maintenance of sleep improvements? and (c) What is the clinical impact of sleep improvement on daytime fatigue and performance, psychological symptoms, and quality of life? The public health significance of the proposed study is that it will provide useful information about optimal models for integrating behavioral and pharmacological therapies for the clinical management of insomnia. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Behavioral Intervention for Insomnia in Older Adults Principal Investigator & Institution: Epstein, Dana R.; ; U.S. Carl T. Hayden Vet Affairs Med Ctr Affairs Medical Center Phoenix, Az 85012 Timing: Fiscal Year 2000; Project Start 5-SEP-1998; Project End 1-JUL-2003 Summary: Insomnia is a prevalent health problem and frequent complaint of older adults. The majority of research in the nonpharmacological treatment of insomnia has focused on young and middle-aged adults while only a small number of studies have evaluated treatment for late-life insomnia. Knowledge of the intervention or combination of interventions best suited for older adults is limited. Therefore, the purpose of the study is to evaluate and compare the efficacy of single interventions (stimulus control instructions, sleep restriction therapy) and multi- component intervention (stimulus control instructions and sleep restriction therapy) for sleep maintenance insomnia in community dwelling older adults. The study will incorporate multiple sleep measures to determine the short and long-term effects of the interventions on sleep outcomes. The efficiency of the interventions, intervention dosage, compliance with treatment and clinical significance of the outcomes will be addressed. The long-term goal of the research is to provide clinically significant and applicable non-pharmacological, theory driven intervention that effectively addresses the specific
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insomnia problems of older adulthood. One hundred eighty community dwelling older adults with sleep maintenance insomnia will participate in a randomized controlled study using a waiting-list design. Subjects will be randomly assigned to one of the four conditions: (a) multicomponent intervention, (b) stimulus control instructions, (c) sleep restriction therapy, or (d) waiting-list control. There will be a 2- week baseline period, a 6-week treatment period, and a 2-week post- treatment period. The waiting-list subjects will receive treatment after the immediate treatment groups have completed their treatment and immediate post-treatment phases. Follow up evaluation will occur for 2week periods at 3 and 12 months post-treatment. Descriptive and inferential statistics will be used to accomplish the specific aims of the study. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Behavioral Treatment for Comorbid Geriatric Insomnia Principal Investigator & Institution: Rybarczyk, Bruce D.; ; RushPresbyterian-St Lukes Medical Ctr 1653 W Congress Pkwy Chicago, Il 60612 Timing: Fiscal Year 2000; Project Start 5-AUG-2000; Project End 1-JUL2004 Summary: Description (adapted from the investigator's abstract): This is a revised application to test the efficacy of an empirically based cognitivebehavioral intervention for older adults with insomnia and co-morbid chronic illness recruited from an HMO population. The primary objective of the study will be to compare the efficacy of behavioral treatments for insomnia among patients with 3 common age-related chronic illnesses: osteo-arthritis (OA), chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) because exceptionally high rates of comorbid insomnia have been found in the 3 groups. A second major objective is to determine whether an effective behavioral treatment can diminish the well-established effects of insomnia on quality of life among those with chronic illness. The proposed study will include random assignment of 3 groups of 55 HMO patients 55 years or older with OA, COPD and CAD and co-morbid insomnia to an 8-week cognitivebehavioral treatment class or placebo control class. The behavioral intervention will be empirically based with both cognitive-behavioral and relaxation approaches. The placebo control group will be a wellness/stress management class. Outcomes will be assessed at 4, 8, and 12 months post treatment follow-up intervals. Sleep quantity and quality will be evaluated using polysomnography, actigraphy and self report
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measures. Quality of life, functional status and mood will also be assessed. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Beta Eeg Activity In Insomnia Principal Investigator & Institution: Perlis, Michael L.; Psychiatry; University of Rochester River Campus Sta Rochester, Ny 14627 Timing: Fiscal Year 2001; Project Start 6-DEC-2000; Project End 0-NOV2003 Summary: (Adapted from applicant's abstract) It has been estimated that between 10 and 15 percent of the population has chronic Primary Insomnia. Thus, in the United States alone between 27 and 41 million people suffer from a disorder that diminishes their quality of life, negatively impacts on their work performance and puts them at increased risk for medical and psychiatric illness. The economic costs associated with insomnia are estimated to be in the tens of billions of dollars per annum. Despite its prevalence and consequences, little is known about the pathophysiology of insomnia and how it is related to the presenting symptoms of the disorder. Recent work on the spectral components of the sleep EEG show that Beta frequency EEG activity at/around sleep onset and during NREM sleep is increased in patients with Primary Insomnia, in comparison to both good sleeper controls and MDD patients with secondary insomnia. While this suggests that patients with Primary Insomnia exhibit higher than normal levels of CNS arousal at sleep onset and during NREM sleep, little is known, about whether high frequency EEG activity in insomnia is 1) limited to the Beta activity, 2) actually CNS in origin 3), if CNS in origin, preponderant at specific EEG sites, 4) varies with symptom intensity and 5) correlated with the subjective perception of sleep quality and quantity. We propose to undertake one experiment in which three groups of subjects will be studied polysomnographically for four consecutive nights. The subject groups will be 30 patients with Primary Insomnia, 30 patients with insomnia secondary to Major Depression, and 30 good sleeper controls. Digital EEG data from each night of study will be obtained from 10 sites (F3,F4,C3,C4,T5,T6,P3,P4,O1 ,02) and power spectral data will be compiled for each of the first 4 NREM and REM cycles and for each stage of sleep. Group differences for Beta-I (14-20Hz), Beta-2 (20-35Hz), Gamma (35-45Hz) and Omega (45-125 Hz) will be assessed taking into account site-to-site and night-to-night variability. In addition, we will evaluate the extent to which high frequency activity is associated with the perception of sleep quality and quantity. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Case Control Study of Insomnia in Non-Depressed Elderly Principal Investigator & Institution: Pack, Allan I.; Professor of Medicine; University of Pennsylvania 1 College Hall Philadelphia, Pa 19104 Timing: Fiscal Year 2000 Summary: The overall goal of this study is to evaluate mechanisms leading to insomnia in the elderly. This is a common complaint in this age group. About 10% of elderly have long-lasting frequent insomnia (difficulty sleeping). Our study is directed at investigating underlying mechanisms. We will employ a case-control study. Specifically we will recruit elderly subjects with long-lasting insomnia (cases) and subjects with no or rare insomnia in the previous one year (controls). The fundamental hypothesis on which our study is based is that age-related changes in the sleep and circadian processes are major risk factors for insomnia and compound the effects of sleep disorders and somatic diseases that interrupt sleep. Our specific aims are the following: 1. Determine the relative role of physiological changes with age (phase advance of the circadian clock, reduced melatonin levels, decrease in EEG slow wave activity) in causation of insomnia. 2. Determine whether sleep disorders (sleep apnea and nocturnal myoclonus) are risk factors for insomnia in the elderly. 3. Determine whether physiological changes in homeostatic sleep drive and/or the circadian system augment the effects of sleep or somatic disorders that interrupt sleep in the elderly. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Computerized Self-Help Treatment for Primary Insomnia Principal Investigator & Institution: Riley, William T.; ; Personal Improvement Computer Systems 12007 Sunrise Valley Dr, Ste 480 Reston, Va 22091 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 1-AUG2001 Summary: The primary goal of the project is to develop a hand-held computer that will provide a treatment program for individuals with primary chronic insomnia. The computer will utilize prompting and timing mechanisms in order to measure sleep behavior and thus create an appropriate treatment program for the specific user. Based on the behavioral principles of stimulus control and sleep restrictions, the computer will prompt times to bed and out of bed, adjusting these times in reference to the individual's previous night's sleep. For phase I, a focus group will be conducted with 10 individuals suffering from primary chronic insomnia that will aid the development of the computer program
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and a subsequent program guide and relaxation audiocassette. The product will then be tested in a small scale feasibility study with 60 participants who suffer from primary chronic insomnia. Development of the program will follow a structured "proof of concept" approach involving several interactive cycles of prototype development, testing, and refinement. Data from the study and feedback from subjects will be used to guide further product development and the need to tailor algorithms for primary chronic insomnia users. PROPOSED COMMERCIAL APPLICATIONS: The proposed product, the Insomnia Assessment and Treatment program, will provide a computer-assisted, self-help behavioral strategy for people experiencing chronic primary insomnia. With over 30 million adults in the U.S. experiencing chronic primary insomnia and with only a small percentage of people with insomnia utilizing professional treatment, there is a large market of people with insomnia who desire a readily available and effective treatment. Given the superior long-term outcomes and acceptability of behavioral treatments for insomnia relative to pharmacologic treatments, a computer-assisted self-help behavioral treatment for insomnia should have wide commercial appeal. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Dose/Response Effects of Behavioral Insomnia Therapy Principal Investigator & Institution: Edinger, Jack D.; Clinical Professor; Psychiatry and Behavioral Scis; Duke University Durham, Nc 27706 Timing: Fiscal Year 2000; Project Start 1-AUG-1994; Project End 8-FEB2002 Summary: Persistent primary insomnia (PPI) is a prevalent and debilitating sleep disorder which, in middle-aged and older adults is characterized by an unrelenting difficulty maintaining sleep. Available sedative hypnotic medications may provide PPI patients some short-term relief but such agents fail to address the underlying behavioral/psychological factors which perpetuate PPI. Over the past decade we have developed, refined, and repeatedly tested a cognitivebehavioral therapy (CBT) for the treatment of sleep-maintenance difficulties. Our most recent results show CBT-treated patients significantly more often achieve a priori- defined criterion levels of improvement than do those receiving either a behavioral placebo or relaxation therapy (RT). During our currently funded trial (Grant number MH 48187) we have begun to explore CBT's dose-response curve (i.e., number of treatment sessions and time in treatment vs. outcome) and have observed that: (1) PPI patients are more likely to achieve stable levels of sleep improvement following multiple CBT sessions than
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following one CBT session; and (2) a subset of patients (we call Type 1 insomniacs) who report relatively low self- efficacy in regard to sleep, view sleep as relatively unpredictable/ uncontrollable and have relatively elevated concerns about their insomnia prior to treatment, show stable gains following one CBT session. The proposed project's Specific Aims/Major Objectives entail conducting a prospective randomized clinical trial to confirm these findings. One arm of this study's 5 x 2 x 11 factorial design will compare 1,2,4 and 8 therapistguided sessions of CBT with a waiting list condition. The second arm of the design will compare treatment-related improvements of preidentified Type 1 insomniacs with improvements shown by our remaining subjects (herein called Type II insomniacs). The final arm is a repeated-measures factor consisting of 11 time points (i.e. baseline, weekly during treatment, and 2 follow-up periods) at which sleep changes are assessed. Subjects will be assessed at all 11 time points with sleep logs, wrist actigraphy, an Insomnia Symptom Questionnaire, a Sleep Efficacy Scale, and the State-Trait Anxiety and Beck Depression Scales. These assessments will be used to determine change/improvements in subjective/objective sleep measures, global insomnia symptoms and general mood states. Multivariate statistics and tests of clinical significance will be conducted with these various measures. Analyses will also be conducted to assess the separate contributions of such treatment dosing factors as the number of therapist contacts received and the time given to subjects for treatment implementation. Results should provide information which helps us to more accurately titrate the dose of CBT treatment with different patient types. We should also develop a better understanding of the time course over which treatment-related improvements might be expected for insomniacs in general and for specific primary insomniac subtypes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Enhancing Effectiveness of Light Therapy for Insomnia Principal Investigator & Institution: Savage, Henry; Apollo Light Systems, Inc. 352 West 1060 South Orem, Ut 84058 Timing: Fiscal Year 2000; Project Start 5-AUG-2000; Project End 4-AUG2002 Summary: The direct economic costs of insomnia in the United States exceeds $15 billion per year. Up to 50% of the population over 65 years suffers from chronic insomnia. The result is both compromised health and a reduction in the quality of life. The magnitude of the problem is underscored by the fact that approximately 40% of hypnotic medications are prescribed to individuals over 60 years of age, and the proportion of
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use increases with age. The features that make up age-related sleep disturbance are suggestive of a circadian rhythms involvement, and growing evidence suggests that timed exposure to bright light can be an effective treatment for this disorder. Yet, previous work makes it clear that bright light treatments could be more beneficially applied if greater attention is given to specific physiological and behavioral factors that intervene to limit efficacy. The current application seeks to take advantage of recent findings which suggest that a low-maintenance treatment strategy that controls judiciously an individual's exposure to light throughout the 24-hour day may be critical to making this promising non-drug approach more effective. Using a lab-based assessment and in-home treatment approach, we will examine the effects a home ambient light operating system (HALOS) on the sleep quality and waking function of a group of older subjects with sleep maintenance insomnia. Development and implementation of this safe, affordable and easy-to-use approach for the effective treatment of age-related sleep disturbance will make a significant positive impact on the quality of life of individuals suffering from the disorder, while reducing the substantial economic cost to our health care system associated with the treatment and consequences of age-related insomnia. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: High Tech/Low Cost Home Treatment for Geriatric Insomnia Principal Investigator & Institution: Alsten, Christopher R.; Inner Health, Inc. 1260 Lincoln Ave San Diego, Ca 92103 Timing: Fiscal Year 2001; Project Start 1-DEC-1998; Project End 1-MAY2003 Summary: This study will test the efficacy of a technology-enhanced home behavioral treatment (THBT) or older adults with insomnia and comorbid chronic illness. The SBIR 1 study found that THBT yielded short-term reductions in insomnia compared to no treatment. These benefits were comparable to those obtained from a classroom treatment at much less cost. The goal of the proposed study will be extend these findings using a more precise methodology, measurement of longer-term benefits, and comparison to an alternative self-help treatment. Subjects will include 80 older adults with one of two common chronic diseases with high rates of comorbid insomnia: osteoarthritis and coronary artery disease. They will receive one of the two treatments: THBT with video instruction on cognitive-behavioral (CB) techniques and 3-D audio relaxation training; or bibliotherapy treatment using a previously tested CB self-help book. Outcomes will be assessed at post-treatment and 1
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year follow-up using objective and self-report measures of sleep. Quality of life, functional status and health care utilization benefits will be assessed. This study complements an R01 proposal by the coinvestigators which includes a classroom CB treatment and a placebo treatment, thus allowing for outcome comparisons across a continuum of behavioral treatment modalities. An easy-to-use home treatment package would have strong potential as a first-line treatment for geriatric insomnia. PROPOSED COMMERCIAL APPLICATION: Not available Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Pharmacotherapy of Alcoholism and Comorbid Insomnia Principal Investigator & Institution: Brower, Kirk J.; Associate Professor of Psychiatry; Psychiatry; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2000; Project Start 7-SEP-1999; Project End 1-AUG2004 Summary: Kirk J. Brower, M.D., an associate professor of psychiatry with tenure at the University of Michigan (UM) Medical School, is applying for the Midcareer Investigator Award in Patient-Oriented Research. The UM Department of Psychiatry provides a rich environment for alcohol research, including a large base of NIH funding and an established Alcohol Research Center that is currently engaged in multiple clinical studies. Dr. Brower, broad-certified in addiction psychiatry, is Executive Director of Chelsea Arbor Treatment Center, the dedicated facility in the Department that exclusively treats people with alcohol and other drug problems. He is also the director of the ACGME-accredited fellowship program in addiction psychiatry at UM and co-principal investigator on the Department s NIAAA T32 Training Grant for postdoctoral research fellows. He mentors this year s competitively selected (one per year) ACNP Glaxo Wellcome Research Fellow in Clinical Neuropharmacology. Dr. Brower s long-term career goals are to develop and disseminate new therapeutic options for patients with alcoholism and alcohol abuse who are likely to relapse despite current or conventional treatments. Comorbid insomnia, craving, and mood disturbances are targeted because they may increase relapse risk via neurobiological mechanisms that are amenable to pharmacotherapy. Dr. Brower s short-term career goals are to increase his expertise in sleep medicine, sleep research, and pharmacotherapy trials. His career development plan includes advanced coursework in clinical research design and biostatistics, focused activity in sleep medicine at the University of Michigan, and special leave to visit other institutions where exemplary sleep research and/or state-of-the-art pharmacotherapy trials for alcoholism are being conducted. Dr. Brower
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has current research funding from Pfizer, Inc. to study the effects of sertraline on the sleep of depressed alcoholics. The proposed research project is a randomized, double-blind, placebo-controlled trial gabapentin for treating alcoholism and comorbid insomnia. This 6-week trial with an additional 6-week follow-up period will investigate the effects of medication on both sleep and drinking outcomes, and it will utilize polysomnographic measures as potential neurophysiological predictors of treatment outcome. Given the high prevalence, costs and comorbidity of alcoholism and insomnia, this topic requires considerably more research attention than it has received. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Psychobiology and Treatment Response in Primary Insomnia Principal Investigator & Institution: Buysse, Daniel J.; Associate Professor; Psychiatry; University of Pittsburgh at Pittsburgh 4200 5Th Ave Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 1-DEC-1977; Project End 0-NOV2006 Summary: Insomnia is a widely prevalent problem with serious consequences for mental and physical health, including risk for the development of major depressive and anxiety disorders. Fundamental questions persist regarding how affective disturbance is related to sleep disturbances; focusing on primary insomnia is a key to addressing these questions. The broad aim of this study is to better define the psychobiology of insomnia based on clues from its clinical phenomenology, responses to pharmacological treatment probes, and functional neuroimaging studies of sleep and wake states. Our model of primary insomnia emphasizes two major dimensions of dysfunction, affective disturbance and heightened central nervous system arousal. We propose that individuals with primary insomnia vary in their degree of affective disturbance and heightened arousal, leading to different individual profiles of sleep-wake behaviors. These different profiles may require pharmacotherapy specifically tailored to the individual's symptom constellation. In order to test our model, we will use innovative methods of clinical assessment (including mood and anxiety "spectrum" assessments and ecological momentary assessment of mood and arousal), pharmacological treatment problems, and [18F]-FDG positron emission tomography (PET) studies during wakefulness, NREM sleep to identify functional neuoanatomic correlates to affective disturbance and heightened arousal. We will address the following specific aims: Aim 1: To characterize the dimensions of affective disturbance and heightened
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arousal among patients with primary insomnia; the relationship of these dimensions to each other; and their relationships to insomnia symptoms. Aim 2: To determine the differential effects of treatment with an antidepressant (nefazodone), a benzodiazepine receptor agonist (zolpidem), and placebo on the dimensions of affective disturbance and heightened arousal in patients with primary insomnia. Aim 3: To examine the functional neuroanatomy of primary insomnia during waking, NREM sleep, and REM sleep as related to the dimensions of affective disturbance and heightened arousal. Results from this study will lead to improved understanding of the psychobiology of primary insomnia and its relationship to mood and anxiety disorders; better recognition of relevant insomnia subgroups for future classifications; and the development of more targeted and effective treatments for primary insomnia. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Role of Melatonin in Secondary Insomnia in the Elderly Principal Investigator & Institution: Gooneratne, Nalaka S.; Medicine; University of Pennsylvania 1 College Hall Philadelphia, Pa 19104 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2005 Summary: Chronic insomnia affects up to 30% of the elderly and significantly impairs quality of life and daytime functioning. It is often secondary to other medical conditions, such as pain from osteoarthritis. Recent work has suggested that melatonin, a neurohormone produced by the pineal gland and regulated by the suprachiasmatic nucleus, the primary circadian pacemaker, is decreased in elderly insomniacs. However, treatment trials in primary insomniacs have been equivocal. This has raised many questions regarding the function of melatonin such as its role in sleep-wake regulation and whether it has nocturnal sleeppromoting effects. Interestingly, pain and non-steroidal antiinflammatory drugs blunt melatonin rhythms. Thus, I believe that melatonin secretion is impaired in the elderly with chronic pain and that this contributes to their insomnia. To address the hypothesis, the applicant proposes the following aims: 1) A case-control study to test the hypothesis that melatonin deficiency is a risk factor for insomnia in the elderly with osteoarthritis pain and identify a threshold level to distinguish melatonin deficient patients; 2) A randomized, double-blind, placebo controlled trial of melatonin replacement therapy in elderly insomniacs with osteoarthritis pain to test the hypothesis that melatonin deficiency is a causal factor for their development of insomnia. Analysis will include univariable and multivariable models, and receiver operator
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curve analysis for Aim 1, and comparison of melatonin vs. placebo treatment arms on l objective parameters for Aim 2. This protocol may provide new insights into the neurohormonal risk factors for the development of insomnia, test the model that melatonin deficiency is a causal factor for insomnia, provide a mechanistic basis for targeted melatonin replacement therapy, and provide the training necessary to conduct rigorous, independently-funded, patient-oriented research. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Sleep Disturbances and Risk for Alcohol Disorders Principal Investigator & Institution: Crum, Rosa M.; Assistant Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 9-SEP-2001; Project End 1-AUG2003 Summary: (Provided by applicant): The overall aim of this application is to extend and strengthen prior work which has examined the relationship of insomnia and other sleep disturbances with the development of alcohol use disorders and problem drinking. The focus of the proposed analyses is the assessment of these association using data from two existing longitudinal surveys: 1) the Johns Hopkins Precursors study, and 2) the Baltimore ECA Follow-up Study. The primary goal of the current application is to assess the following specific aims: 1) to test whether insomnia and other sleep disturbances are associated with an increased risk for problematic alcohol use, and alcohol abuse and dependence; and whether this relationship differs by sex; 2) to test whether psychiatric comorbidity (such as depressive symptoms , depressive disorders, anxiety, and psychiatric distress) are mediators of this relationship; 3) to assess whether those with remitted alcohol abuse or dependence have higher rates of sleep disturbance compared to those who never abused alcohol; and 4) to assess the natural history of individuals with alcohol abuse and dependence who self-report insomnia and other sleep disturbances, specifically to test whether the prognosis for remission, drinking patterns presence of comorbid psychopathology, and subsequent sleep patterns differ for individuals with an alcohol use disorder, or problem drinking, if they have insomnia at baseline relative to those with alcohol abuse and dependence, or problem drinking who have no sleep disturbance. Prospective analyses of the relationship of insomnia with alcohol use disorders or problematic drinking have been few and of these prior studies, the follow-up intervals have been relatively short. We propose to complete secondary analyses of two wellstudied prospective data sets, that have long follow-up intervals (mean of
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13 years for the Baltimore ECA Follow- up study, and 36 to 50 years for the Johns Hopkins Precursors Study), and relatively low study attrition, which if successfully completed can improve our understanding of insomnia and other sleep difficulties as potential long term risk factors for problematic drinking behavior and alcohol abuse or dependence. Information from these unique data sets allow the ability to assess important mediating, as well as potential confounding and effect modifying characteristics such as the occurrence of depressive symptoms as well as other psychopathology and substance use. The data analyses should provide, in a cost-effective manner, information on the relationship of insomnia and alcohol condition, which will help guide future experimental and observational studies. The results may highlight a potential focus for future investigations of prevention and early intervention efforts for reducing the incidence and prevalence of alcohol abuse and dependence. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Yoga as a Treatment for Insomnia Principal Investigator & Institution: Khalsa, Sat B.; ; Brigham and Women's Hospital 75 Francis St Boston, Ma 02115 Timing: Fiscal Year 2000; Project Start 8-SEP-2000; Project End 1-AUG2005 Summary: (Applicant's Abstract): The purpose of this award is to provide support for a transition in career direction from basic research in circadian rhythms and sleep, to a long term goal of an established clinical research program evaluating effective alternative/complementary approaches in sleep disorders medicine. Immediate goals toward this end include training in clinical sleep disorders research. Participation in existing local training programs, courses, and seminars in the research fields of both sleep disorders and mind/body medicine will contribute to the career development plan. The main focus of this plan involves the completion of a research study to evaluate the effectiveness of yoga in treating insomnia. The primary sponsor of this award has a strong history of research in sleep disorders research whereas the cosponsor adds significant research experience in insomnia and the treatment of insomnia. The proposed collaborators will contribute additional expertise in insomnia and autonomic function. Brigham and Women's Hospital and the Harvard Medical area provide an ideal environment for research support and training in both sleep disorders and alternative medicine. Insomnia is a prevalent sleep disorder in which cognitive and/or physiological arousal associated with sustained sympathetic activation is one of the underlying causes. Treatments which address this arousal
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have been shown to be effective. Research studies have documented the effectiveness of yoga in reducing sympathetic activation and in the treatment of specific medical disorders. Although it has been used and recommended for the treatment of insomnia, its effectiveness has not been adequately evaluated. Subjective and objective measures of sleep and sympathovagal balance will be evaluated before and after a 2-month treatment in psychophysiological insomniacs randomized into yoga treatment and control groups. We anticipate that yoga will prove to be an effective insomnia treatment which reduces sympathovagal balance. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “insomnia” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for insomnia in the PubMed Central database: ·
Fatal Familial Insomnia and Familial Creutzfeldt-Jakob Disease: Different Prion Proteins Determined by a DNA Polymorphism by L Monari, SG Chen, P Brown, P Parchi, RB Petersen, J Mikol, F Gray, P Cortelli, P Montagna, B Ghetti, LG Goldfarb, DC Gajdusek, E Lugaresi, P Gambetti, and L Autilio-Gambetti; 1994 March 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43466
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Long term benzodiazepine use for insomnia in patients over the age of 60: discordance of patient and physician perceptions by Leevin Mah and Ross EG Upshur; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=113266
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20
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Treatment of primary insomnia by Jacques Montplaisir; 2000 August 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80369&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with insomnia, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “insomnia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “insomnia” (hyperlinks lead to article summaries): ·
86 cases of insomnia treated by double point needling--daling through to waiguan. Author(s): Ren Y. Source: J Tradit Chin Med. 1985 March; 5(1): 22. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3849624&dopt=Abstract
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A behavioral perspective on insomnia treatment. Author(s): Spielman AJ, Caruso LS, Glovinsky PB. Source: The Psychiatric Clinics of North America. 1987 December; 10(4): 541-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3332317&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults. Author(s): Edinger JD, Hoelscher TJ, Marsh GR, Lipper S, IonescuPioggia M. Source: Psychol Aging. 1992 June; 7(2): 282-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1610517&dopt=Abstract
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A comparison of progressive relaxation and autogenic training as treatments for insomnia. Author(s): Nicassio P, Bootzin R. Source: Journal of Abnormal Psychology. 1974 June; 83(3): 253-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4844912&dopt=Abstract
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A comparison of relaxation techniques with electrosleep therapy for chronic, sleep-onset insomnia a sleep-EEG study. Author(s): Coursey RD, Frankel BL, Gaarder KR, Mott DE. Source: Biofeedback Self Regul. 1980 March; 5(1): 57-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6989409&dopt=Abstract
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A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. Author(s): Friedman L, Bliwise DL, Yesavage JA, Salom SR. Source: J Gerontol. 1991 January; 46(1): P1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1986039&dopt=Abstract
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A reply to "Critique of 'Treatment of Insomnia by Relaxation Training': relaxation Training, Rogerian Therapy, or Demand Characteristics". Author(s): Baker BL, Kahn M. Source: Journal of Abnormal Psychology. 1972 February; 79(1): 94-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5060985&dopt=Abstract
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Active and placebo effects in treatment of moderate and severe insomnia. Author(s): Carr-Kaffashan L, Woolfolk RL.
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Source: J Consult Clin Psychol. 1979 December; 47(6): 1072-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=41856&dopt=Abstract ·
Active and placebo treatment effects on moderate insomnia under counterdemand and positive demand instructions. Author(s): Steinmark SW, Borkovec TD. Source: Journal of Abnormal Psychology. 1974 April; 83(2): 157-63. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4825210&dopt=Abstract
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An evaluation of behavioral treatments for insomnia in the older adult. Author(s): Engle-Friedman M, Bootzin RR, Hazlewood L, Tsao C. Source: Journal of Clinical Psychology. 1992 January; 48(1): 77-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1556221&dopt=Abstract
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An evaluation of tailored psychological treatment of insomnia. Author(s): Espie CA, Brooks DN, Lindsay WR. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1989 June; 20(2): 143-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2685045&dopt=Abstract
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An hypnotic technique for treating insomnia. Author(s): Bauer KE, McCanne TR. Source: Int J Clin Exp Hypn. 1980 January; 28(1): 1-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7353922&dopt=Abstract
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Behavioral self-management in treating sleep-maintenance insomnia. Author(s): Thoresen CE, Coates TJ, Kirmil-Gray K, Rosekind MR. Source: Journal of Behavioral Medicine. 1981 March; 4(1): 41-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7026793&dopt=Abstract
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Biofeedback and progressive relaxation treatment of sleep-onset insomnia: a controlled, all-night investigation. Author(s): Freedman R, Papsdorf JD.
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Source: Biofeedback Self Regul. 1976 September; 1(3): 253-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=791382&dopt=Abstract ·
Brief integrative dynamic psychotherapy for insomnia. Systematic evaluation of two cases. Author(s): Nielsen G. Source: Psychotherapy and Psychosomatics. 1990; 54(4): 187-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2100011&dopt=Abstract
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Causes and treatment of insomnia among adolescents. Author(s): Morrison JR, Kujawa E Jr, Storey BA. Source: The Journal of School Health. 1985 April; 55(4): 148-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3887034&dopt=Abstract
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Cerebral electrotherapy with electronic noise in neuroses and insomnia. Author(s): Grunner O, Petranek S, Jirovsky V. Source: Act Nerv Super (Praha). 1971; 13(3): 190. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5315626&dopt=Abstract
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Chronic insomnia: outcome of hypnotherapeutic intervention in six cases. Author(s): Becker PM. Source: Am J Clin Hypn. 1993 October; 36(2): 98-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8259769&dopt=Abstract
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Chronotherapy: resetting the circadian clocks of patients with delayed sleep phase insomnia. Author(s): Czeisler CA, Richardson GS, Coleman RM, Zimmerman JC, Moore-Ede MC, Dement WC, Weitzman ED. Source: Sleep. 1981; 4(1): 1-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7232967&dopt=Abstract
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Clinical trial of suanzaorentang in the treatment of insomnia. Author(s): Chen HC, Hsieh MT.
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Source: Clinical Therapeutics. 1985; 7(3): 334-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3888394&dopt=Abstract ·
Consulting about insomnia: a method and some preliminary data. Author(s): Hauri PJ. Source: Sleep. 1993 June; 16(4): 344-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8341895&dopt=Abstract
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Controlled comparison of progressive relaxation, stimulus control, and paradoxical intention therapies for insomnia. Author(s): Turner RM, Ascher LM. Source: J Consult Clin Psychol. 1979 June; 47(3): 500-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=393734&dopt=Abstract
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Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia. Author(s): Borkovec TD, Fowles DC. Source: Journal of Abnormal Psychology. 1973 August; 82(1): 153-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4730647&dopt=Abstract
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Coping with insomnia. Helping patients manage sleeplessness without drugs. Author(s): Fletcher DJ. Source: Postgraduate Medicine. 1986 February 1; 79(2): 265-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3511468&dopt=Abstract
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Delayed sleep phase syndrome. A chronobiological disorder with sleep-onset insomnia. Author(s): Weitzman ED, Czeisler CA, Coleman RM, Spielman AJ, Zimmerman JC, Dement W, Richardson G, Pollak CP. Source: Archives of General Psychiatry. 1981 July; 38(7): 737-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7247637&dopt=Abstract
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Effects of metronome-conditioned relaxation, metronome-induced relaxation, and progressive muscle relaxation on insomnia. Author(s): Pendleton LR, Tasto DL. Source: Behaviour Research and Therapy. 1976; 14(2): 165-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=779760&dopt=Abstract
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Efficacy of behavioral versus triazolam treatment in persistent sleeponset insomnia. Author(s): McClusky HY, Milby JB, Switzer PK, Williams V, Wooten V. Source: The American Journal of Psychiatry. 1991 January; 148(1): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1888345&dopt=Abstract
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Efficiency of transcranial electrostimulation on anxiety and insomnia symptoms during a washout period in depressed patients. A doubleblind study. Author(s): Philip P, Demotes-Mainard J, Bourgeois M, Vincent JD. Source: Biological Psychiatry. 1991 March 1; 29(5): 451-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2018818&dopt=Abstract
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Guided fantasy as a treatment for childhood insomnia. Author(s): Porter J. Source: The Australian and New Zealand Journal of Psychiatry. 1975 September; 9(3): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1106390&dopt=Abstract
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Hypnotic relaxation and the reduction of sleep onset insomnia. Author(s): Stanton HE. Source: Int J Psychosom. 1989; 36(1-4): 64-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2689375&dopt=Abstract
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Indirect suggestions through personalized fairy tales for treatment of childhood insomnia. Author(s): Levine ES.
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Source: Am J Clin Hypn. 1980 July; 23(1): 57-63. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7468519&dopt=Abstract ·
Insomnia among addicts during supervised withdrawal from opiates: a comparison of oral methadone and electrostimulation. Author(s): Gossop M, Bradley B. Source: Drug and Alcohol Dependence. 1984 March; 13(2): 191-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6609807&dopt=Abstract
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Insomnia and hypnotherapy. Author(s): Anderson JA, Dalton ER, Basker MA. Source: Journal of the Royal Society of Medicine. 1979 October; 72(10): 734-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=399619&dopt=Abstract
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Insomnia and related sleep disorders. Author(s): Mendelson WB. Source: The Psychiatric Clinics of North America. 1993 December; 16(4): 841-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8309815&dopt=Abstract
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Insomnia and the attribution process. Author(s): Storms MD, Nisbett RE. Source: J Pers Soc Psychol. 1970 October; 16(2): 319-28. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5479134&dopt=Abstract
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Insomnia. Author(s): Jahanshahi M. Source: Nursing (Lond). 1986 September; 3(9): 328-32. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3528949&dopt=Abstract
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Insomnia: nonpharmacologic management by private practice physicians. Author(s): Nicassio PM, Pate JK, Mendlowitz DR, Woodward N.
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Source: Southern Medical Journal. 1985 May; 78(5): 556-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2859655&dopt=Abstract ·
Lidocaine injection of auricular points in the treatment of insomnia. Author(s): Lee TN. Source: Am J Chin Med. 1977 Spring; 5(1): 71-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=848457&dopt=Abstract
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Multifactor behavioral treatment of chronic sleep-onset insomnia using stimulus control and the relaxation response. A preliminary study. Author(s): Jacobs GD, Rosenberg PA, Friedman R, Matheson J, Peavy GM, Domar AD, Benson H. Source: Behavior Modification. 1993 October; 17(4): 498-509. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8216184&dopt=Abstract
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Nonpharmacologic treatments of insomnia. Author(s): Bootzin RR, Perlis ML. Source: J Clin Psychiatry. 1992 June; 53 Suppl: 37-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1613018&dopt=Abstract
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Paradoxical intention in the treatment of chronic insomnia: six case studies illustrating variability in therapeutic response. Author(s): Espie CA, Lindsay WR. Source: Behaviour Research and Therapy. 1985; 23(6): 703-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3907617&dopt=Abstract
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Personality measures and evoked responses in chronic insomniacs. Author(s): Coursey RD. Source: Journal of Abnormal Psychology. 1975 June; 84(3): 239-49. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1133252&dopt=Abstract
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Progressive relaxation, EMG biofeedback and biofeedback placebo in the treatment of sleep-onset insomnia. Author(s): Nicassio PM, Boylan MB, McCabe TG.
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Source: The British Journal of Medical Psychology. 1982 June; 55(Pt 2): 159-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7104246&dopt=Abstract ·
Relaxation and hypnosis in the treatment of insomnia. Author(s): Graham KR, Wright GW, Toman WJ, Mark CB. Source: Am J Clin Hypn. 1975 July; 18(1): 39-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1163461&dopt=Abstract
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Relaxation for insomnia and hypnotic medication use in older women. Author(s): Lichstein KL, Johnson RS. Source: Psychol Aging. 1993 March; 8(1): 103-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8461107&dopt=Abstract
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Relaxation training and attention placebo in the treatment of severe insomnia. Author(s): Lick JR, Heffler D. Source: J Consult Clin Psychol. 1977 April; 45(2): 153-61. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=321491&dopt=Abstract
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Relaxation treatment for insomnia: a component analysis. Author(s): Woolfolk RL, McNulty TF. Source: J Consult Clin Psychol. 1983 August; 51(4): 495-503. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6352753&dopt=Abstract
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Relaxation treatment of pseudoinsomnia and idiopathic insomnia: an electroencephalographic evaluation. Author(s): Borkovec TD, Grayson JB, O'Brien GT, Weerts TC. Source: J Appl Behav Anal. 1979 Spring; 12(1): 37-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=381276&dopt=Abstract
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Resolving the relationships between placebos, misattribution, and insomnia: an individual-differences perspective. Author(s): Brockner J, Swap WC.
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Source: J Pers Soc Psychol. 1983 July; 45(1): 32-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6886968&dopt=Abstract
Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH]
Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Bibliotherapy: A form of supportive psychotherapy in which the patient is given carefully selected material to read. [NIH] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Comorbidity: Two or more diseases or conditions existing together in an individual. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Criterion: A standard by which something may be judged. [EU] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Pertaining to the epigastrium. [EU] Hypnotic: A drug that acts to induce sleep. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Idiopathic: Results from an unknown cause. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic,
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anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU]
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Paradoxical: Occurring at variance with the normal rule. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The number of events, e.g., instances of a given disease or other condition, in a given population at a designated time. When used without qualification, the term usually refers to the situation at specific point in time (point prevalence). Prevalence is a number, not a rate. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Rauwolfia: A genus of the Apocynaceae or dogbane family of tropical trees and shrubs containing alkaloids. These alkaloids have been used as tranquilizers and antihypertensive agents. Reserpine is derived from R. serpentina. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Remission: A diminution or abatement of the symptoms of a disease; also
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the period during which such diminution occurs. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Triazolam: A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries. [NIH]
Urinary: Pertaining to the urine; containing or secreting urine. [EU] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
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CHAPTER 5. PATENTS ON INSOMNIA Overview You can learn about innovations relating to insomnia by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with insomnia within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with insomnia. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
24Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Insomnia By performing a patent search focusing on insomnia, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on insomnia: ·
Method for treating anxiety, anxiety disorders and insomnia Inventor(s): Chouinard; Guy (4015 Chemin Trafalgar, Montreal, CA), Chouinard; Guy (4015 Chemin Trafalgar, Montreal, CA) Assignee(s): none reported, none reported Patent Number: 6,372,792 Date filed: January 29, 1998 Abstract: Treatment of the anxiety disorders and insomnia in humans may be accomplished by administering gabapentin in an effective amount. Excerpt(s): This invention relates to treatment of anxiety, including all of the anxiety disorders, and insomnia in humans by administration of gabapentin, its derivatives and pharmaceutically acceptable salts. ... This invention relates to treatment of anxiety, including all of the anxiety disorders, and insomnia in humans by administration of gabapentin, its derivatives and pharmaceutically acceptable salts. ... It has been found that gabapentin surprisingly has properties that also enables it to be used effectively to treat anxiety and all of the anxiety disorders, and may also be used to treat patients with insomnia. The etiology of anxiety and the anxiety disorders is unknown and the biochemical defect is also unknown. We postulate that the specific effect of gabapentin on insomnia, anxiety and the anxiety disorders implicates an indirect involvement with gamma aminobutyric acid (GABA) in its mechanism of action, as is the case for another group of drugs, the benzodiazepines, with their effects on anxiety and insomnia. It has been found that benzodiazepines act through their own benzodiazepine receptor which is coupled with the GABA receptor. We suggest that gabapentin does the same through its own receptor, which we name the Gabapentin receptor,
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also coupled with the GABA receptor. We propose that the gabapentin receptor is coupled with one of the subunits (.alpha., .beta., .delta. or .epsilon.) of the GABA.sub.A -receptor. This surprising finding has never been suggested or proposed previously. The clinical effects observed have lead us to this conclusion. Use of the term "gabapentin" in this application is intended to encompass gabapentin, pregabalin and their pharmaceutically acceptable salts. ... It has been found that gabapentin surprisingly has properties that also enables it to be used effectively to treat anxiety and all of the anxiety disorders, and may also be used to treat patients with insomnia. The etiology of anxiety and the anxiety disorders is unknown and the biochemical defect is also unknown. We postulate that the specific effect of gabapentin on insomnia, anxiety and the anxiety disorders implicates an indirect involvement with gamma aminobutyric acid (GABA) in its mechanism of action, as is the case for another group of drugs, the benzodiazepines, with their effects on anxiety and insomnia. It has been found that benzodiazepines act through their own benzodiazepine receptor which is coupled with the GABA receptor. We suggest that gabapentin does the same through its own receptor, which we name the Gabapentin receptor, also coupled with the GABA receptor. We propose that the gabapentin receptor is coupled with one of the subunits (.alpha., .beta., .delta. or .epsilon.) of the GABA.sub.A -receptor. This surprising finding has never been suggested or proposed previously. The clinical effects observed have lead us to this conclusion. Use of the term "gabapentin" in this application is intended to encompass gabapentin, pregabalin and their pharmaceutically acceptable salts. ... Generalized anxiety disorder (GAD) is characterized by intense fearfulness expressed through symptoms that can affect almost all anatomic body regions. In cases of panic attacks associated or not with panic disorder, anxiety symptoms are associated with recognizable panic attacks, with or without agoraphobia. The essential feature of a Panic Attack is a discrete period of intense fear or discomfort that is accompanied by at least 4 to 13 somatic or cognitive symptoms,. Panic Attacks can occur in a variety of Anxiety Disorders (e.g., Panic Disorders, Social Phobia, Posttraumatic Stress Disorder). Essential and specific features of GAD remain to be the presence of unrealistic and inappropriate apprehensive expectation, which may persist for several months and be associated to secondary symptoms, including signs of vigilance (irritability, insomnia, difficulty concentrating), motor tension (trembling, muscle tension, restlessness, fatigability), and autonomic hyperactivity (cardiac palpitations, shortness of breath, smothering sensations, sweatiness of hands and skin). ... Generalized anxiety disorder (GAD) is characterized by intense fearfulness expressed through symptoms that can affect almost all anatomic body regions. In cases of
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panic attacks associated or not with panic disorder, anxiety symptoms are associated with recognizable panic attacks, with or without agoraphobia. The essential feature of a Panic Attack is a discrete period of intense fear or discomfort that is accompanied by at least 4 to 13 somatic or cognitive symptoms,. Panic Attacks can occur in a variety of Anxiety Disorders (e.g., Panic Disorders, Social Phobia, Posttraumatic Stress Disorder). Essential and specific features of GAD remain to be the presence of unrealistic and inappropriate apprehensive expectation, which may persist for several months and be associated to secondary symptoms, including signs of vigilance (irritability, insomnia, difficulty concentrating), motor tension (trembling, muscle tension, restlessness, fatigability), and autonomic hyperactivity (cardiac palpitations, shortness of breath, smothering sensations, sweatiness of hands and skin). Web site: http://www.delphion.com/details?pn=US06372792__ ·
Treatment of insomnia Inventor(s): Kavey; Neil B. (26 W. Orchard Rd., Chappaqua, NY 10514), Kavey; Neil B. (26 W. Orchard Rd., Chappaqua, NY 10514) Assignee(s): none reported, none reported Patent Number: 6,344,487 Date filed: June 5, 2000 Abstract: The invention is directed to a method for the treatment of a patient suffering from insomnia. The claimed method comprises the administration of a compound selected from the group consisting of the pharmaceutically acceptable forms of dosage of mirtazapine, nortriptyline and mixtures thereof in dosages ranging from about 0.5 to about 10.0 milligrams. Excerpt(s): This invention relates to a method for the treatment of individuals suffering from insomnia. ... This invention relates to a method for the treatment of individuals suffering from insomnia. ... A large percentage of the adult population suffers from insomnia in some form at some time in their lives. This may vary from a single episode of one night's duration to chronic conditions. Transient insomnia is an insomnia that is present for one to several days, and is less than one week in duration. Short term insomnia is an insomnia of one to three weeks in duration. Chronic insomnia is typically accepted to involve episodes greater than three (3) weeks in duration. The insomnia may further involve onset insomnia (difficulty in falling asleep) and/or maintenance insomnia (difficulty in maintaining uninterrupted sleep). It is well known that the sleep deprivation resulting from such insomnia adversely affects
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cognition, safety and quality of life. ... A large percentage of the adult population suffers from insomnia in some form at some time in their lives. This may vary from a single episode of one night's duration to chronic conditions. Transient insomnia is an insomnia that is present for one to several days, and is less than one week in duration. Short term insomnia is an insomnia of one to three weeks in duration. Chronic insomnia is typically accepted to involve episodes greater than three (3) weeks in duration. The insomnia may further involve onset insomnia (difficulty in falling asleep) and/or maintenance insomnia (difficulty in maintaining uninterrupted sleep). It is well known that the sleep deprivation resulting from such insomnia adversely affects cognition, safety and quality of life. ... Known treatments for insomnia include the administration of medication, either of the non-barbiturate or barbiturate type, shortly before bedtime. While both types of sedatives may be used to effectively treat insomnia, neither is without its undesirable side effects. Barbiturate type sedatives, such as secobarbital (sold by Eli Lilly and Company under the tradename of Seconal.RTM.) are general depressants. While effective, these medications are well known to lose their effectiveness after a few days. Furthermore, they are highly addictive and commonly abused. They are therefore no longer widely prescribed. ... Known treatments for insomnia include the administration of medication, either of the non-barbiturate or barbiturate type, shortly before bedtime. While both types of sedatives may be used to effectively treat insomnia, neither is without its undesirable side effects. Barbiturate type sedatives, such as secobarbital (sold by Eli Lilly and Company under the tradename of Seconal.RTM.) are general depressants. While effective, these medications are well known to lose their effectiveness after a few days. Furthermore, they are highly addictive and commonly abused. They are therefore no longer widely prescribed. Web site: http://www.delphion.com/details?pn=US06344487__ ·
Use of Gaba-analogues for treating insomnia Inventor(s): Magnus; Leslie (Livingston, NJ), Segal; Catherine A. (Chester, NJ), Magnus; Leslie (Livingston, NJ), Segal; Catherine A. (Chester, NJ) Assignee(s): Warner-Lambert Company (Morris Plains, NJ), WarnerLambert Company (Morris Plains, NJ) Patent Number: 6,306,910 Date filed: January 9, 2001 Abstract: The instant invention is a method of using analogs of glutamic acid and gamma-aminobutyric acid to treat insomnia.
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Excerpt(s): The present invention relates to the use of analogs of glutamic acid and gamma-aminobutyric acid (GABA) for the treatment of insomnia. ... The present invention relates to the use of analogs of glutamic acid and gamma-aminobutyric acid (GABA) for the treatment of insomnia. ... Insomnia and sleeplessness are common problems. Often, the insomnia or sleeplessness is precipitated by stress, emotional and physical causes. ... Insomnia and sleeplessness are common problems. Often, the insomnia or sleeplessness is precipitated by stress, emotional and physical causes. ... All that is required to practice the method of this invention is to administer a GABA analog in an amount that is effective to treat insomnia. Such amounts will generally be from about 1 to about 300 mg per kg of subject body weight. Typical doses will be from about 10 to about 5000 mg per day for an adult subject of normal weight. It is expected that common doses that might be administered could be from 100 mg three times a day up to 600 mg four times a day. Commercially available capsules of 100 mg, 300 mg, and 400 mg of gabapentin can be administered. Alternate forms include liquids and film-coated tablets. ... All that is required to practice the method of this invention is to administer a GABA analog in an amount that is effective to treat insomnia. Such amounts will generally be from about 1 to about 300 mg per kg of subject body weight. Typical doses will be from about 10 to about 5000 mg per day for an adult subject of normal weight. It is expected that common doses that might be administered could be from 100 mg three times a day up to 600 mg four times a day. Commercially available capsules of 100 mg, 300 mg, and 400 mg of gabapentin can be administered. Alternate forms include liquids and film-coated tablets. Web site: http://www.delphion.com/details?pn=US06306910__ ·
Treatment of transient and short term insomnia Inventor(s): Kavey; Neil B. (26 W. Orchard Rd., Chappaqua, NY 10514), Kavey; Neil B. (26 W. Orchard Rd., Chappaqua, NY 10514) Assignee(s): none reported, none reported Patent Number: 6,211,229 Date filed: February 17, 2000 Abstract: The invention is directed to a method for the treatment of a patient suffering from transient or short term insomnia. The claimed method comprises the administration of a compound selected from the group consisting of the pharmaceutically acceptable forms of doxepin, amitriptyline, trimipramine, trazodone and mixtures thereof in dosages ranging from about 0.5 to about 20.0 milligrams.
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Excerpt(s): This invention relates to a method for the treatment of individuals suffering from transient or short term insomnia. ... This invention relates to a method for the treatment of individuals suffering from transient or short term insomnia. ... A large percentage of the adult population suffers from insomnia in some form at some time in their lives. This may vary from a single episode of one night's duration to chronic conditions. Transient insomnia is an insomnia that is present for one to several days, and is less than one week in duration. Short term insomnia is an insomnia of one to three weeks in duration. Chronic insomnia is typically accepted to involve episodes greater than three (3) weeks in duration. The insomnia may further involve onset insomnia (difficulty in falling asleep) and/or maintenance insomnia (difficulty in maintaining uninterrupted sleep). It is well known that the sleep deprivation resulting from such insomnia adversely affects cognition, safety and quality of life. ... A large percentage of the adult population suffers from insomnia in some form at some time in their lives. This may vary from a single episode of one night's duration to chronic conditions. Transient insomnia is an insomnia that is present for one to several days, and is less than one week in duration. Short term insomnia is an insomnia of one to three weeks in duration. Chronic insomnia is typically accepted to involve episodes greater than three (3) weeks in duration. The insomnia may further involve onset insomnia (difficulty in falling asleep) and/or maintenance insomnia (difficulty in maintaining uninterrupted sleep). It is well known that the sleep deprivation resulting from such insomnia adversely affects cognition, safety and quality of life. ... Known treatments for insomnia include the administration of medication, either of the non-barbiturate or barbiturate type, shortly before bedtime. While both types of sedatives may be used to effectively treat insomnia, neither is without its undesirable side effects. Barbiturate type sedatives, such as secobarbital (sold by Eli Lilly and Company under the tradename of Seconal.RTM.) are general depressants. While effective, these medications are well known to lose their effectiveness after a few days. Furthermore, they are highly addictive and commonly abused. They are therefore no longer widely prescribed. ... Known treatments for insomnia include the administration of medication, either of the nonbarbiturate or barbiturate type, shortly before bedtime. While both types of sedatives may be used to effectively treat insomnia, neither is without its undesirable side effects. Barbiturate type sedatives, such as secobarbital (sold by Eli Lilly and Company under the tradename of Seconal.RTM.) are general depressants. While effective, these medications are well known to lose their effectiveness after a few days. Furthermore, they are highly addictive and commonly abused. They are therefore no longer widely prescribed.
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Web site: http://www.delphion.com/details?pn=US06211229__ ·
Method for treating insomnia Inventor(s): Tran; Pierre Van (Carmel, IN), Tran; Pierre Van (Carmel, IN) Assignee(s): Eli Lilly and Company (Indianapolis, IN), Eli Lilly and Company (Indianapolis, IN) Patent Number: 5,744,470 Date filed: February 10, 1997 Abstract: The invention provides a method for treating insomnia comprising administering an effective amount of olanzapine to a patient in need thereof. Excerpt(s): This invention provides a method for using 2-methyl-4-(4methyl-1-piperazinyl)-10H-thieno›2,3-b!›1,5!benzodiazepine, (hereinafter referred as "olanzapine"), for the treatment of insomnia. ... This invention provides a method for using 2-methyl-4-(4-methyl-1-piperazinyl)-10Hthieno›2,3-b!›1,5!benzodiazepine, (hereinafter referred as "olanzapine"), for the treatment of insomnia. ... Insomnia is one of the most common complaints in general medical practice. There is a one year prevalance of as high as 40%. DSM-IV, p. 553 (American Psychiatric Association, Washington, D.C. 1994). A variety of pharmacological agents are used to treat insomnia; however, the "perfect" agent would allow sleep to occur, with normal sleep architecture, rather than produce a pharmacologically altered sleep pattern. The "perfect" agent would not cause next-day effects, either rebound anxiety or continued sedation. There continues to be a need for more desirable drugs having at least several of the characteristics described for the "perfect" agent. ... Insomnia is one of the most common complaints in general medical practice. There is a one year prevalance of as high as 40%. DSM-IV, p. 553 (American Psychiatric Association, Washington, D.C. 1994). A variety of pharmacological agents are used to treat insomnia; however, the "perfect" agent would allow sleep to occur, with normal sleep architecture, rather than produce a pharmacologically altered sleep pattern. The "perfect" agent would not cause next-day effects, either rebound anxiety or continued sedation. There continues to be a need for more desirable drugs having at least several of the characteristics described for the "perfect" agent. ... Benzodiazepine hypnotics have been prescribed in the past; however, benzodiazepines are generally not a drug of choice for the treatment of insomnia due to benzodiazepine side effects and difficulties with treating the elderly patient with benzodiazepines. Untreated or improperly treated insomnia is associated with a four fold increase in accidents.
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Goodman and Gillman, The Pharmacological Basis of Therapeutics, 385 (McGraw Hill, New York 9th ed.) 1996. ... Benzodiazepine hypnotics have been prescribed in the past; however, benzodiazepines are generally not a drug of choice for the treatment of insomnia due to benzodiazepine side effects and difficulties with treating the elderly patient with benzodiazepines. Untreated or improperly treated insomnia is associated with a four fold increase in accidents. Goodman and Gillman, The Pharmacological Basis of Therapeutics, 385 (McGraw Hill, New York 9th ed.) 1996. Web site: http://www.delphion.com/details?pn=US05744470__ ·
Natural sleeping pill to prevent and alleviate insomnia Inventor(s): Jean-Louis; Louis J. (951 mWillowleaf Dr., No. 1404, San Jose, CA 95128), Jean-Louis; Sylvia L. (951 mWillowleaf Dr., No. 1404, San Jose, CA 95128), Jean-Louis; Louis J. (951 mWillowleaf Dr., No. 1404, San Jose, CA 95128), Jean-Louis; Sylvia L. (951 mWillowleaf Dr., No. 1404, San Jose, CA 95128) Assignee(s): none reported, none reported Patent Number: 4,833,154 Date filed: December 14, 1987 Abstract: A natural sleeping pill for preventing and alleviating insomnia, designed specifically for people who enjoy absolutely no benefit from other conventional drugs and those who abstain from their use because of their highly addictive nature and side-effects and the same comprises Vitamin C in dosage, including but not limited to, 10,000 MG; LTryptrophane in dosage, including but not limited to, 6,000 MG; Calcium in dosage, including but not limited to, 1,000 MG; and Inositol in dosage, including but not limited, to 1,000 MG. The foregoing dosages may be increased or decreased to suit the particular needs of the different facets of the insomniac population. Moreover, the different dosages of these four (4) natural and organic substances will be pulverized and may be recommended for use as is or enclosed in a bio-degradable capsule for oral ingestion by those seeking genuine relief from insomnia. This is, in short, the formula for a revolutionary, highly efficient, non-addictive, natural sedative to prevent, treat otherwise alleviate insomnia, thereby bring genuine relief to tens of millions of people who are suffering from this so-called incurable disease. Excerpt(s): This invention relates to the field of natural, non-prescription sleeping medications. It's a natural sedative which prevents and alleviates insomnia. It is specifically designed for all people, especially
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those who, for one reason or another, do not find any relief from the use of other conventional drugs. Some of these people are reluctanct to ingest these products because of their highly addictive nature and the dangerous side-effects they cause. ... This invention relates to the field of natural, non-prescription sleeping medications. It's a natural sedative which prevents and alleviates insomnia. It is specifically designed for all people, especially those who, for one reason or another, do not find any relief from the use of other conventional drugs. Some of these people are reluctanct to ingest these products because of their highly addictive nature and the dangerous side-effects they cause. ... Heretofore a wide variety of sleeping medications have been produced and are currently available on the market today. Each one of them, however, has some rather serious drawbacks. Some of them provide relief only to a small segment of the insomniac population, while the majority of those suffering from this terrible disease derive no benefit from them whatsoever. Others are highly addictive and produce some dangerous side-effects. These side-effects range from drowsiness to dry mouth, dizziness, blurred vision, stuffy nose, constipation, rapid heart beat, muscle spasms, restlessness, stiffness, uncontrollable trembling and shaking of hands, fingers and feet, reduced sexual drive, infertility, major weight gain and menstrual irregularities in women. In addition, the possibility still exists that the protracted use of these prescriptions may later cause other physical and emotional problems that are yet unknown to the medical community. It is not hyperbolic, then, to corroborate that the risks that some of these sleeping pills pose to consumers' health and physical wellbeing far outweigh the temporary relief they derive from their use. It is, therefore, conclusive that the tens of millions of people who are suffering from insomnia will find it highly desirable to have a sleeping pill, which is highly effective, non-addictive and does not cause any of the foregoing side-effects. ... Heretofore a wide variety of sleeping medications have been produced and are currently available on the market today. Each one of them, however, has some rather serious drawbacks. Some of them provide relief only to a small segment of the insomniac population, while the majority of those suffering from this terrible disease derive no benefit from them whatsoever. Others are highly addictive and produce some dangerous side-effects. These sideeffects range from drowsiness to dry mouth, dizziness, blurred vision, stuffy nose, constipation, rapid heart beat, muscle spasms, restlessness, stiffness, uncontrollable trembling and shaking of hands, fingers and feet, reduced sexual drive, infertility, major weight gain and menstrual irregularities in women. In addition, the possibility still exists that the protracted use of these prescriptions may later cause other physical and emotional problems that are yet unknown to the medical community. It is
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not hyperbolic, then, to corroborate that the risks that some of these sleeping pills pose to consumers' health and physical wellbeing far outweigh the temporary relief they derive from their use. It is, therefore, conclusive that the tens of millions of people who are suffering from insomnia will find it highly desirable to have a sleeping pill, which is highly effective, non-addictive and does not cause any of the foregoing side-effects. ... Consequently, we claim the following as the objects and advantages of the invention: to produce a highly effective and natural sleeping pill to prevent and relieve insomnia. This substance is specifically designed for all people, especially those who find that other conventional medications that are currently on the market do not alleviate their condition. ... Consequently, we claim the following as the objects and advantages of the invention: to produce a highly effective and natural sleeping pill to prevent and relieve insomnia. This substance is specifically designed for all people, especially those who find that other conventional medications that are currently on the market do not alleviate their condition. Web site: http://www.delphion.com/details?pn=US04833154__ ·
Field producing instrument for the electrotherapeutic self-treatment of pain and insomnia Inventor(s): Bacchelli; Luciano (4, rue d'Orzival, Sierre Vallese, CH), Bacchelli; Luciano (4, rue d'Orzival, Sierre Vallese, CH) Assignee(s): none reported, none reported Patent Number: 4,616,654 Date filed: October 9, 1984 Abstract: Disclosed herein is an instrument for the electrotherapeutic selftreatment of pain and insomnia comprising a set of three plates, coplanar one with respect to the other and interspaced, the two outside ones of which are connected to the negative pole of a current generator constituted by a microbattery, while the one in the center is connected to the positive pole. The outside plates and the one in the center define electrodes made of metal of different characteristics, the former zinc and the latter brass.In this way, two different electric fields are originated: one at the surface due to the diversity in the nature of the electrodes and one deep-seated due to the auxiliary generator. Excerpt(s): The invention relates to a personal use field producing instrument of a new type for the electrotherapeutic self-treatment of pain and insomnia, constituted by a very small device whose dimensions and lightness are such as to render it suitable to be applied directly, held in
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position by means of a plaster or anything else able to maintain it in close contact, to any painful part of the body for an unlimited amount of time both during the day and the night. The solution evolved is, in fact, the fruit of ambition whereby it be possible for all and sundry to possess a personal instrument that fits into the pocket and has the ability to eliminate pains, free one from anxiety and depression, overcome insomnia, cure colds and provide a remedy for the annoyance of snoring, without encumbering leads or other application dependent items. ... The invention relates to a personal use field producing instrument of a new type for the electrotherapeutic self-treatment of pain and insomnia, constituted by a very small device whose dimensions and lightness are such as to render it suitable to be applied directly, held in position by means of a plaster or anything else able to maintain it in close contact, to any painful part of the body for an unlimited amount of time both during the day and the night. The solution evolved is, in fact, the fruit of ambition whereby it be possible for all and sundry to possess a personal instrument that fits into the pocket and has the ability to eliminate pains, free one from anxiety and depression, overcome insomnia, cure colds and provide a remedy for the annoyance of snoring, without encumbering leads or other application dependent items. ... In addition to what has been stated above, the said plates cannot be applied properly onto the acupuncture meridian points, they do not combat anxiety, depression, insomnia and snoring, and they cannot be applied to the skin for an unlimited period of time. ... In addition to what has been stated above, the said plates cannot be applied properly onto the acupuncture meridian points, they do not combat anxiety, depression, insomnia and snoring, and they cannot be applied to the skin for an unlimited period of time. Web site: http://www.delphion.com/details?pn=US04616654__
Patent Applications on Insomnia As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to insomnia:
25
This has been a common practice outside the United States prior to December 2000.
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·
Method of treating hypersomnia sleep disturbance or insomnia sleep disturbance that is secondary to another condition Inventor(s): McLeod, Malcolm N. ; (Chapel Hill, NC) Correspondence: Jenkins & Wilson, PA; 3100 Tower Blvd; Suite 1400; Durham; NC; 27707; US Patent Application Number: 20020032182 Date filed: July 31, 2001 Abstract: The method of this invention is directed to a treatment of hypersomnia or insomnia that is secondary to another condition in men and women by administering to a patient a therapeutically effective amount of chromium in a pharmaceutically acceptable form, for instance in conjunction with the administration of another composition to treat the other condition, such as a standard antidepressant composition, such as a selective serotonin reuptake inhibitor composition. Chromium is administered to the patient at dosages in a preferred range of about 200 to about 500 micrograms chromium. Excerpt(s): The present invention relates generally to a treatment for a sleep disturbance, i.e., sleepiness (clinically known as hypersomnia) or insomnia, that is secondary to another condition, i.e., depression or premenstrual syndrome, and more particularly to the treatment of sleepiness or insomnia, that is secondary to depression or pre-menstrual syndrome, using chromium. The present invention even more particularly relates to a method of treating the sleepiness or insomnia, that is secondary to depression or pre-menstrual syndrome, by administering chromium to a patient concurrently with the administration of an antidepressant composition, for instance a selective serotonin reuptake inhibitor such as sertraline or paroxetine, to the patient. ... It is also preferable to take the last, or only, daily dose of chromium eight (8) hours prior to sleep to avoid insomnia. It is also noted that diabetics and hypoglycemics should use chromium only under a physician's supervision. ... During the fourth week she took ginseng and continued sertraline at 100 mg per day. During the middle of this week she complained of low energy, headache, restlessness, and initial insomnia. She stated that she definitely had less energy than week two when she was taking chromium picolinate. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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·
Method for the treatment of insomnia Inventor(s): Magnus, Leslie ; (Livingston, NJ), Segal, Catherine A. ; (Chester, NJ) Correspondence: Charles W. Ashbrook; Warner-Lambert Company; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20020004528 Date filed: August 3, 2001 Abstract: The instant invention is a method of using certain analogs of glutamic acid and gamma-aminobutyric acid to treat insomnia. Excerpt(s): The present invention relates to the use of analogs of glutamic acid and gamma-aminobutyric acid (GABA) for the treatment of insomnia. ... Insomnia and sleeplessness are common problems. Often, the insomnia or sleeplessness is precipitated by stress, emotional and physical causes. ... All that is required to practice the method of this invention is to administer a GABA analog in an amount that is effective to treat insomnia. Such amounts will generally be from about 1 to about 300 mg per kg of subject body weight. Typical doses will be from about 10 to about 5000 mg per day for an adult subject of normal weight. It is expected that common doses that might be administered could be from 100 mg three times a day up to 600 mg four times a day. Commercially available capsules of 100 mg, 300 mg, and 400 mg of gabapentin can be administered. Alternate forms include liquids and film-coated tablets. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with insomnia, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “insomnia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on insomnia. You can also use this procedure to view pending patent applications concerning insomnia. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click
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on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Cardiac: Pertaining to the heart. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Microgram: A unit of mass (weight) of the metric system, being onemillionth of a gram (10-6 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Nortriptyline: A metabolite of amitryptyline that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Secobarbital: A barbiturate that is used as a sedative. Secobarbital is reported to have no anti-anxiety activity. [NIH] Trimipramine: Tricyclic antidepressant similar to imipramine, but with more antihistaminic and sedative properties. [NIH]
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CHAPTER 6. BOOKS ON INSOMNIA Overview This chapter provides bibliographic book references relating to insomnia. You have many options to locate books on insomnia. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on insomnia include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “insomnia” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on insomnia: ·
Live Now, Age Later: Proven Ways to Slow Down the Clock Source: New York, NY: Warner Books. 1999. 398 p.
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Contact: Available from Warner Books. 1271 Avenue of the Americas, New York, NY 10020. (800) 759-0190. E-mail:
[email protected]. Website: www.twbookmark.com. PRICE: $7.99 plus shipping and handling. Summary: This book offers practical strategies and healthy living advice for people who want to slow down their own aging process. The book is written in casual language with an emphasis on explaining medical and health issues for the general public. Twenty chapters cover Alzheimer's disease, cancer, constipation, depression, hearing loss, heart attacks, erectile dysfunction (impotence), insomnia, libido, menopause, osteoarthritis, osteoporosis, prostate enlargement, aging skin, stroke, diminished taste and smell, tinnitus, tooth loss, and loss of vision (macular degeneration, cataracts, glaucoma). Each chapter reviews the topic in question, risk factors, the type of symptoms that can be expected, diagnostic tests that are used to confirm the problem, treatment options, and prognosis. A final section offers general health guidelines that focus on the importance of positive thinking and healthy lifestyle choices. A subject index concludes the book.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to insomnia (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
A Good Night's Sleep : A Step-By-Step Program for Overcoming Insomnia and Other Sleep Problems by Jerrold S. Maxmen (1985); ISBN: 0393014371; http://www.amazon.com/exec/obidos/ASIN/0393014371/icongroupin terna
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Anyone for Insomnia? : A Playful Look at Sleeplessness by Richard Willard Armour (1982); ISBN: 0912800690; http://www.amazon.com/exec/obidos/ASIN/0912800690/icongroupin terna
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Beat Insomnia by James Wagenvoord (1984); ISBN: 0688031684; http://www.amazon.com/exec/obidos/ASIN/0688031684/icongroupin terna
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Behavioral Treatment for Persistent Insomnia (1987); ISBN: 0205144004; http://www.amazon.com/exec/obidos/ASIN/0205144004/icongroupin terna
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Behavioral Treatment for Persistent Insomnia (Psychology Practitioner Guidebooks) by Patricia Lacks (1987); ISBN: 0205143997; http://www.amazon.com/exec/obidos/ASIN/0205143997/icongroupin terna
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Case Studies in Insomnia (Critical Issues in Psychiatry) by Peter J. Hauri (Editor) (1991); ISBN: 0306437910; http://www.amazon.com/exec/obidos/ASIN/0306437910/icongroupin terna
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Creative Insomnia by Douglas Colligan (1978); ISBN: 0531099016; http://www.amazon.com/exec/obidos/ASIN/0531099016/icongroupin terna
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Don't Just Lie There : Michael Van Straten's Guide to Good Sleep by Michael Van Straten (1991); ISBN: 1856260127; http://www.amazon.com/exec/obidos/ASIN/1856260127/icongroupin terna
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Easy Sleep : How to Get and Keep It by John Gnap (1978); ISBN: 0812824350; http://www.amazon.com/exec/obidos/ASIN/0812824350/icongroupin terna
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Evaluation and Treatment of Insomnia by Anthony Kales (1984); ISBN: 0195034341; http://www.amazon.com/exec/obidos/ASIN/0195034341/icongroupin terna
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Everybody's Guide to Natural Sleep (1990); ISBN: 0874775698; http://www.amazon.com/exec/obidos/ASIN/0874775698/icongroupin terna
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Everybody's Guide to Natural Sleep : A Drug-Free Approach to Overcoming Insomnia and Other Sleep Disorders by Philip Goldberg, Daniel Kaufman (1990); ISBN: 0874775701; http://www.amazon.com/exec/obidos/ASIN/0874775701/icongroupin terna
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Get a Better Night's Sleep by Ian Oswald, Kirstine Adam (1983); ISBN: 0668053356; http://www.amazon.com/exec/obidos/ASIN/0668053356/icongroupin terna
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Getting to Sleep : Simple, Effective Methods for Falling and Staying Asleep, Getting the Rest You Need, and Awakening Refreshed and Renewed by Ellen Mohr Catalano (1990); ISBN: 0934986932; http://www.amazon.com/exec/obidos/ASIN/0934986932/icongroupin terna
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How to Get a Good Night's Sleep by Richard Trubo (1978); ISBN: 0316853496; http://www.amazon.com/exec/obidos/ASIN/0316853496/icongroupin terna
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How to Sleep Better : A Drug-Free Program for Overcoming Insomnia by Thomas J., Coates (1977); ISBN: 0134338545; http://www.amazon.com/exec/obidos/ASIN/0134338545/icongroupin terna
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How to Sleep Without Drugs by Jeffrey Sussman (1989); ISBN: 0870523139; http://www.amazon.com/exec/obidos/ASIN/0870523139/icongroupin terna
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Imidazopyridines in Sleep Disorders : A Novel Experimental and Therapeutic Approach (L.E.R.S. Monograph Series, Vol 6) by J.P. Sauvanet, et al (1987); ISBN: 0881673773; http://www.amazon.com/exec/obidos/ASIN/0881673773/icongroupin terna
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Inside Insomnia/How to Sleep Better Tonight by Bernard V. Dryer, Ellen S. Kaplan (1986); ISBN: 0394746198; http://www.amazon.com/exec/obidos/ASIN/0394746198/icongroupin terna
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Insomnia : A Guide for Medical Practitioners by A. N. Nicholson (1984); ISBN: 0852007639; http://www.amazon.com/exec/obidos/ASIN/0852007639/icongroupin terna
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Insomniacs of the World, Goodnight; A Bedside Book, by Random House [1974]Rc New York (1974); ISBN: 0394489985; http://www.amazon.com/exec/obidos/ASIN/0394489985/icongroupin terna
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Natural Sleep : (How to Get Your Share ) by Philip Goldberg, Daniel Kaufman (1978); ISBN: 0878572163; http://www.amazon.com/exec/obidos/ASIN/0878572163/icongroupin terna
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Overcoming Insomnia (1989); ISBN: 0399134603; http://www.amazon.com/exec/obidos/ASIN/0399134603/icongroupin terna
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Overcoming Insomnia : A Medical Program for Problem Sleepers by Donald Sweeney (1989); ISBN: 0399134050; http://www.amazon.com/exec/obidos/ASIN/0399134050/icongroupin terna
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Rock and Roll Babylon by John Pidgeon (1981); ISBN: 0831774193; http://www.amazon.com/exec/obidos/ASIN/0831774193/icongroupin terna
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Sleep and Sleeplessness in Advanced Age by Rene Spiegel (1980); ISBN: 0893351040; http://www.amazon.com/exec/obidos/ASIN/0893351040/icongroupin terna
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Sleep at Last or How Not to Be an Insomniac by Paul James (1982); ISBN: 0831749008; http://www.amazon.com/exec/obidos/ASIN/0831749008/icongroupin terna
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Sleep, Benzodiazepines and Performance : Experimental Methodologies and Research Prospects by I. Hindmarch (Editor) (1984); ISBN: 0387132910; http://www.amazon.com/exec/obidos/ASIN/0387132910/icongroupin terna
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Sleeping Pills, Insomnia, and Medical Practice : Report of a Study 98P by Institute of Medicine. Division of Mental Health and Behavio (1979); ISBN: 0309028817; http://www.amazon.com/exec/obidos/ASIN/0309028817/icongroupin terna
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Somniquest : The 5 Types of Sleeplessness and How to Overcome Them by Alice Kuhn Schwartz (1979); ISBN: 0517536986; http://www.amazon.com/exec/obidos/ASIN/0517536986/icongroupin terna
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Sound Sleep (1980); ISBN: 0671449117; http://www.amazon.com/exec/obidos/ASIN/0671449117/icongroupin terna
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Sound Sleep : Key to a Healthier Life by Quentin R. Regestein (1980); ISBN: 0671249606; http://www.amazon.com/exec/obidos/ASIN/0671249606/icongroupin terna
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Stress Test Biofeedback Card and Booklet by Alfred A. Barrios (1985); ISBN: 0960192638; http://www.amazon.com/exec/obidos/ASIN/0960192638/icongroupin terna
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Sweet Dreams : A Guide to Productive Sleep by Frank B;Meier, Paul Minirth, Richard Flournoy (1985); ISBN: 093362901X; http://www.amazon.com/exec/obidos/ASIN/093362901X/icongroupi nterna
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Sweet Dreams : Fourteen Ways to Sleep at Will by George Bemis Belting, Elizabeth Kuhl Belting (1976); ISBN: 0847316092; http://www.amazon.com/exec/obidos/ASIN/0847316092/icongroupin terna
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The Sleep Book : Understanding and Preventing Sleep Problems in People over 50 by Ernest Hartmann (1987); ISBN: 0673248259; http://www.amazon.com/exec/obidos/ASIN/0673248259/icongroupin terna
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The Use and Misuse of Sleeping Pills : A Clinical Guide to Treatment by Wallace B. Mendelson (1980); ISBN: 0306403706; http://www.amazon.com/exec/obidos/ASIN/0306403706/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “insomnia” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Behavioral treatment for persistent insomnia. Author: Patricia Lacks; Year: 1987; New York: Pergamon Press, 1987; ISBN: 008034318X http://www.amazon.com/exec/obidos/ASIN/008034318X/icongroupi nterna
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Benzodiazepines and insomnia: papers from symposia held at the VII World Congress of Psychiatry, Vienna, July 1983, and the 14th CINP Congress, Florence, June 1984. Author: guest editors, Malcolm Lader, Elio Lugaresi, Robert G. Richardson; Year: 1985; New York, N.Y., U.S.A.: Raven Press, c1985
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Case studies in insomnia. Author: edited by Peter J. Hauri; with a foreword by William C. Dement; Year: 1991; New York: Plenum Medical Book Co., c1991; ISBN: 0306437910 http://www.amazon.com/exec/obidos/ASIN/0306437910/icongroupin terna
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Congestive neurasthenia, or insomnia and nerve depression. Author: Whittle, Edward George; Year: 1889; London, Lewis, 1889
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Creative insomnia. Author: Douglas Colligan; Year: 1978; New York: Watts, 1978; ISBN: 0531099016 http://www.amazon.com/exec/obidos/ASIN/0531099016/icongroupin terna
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Dental-mental connection: insomnia and nerve strain: oral infection & mental diseases. Author: Davidson, Jonathan R. T., 1943-; Year: 1999; Santa Monica, Calif.: Institute of Science, 1999
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Evaluation and treatment of insomnia. Author: Anthony Kales, Joyce D. Kales; Year: 1984; New York: Oxford University Press, 1984; ISBN: 0195034341 http://www.amazon.com/exec/obidos/ASIN/0195034341/icongroupin terna
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Fatal familial insomnia: inherited prion diseases, sleep, and the thalamus. Author: editors, Christian Guilleminault ... [et al.]; Year: 1994; New York: Raven Press, c1994; ISBN: 0781701147 http://www.amazon.com/exec/obidos/ASIN/0781701147/icongroupin terna
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Goodbye insomnia, hello sleep. Author: Samuel Dunkell; Year: 1994; Secaucus, N.J.: Carol Pub. Group, c1994; ISBN: 1559722479 http://www.amazon.com/exec/obidos/ASIN/1559722479/icongroupin terna
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Herbs for the mind: what science tells us about nature's remedies for depression, stress, memory loss, and insomnia. Author: Jonathan R.T. Davidson, Kathryn M. Connor; Year: 2000; New York: Guilford Press, c2000; ISBN: 157230572X (cloth)
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http://www.amazon.com/exec/obidos/ASIN/157230572X/icongroupi nterna ·
Insomnia: behavioural and cognitive interventions. Author: Riba, Francis J; Year: 1993; Geneva: Division of Mental Health, World Health Organization, c1993
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Insomnia: correlates and treatment considerations: January 1977 through November 1983: 424 citations in English. Author: prepared by Mitchell B. Balter, Charlotte Kenton; Year: 1983; [Bethesda, Md.]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, 1983
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Insomnia: management in good medical practice. Author: by Sir Noel Moynihan and John Marks; Year: 1988; Basle, Switzerland: Editiones Roche, c1988
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Insomnia: psychological assessment and management. Author: Charles M. Morin; series editor's note by David H. Barlow; foreword by William C. Dement; Year: 1993; New York: Guilford Press, 1993; ISBN: 0898622107 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0898622107/icongroupin terna
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Insomnia and its therapeutics. Author: Macfarlane, Alexander William, d. 1892; Year: 1890; London, Lewis, 1890
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Insomnia and nerve strain, by Henry S. Upson ... with skiagraphic illustrations. Author: Upson, Henry S. (Henry Swift), 1859-1913; Year: 1908; New York and London, G. P. Putnam's sons, 1908
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Insomnia in older adults: nonpharmacological treatment: final report. Author: Eva Libman, Catherine Fichten, Laura Creti; Year: 1992; Montréal, Québec: Sir Mortimer B. Davis Jewish General Hospital, Dept. of Psychiatry, Behaviour and Sex Therapy Services, [1992]; ISBN: 2980331600
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Insomnia, a guide for medical practitioners. Author: A.N. Nicholson, J. Marks; Year: 1983; Boston: MTP Press, 1983; ISBN: 0852007639 http://www.amazon.com/exec/obidos/ASIN/0852007639/icongroupin terna
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Insomnia; and other disorders of sleep. By Henry M. Lyman ... Author: Lyman, Henry Munson, 1835-1904; Year: 1885; Chicago, W. T. Keener, 1885
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Insomnia; its causes and treatment. Author: Sawyer, James, Sir, 18441920; Year: 1912; Birmingham, Cornish, 1912
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Integration of behavioral and relaxation approaches in the treatment of chronic pain and insomia: National Institutes of Health Technology
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Assessment Conference statement, October 16-18, 1995. Author: National Institutes of Health Technology Assessment Conference on the Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1995: Bethesda, Md.); Year: 1995; Bethesda, MD: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, Office of Medical Applications of Research, [1995?] ·
Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia: January 1985 through July 1995: 1147 citations. Author: prepared by Martha H. Glock, Richard Friedman, Patricia Myers; Year: 1995; Bethesda, Md. (8600 Rockville Pike): U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section; Pittsburgh, PA: Sold by the Supt. of Docs., U.S. G.P.O., 1995
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Medical management of insomnia in general practice: proceedings of an extended panel discussion held in London on 10 August 1992. Author: edited by Malcolm Lader; text by Tom Smith; Year: 1992; London; New York: Royal Society of Medicine Services, c1992
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Psychological treatment of insomnia. Author: Colin A. Espie; Year: 1991; Chichester; New York: Wiley, c1991; ISBN: 0471923699 (cloth) http://www.amazon.com/exec/obidos/ASIN/0471923699/icongroupin terna
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Sleep and the sleepless; simple rules for overcoming insomnia, by Joseph Collins ... Author: Collins, Joseph, 1866-1950-; Year: 1912; New York, Sturgis & Walton company, 1912
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Sleep disorders: insomnia and narcolepsy. Author: by Henry Kellerman; Year: 1981; New York: Brunner/Mazel, c1981; ISBN: 0876302649 http://www.amazon.com/exec/obidos/ASIN/0876302649/icongroupin terna
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Sleep, insomnia, and hypnotics. Detroit, Mich.: Davis, 1891
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Sleeping pills, insomnia, and medical practice: report of a study. Author: Institute of Medicine, Division of Mental Health and Behavioral Medicine; Year: 1979; Washington: National Academy of Sciences, 1979; ISBN: 0309028817 http://www.amazon.com/exec/obidos/ASIN/0309028817/icongroupin terna
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Sleeplessness and sedatives: relief of simple nervous insomnia. Author: [written by a registered physician for the medical profession]; Year: 1943; St. Louis, Mo.: Dios Chemical Co., c1943
Author: by E.P. Hurd; Year: 1891;
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Treatment of late-life insomnia. Author: editors, Kenneth L. Lichstein, Charles M. Morin; Year: 2000; Thousand Oaks, Calif.: Sage Publications, c2000; ISBN: 0761915060 (c: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0761915060/icongroupin terna
Chapters on Insomnia Frequently, insomnia will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with insomnia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and insomnia using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “insomnia” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on insomnia: ·
Tinnitus and Insomnia Source: in Tyler, R.S., ed. Tinnitus Handbook. San Diego, CA: Singular Publishing Group. 2000. p. 59-84. Contact: Available from Singular-Thomson Learning. P.O. Box 6904, Florence, KY 41022. (800) 477-3692. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $65.95 plus shipping and handling. ISBN: 1565939220. Summary: Sleep disturbance is a frequent complaint of people with tinnitus; indeed some patients regard it as an integral element of the experience of tinnitus. This chapter on tinnitus and insomnia is from an audiology textbook that offers clinicians and recent graduates information on tinnitus (ringing or other sounds in the ears). In the chapter, the author discusses the prevalence and definitions of insomnia (a range of sleep related complaints, including sleep of insufficient duration, of poor quality or effectiveness); the nature and function of sleep; the characteristics of insomnia; the extent of the problem of tinnitus related insomnia; assessment methods, including clinical interview, sleep diaries, assessment of mood, sleep questionnaires, polysomnographic recordings, and other behavioral assessments; models of insomnia; the mechanisms of tinnitus related insomnia; the management of insomnia,
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including medication, behavioral treatment, relaxation therapy, stimulus control techniques, paradoxical intention, sleep restriction, and approaches to the management of intrusive cognition (thoughts); and the management of tinnitus related insomnia. The author concludes that the high prevalence of sleep disorders in populations with tinnitus, and vice versa, requires that researchers and clinicians in the tinnitus field have a responsibility to investigate tinnitus related insomnia more carefully and to seek solutions to the problem. 1 figure. 73 references. ·
Effects of Insomnia on Tinnitus Severity: A Follow-Up Study Source: in Hazell, J., ed. Proceedings of the Sixth International Tinnitus Seminar. London, England: Tinnitus and Hyperacusis Centre. 1999. p. 271-276. Contact: Available from Tinnitus and Hyperacusis Centre. 32 Devonshire Place, London, W1N 1PE, United Kingdom. Fax 44 + (0) 207 486 2218. Email:
[email protected]. Website: www.tinnitus.org. PRICE: Contact publisher for price. ISBN: 0953695700. Also available on CD-ROM. Summary: This article on the interplay between insomnia and tinnitus severity is from a lengthy document that reprints the proceedings of the Sixth International Tinnitus Seminar, held in Cambridge, United Kingdom, in September 1999 and hosted by the British Society of Audiology. In this article, the authors describe their study undertaken to investigate the effects of insomnia on tinnitus severity and to determine how this relationship may evolve with the passage of time. Questionnaires were mailed to patients prior to their initial appointment at the Oregon Health Sciences University Tinnitus Clinic between 1994 and 1997. These questionnaires requested information pertaining to insomnia, tinnitus severity, and loudness. During their initial appointment, patients received counseling, education, and reassurance about tinnitus; audiometric and tinnitus evaluations; and treatment recommendations. Follow up questionnaires were mailed to 350 patients one to four years (mean of 2.3 years) after their initial appointment at the Clinic. Questionnaires were returned by 174 patients (130 males, 44 females; mean age 55.9 years). Even though many of these patients improved in both sleep interference and tinnitus severity, a significant number (43 patients) reported on the follow up questionnaire that they continued to have difficulty sleeping. Reported loudness and severity of tinnitus were significantly greater for this group than for groups of patients who reported that they never or only sometimes have difficulty sleeping. The relationship between sleep disturbance and tinnitus severity became more pronounced with the passage of time. The authors conclude that their findings underscore the importance of identification
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and successful treatment of insomnia for patients with tinnitus. One appendix offers the follow up questionnaire used in the study. 6 tables. 18 references.
General Home References In addition to references for insomnia, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · 100 Questions About Sleep and Sleep Disorders by Sudhansu Chokroverty, M.D.; Paperback - 110 pages, 1st edition (February 15, 2001), Blackwell Science Inc; ISBN: 0865425833; http://www.amazon.com/exec/obidos/ASIN/0865425833/icongroupinterna · The Bible Cure for Sleep Disorders by Don Colbert; Paperback - 96 pages (March 2001), Siloam Press; ISBN: 0884197484; http://www.amazon.com/exec/obidos/ASIN/0884197484/icongroupinterna · Sleep and Its Disorders : What You Should Know by Robert G. Hooper, M.D., Melissa Mulera (Illustrator); Paperback - 176 pages (January 2001), Just Peachy Press; ISBN: 0970002645; http://www.amazon.com/exec/obidos/ASIN/0970002645/icongroupinterna · Sleep Disorders Sourcebook: Basic Consumer Health Information About Sleep and Its Disorders, Including Insomnia, Sleepwalking, Sleep Apmea, Restless) by Jenifer Swanson (Editor); Library Binding - 600 pages (January 1999), Omnigraphics, Inc.; ISBN: 0780802349; http://www.amazon.com/exec/obidos/ASIN/0780802349/icongroupinterna · Sleeping Well: The Sourcebook for Sleep and Sleep Disorders (The Facts for Life) by Michael J. Thorpy, M.D., Jan Yager; Paperback - 342 pages (October 2001), Checkmark Books; ISBN: 0816040907; http://www.amazon.com/exec/obidos/ASIN/0816040907/icongroupinterna
Vocabulary Builder Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Amphetamine:
A powerful central nervous system stimulant and
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sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antiepileptic: An agent that combats epilepsy. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Arrhythmia: An irregular heartbeat. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Audiology: The study of hearing and hearing impairment. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dreams: A series of thoughts, images, or emotions occurring during sleep which are dissociated from the usual stream of consciousness of the waking state. [NIH] Edema: Abnormal fluid accumulation in body tissues. [NIH] Electroencephalography: The recording of the electric currents developed in the brain, by means of electrodes applied to the scalp, to the surface of the brain (intracranial e.) or placed within the substance of the brain (depth e.). [EU]
Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the
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adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Hepatic: Pertaining to the liver. [EU] Hyperacusis: An abnormally disproportionate increase in the sensation of loudness in response to auditory stimuli of normal volume. Cochlear diseases; vestibulocochlear nerve diseases; facial nerve diseases; stapes surgery; and other disorders may be associated with this condition. [NIH] Hypertension: High blood pressure (i.e., abnormally high blood pressure tension involving systolic and/or diastolic levels). The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or taking hypertensive medication. The cause may be adrenal, benign, essential, Goldblatt's, idiopathic, malignant pate, portal, postpartum, primary, pulmonary, renal or renovascular. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Illusions: The misinterpretation of a real external, sensory experience. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Libido: Sexual desire. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU]
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Neurasthenia: A mental disorder characterized by chronic fatigue and concomitant physiologic symptoms. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Osteodystrophy: Defective bone formation. [EU] Paranoia: A psychotic disorder marked by persistent delusions of persecution or delusional jealousy and behaviour like that of the paranoid personality, such as suspiciousness, mistrust, and combativeness. It differs from paranoid schizophrenia, in which hallucinations or formal thought disorder are present, in that the delusions are logically consistent and that there are no other psychotic features. The designation in DSM III-R is delusional (paranoid) disorders, with five types : persecutory, jealous, erotomanic, somatic, and grandiose. [EU] Pemoline: A central nervous system stimulant used in fatigue and depressive states and to treat hyperkinetic disorders in children. [NIH] Pentamidine: Antiprotozoal agent effective in trypanosomiasis, leishmaniasis, and some fungal infections; used in treatment of Pneumocystis carinii pneumonia in HIV-infected patients. It may cause diabetes mellitus, central nervous system damage, and other toxic effects. [NIH]
Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Stroke: Sudden loss of function of part of the brain because of loss of blood
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flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU] Thalamus: Either of two large, ovoid masses, consisting chiefly of grey substance, situated one on each side of and forming part of the lateral wall of the third ventricle. It is divided into two major parts : dorsal and ventral, each of which contains many nuclei. [EU] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tonic: 1. producing and restoring the normal tone. 2. characterized by continuous tension. 3. a term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU]
Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU]
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CHAPTER 7. MULTIMEDIA ON INSOMNIA Overview Information on insomnia can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on insomnia. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Bibliography: Multimedia on Insomnia The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in insomnia (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on insomnia. For more information, follow the hyperlink indicated: ·
Behavioral and pharmacologic management of insomnia. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1993; Format: Videorecording; Marshfield, WI: The Clinic, [1993]
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·
Bio-feedback: waves of the future. Source: Los Angeles County Medical Association; Year: 1975; Format: Videorecording; Garden Grove, Ca.: Trainex, 1975
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Dangerous medications and their effects . Year: 1994; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1994
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Diagnosis and treatment of anxiety and depression in the elderly. Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital, [and] Marshfield Medical Research Foundation; Year: 1992; Format: Videorecording; Marshfield, WI: Marshfield Video Network, [1992]
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Evaluation and treatment of sleep disorders by the general physician. Source: Sleep Research and Treatment Center Pennsylvania State University, The Milton S. Hershey Medical Center; Year: 1976; Format: Motion picture; Hershey: The University, 1976
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Hypertension: your patient and you. Source: Trainex Corporation; Year: 1974; Format: Filmstrip; [Garden Grove, Calif.]: Trainex, c1973
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Insomnia and addiction : meeting the standard of care. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1995; Format: Videorecording; Marshfield, WI: Video Network, [1995]
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Insomnia, in search of Morpheus. Source: Behavioral Sciences Media Laboratory, the Neuropsychiatric Institute, UCLA Center for the Health Sciences; Year: 1979; Format: Videorecording; [Berkeley, Calif.]: Regents of the University of California, c1979
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Insomnia. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996
·
Insomnia. Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital [and] Marshfield Research Foundation; Year: 1990; Format: Videorecording; Marshfield, WI: Marshfield Video Network, [1990]
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Journey into sleep 1997 . Year: 1997; Format: Electronic resource; [United States]: Kryger, c1997
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Man who never slept. Source: produced by Twenty Twenty Television for Channel 4 Television and Discovery Channel; Year: 1998; Format: Videorecording; New York, NY: Ambrose Video Publishing, 1998
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Practical management of insomnia. Source: a co-production of Multimedia Communications and Physician Education and Development; Year: 2001; Format: Videorecording; Oakland, CA: Kaiser Foundation Health Plan, c2001
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·
Sleep disorders. Source: Films for the Humanities & Sciences; produced for Discovery Health Channel by Big Rock Productions; Year: 2002; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2002
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Sleeping well. Source: a presentation of Films for the Humanities & Sciences; Year: 1997; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1997
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Strategies for managing insomnia. Source: American Academy of Family Physicians, American Academy of Sleep Medicine; Year: 1999; Format: Videorecording; Leawood, KS: American Academy of Family Physicians, c1999
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Suicide: the unheard cry. Source: U. S. Army; Year: 1968; Format: Motion picture; [Washington]: The Army; [Atlanta: for loan by National Medical Audiovisual Center], 1968
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Teen and child depression. Source: a presentation of Films for the Humanities & Sciences; Year: 1992; Format: Videorecording; Princeton, N.J.: Films for the Humanities, c1992
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Understanding sleep. Source: a presentation of Films for the Humanities & Sciences; produced by the Cronkite Ward Company for TLC; Year: 2001; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2001
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Wake up, America : a sleep alert. Source: a presentation of Films for the Humanities & Sciences; a presentation of WKRC-TV and Medstar Communications, Inc; Year: 1995; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1995
Vocabulary Builder Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-
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dependent diabetes mellitus. [NIH]
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CHAPTER 8. PERIODICALS AND NEWS ON INSOMNIA Overview Keeping up on the news relating to insomnia can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on insomnia. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover insomnia beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on insomnia is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “insomnia” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Theratechnologies Announces Positive Results of an Efficacy and Safety Phase II Clinical Trial of ThGRF in Sleep Maintenance Insomnia Summary: Montreal, May 29 /PRNewswire-FirstCall/ Theratechnologies (TSE:TH) announces today positive results from its Phase II clinical trial of its ThGRF peptide (TH 9507), a growth hormonereleasing factor analogue, in sleep maintenance insomnia patients in whom sleep disorders are associated with poor daytime performance. The results show improvement in sleep parameters and daytime vigilance as well as a safety profile similar to placebo. This phase II study involved 83 patients, aged 35-50 years old, exhibiting sleep maintenance insomnia. The multicentre study, carried out in eight sites across Canada and Europe, was randomized, double-blind, placebocontrolled, parallel design with patients receiving one of two doses of ThGRF, 0.1 mg or 1 mg, or placebo, administered daily by subcutaneous injection at bedtime over a period of 14 days. The results indicate that sleep efficiency, a primary parameter, measured objectively by polysomnography, improved 5.7% over the study period at the 0.1 mg dose when compared to placebo. A statistical trend was obtained and the result is clearly of clinical interest, as a 5% increase in sleep efficiency is considered by experts to be clinically relevant. Furthermore, sleep efficiency measured subjectively by the Pittsburgh Sleep Diary, another primary parameter, followed the same direction with a 4% increase at 0.1 mg when compared to placebo. In addition to the changes in sleep parameters, the most striking results were a marked enhancement of daytime vigilance. Indeed, a highly statistically and clinically significant improvement was observed in the mean reaction time recorded in the Continuous Performance Task test, for the 0.1 mg dose when compared to placebo. A trend was also
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observed for improved short-term memory at the 0.1 mg dose as assessed by another test of cognitive function, the Digit Span Test. "The data obtained in this Phase II study are clinically significant and provide evidence that this peptide may answer a need particularly among patients affected by poor daytime vigilance, as seen in sleep maintenance insomnia," said lead clinical investigator, Dr. Jacques Montplaisir, of Hopital du Sacre-Coeur's Centre d'etude du sommeil, in Montreal and an internationally recognized expert on sleep disorders. "We are pleased with these data confirming the potential of ThGRF in several key endpoints. All told, these results define a unique clinical profile for this novel peptide, combining improved sleep efficiency and daytime vigilance, as well as a safety profile unequalled by any other therapeutic currently on the market or in development in this indication," said Dr. Thierry Abribat, Chief Scientific Officer of Theratechnologies. "The clinical effects were obtained with a very low dose of 0.1 mg, confirming a different mechanism of action in sleep compared to other indications currently under development," he added. "In light of these positive results, we will actively pursue the clinical development of our ThGRF peptide in this therapeutic field," said Mr. Luc Tanguay, President and Chief Executive Officer of Theratechnologies. "We are very pleased to release the results from this first indication on schedule and are looking forward to disclosing results for our second Phase II study on immune dysfunction in the elderly soon." "This sleep maintenance insomnia Phase II clinical trial of ThGRF is one of five concurrent phase II clinical trials which we are carrying out this year to demonstrate our peptide's effect on sleep, the immune system and anabolism," added Dr. Abribat. Other indications being tested by Theratechnologies include immune response to influenza vaccination in elderly patients, muscle wasting observed in chronic obstructive pulmonary disease (COPD) and functional recovery following hip fracture surgery. The Company is also conducting a fifth phase II clinical trial in the US to demonstrate the safety of ThGRF in patients with controlled type II diabetes. Sleep Maintenance Insomnia In North America, Europe and Japan, sleep disorders affect 126 million people aged 35 to 65. Of these some 70 million people suffer from sleep maintenance insomnia, characterized by disruptive sleep, awakenings
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during the night and impaired daytime vigilance. Significant quality of life impairments are associated with insomnia. Subjects with insomnia generally report poorer attention, concentration, memory, and reaction time. They also report more health concerns that limit physical activity, greater interference of physical or emotional problems with normal social activities, more bodily pain, poorer general health, less vitality, more emotional difficulties, and more mental health problems. The total direct costs in the United States for insomnia in 1995 were estimated to be $13.9 billion, while direct and indirect costs combined (medical, productivity, absenteeism, accidents, etc) related to insomnia reach approximately $100 billion each year. The currently available sleep medications are very efficient as sleep inducing agents. However, daytime side-effects of sedatives are particularly significant, as they may lead to worsening of cognition, psychomotor slowing and accidents. Finally, their long-term use is not recommended due to potential for tolerance and dependence. Thanks to its unique safety and efficacy profile, ThGRF is deemed to become the first compound of a new therapeutic class for the treatment of insomniac patients affected by poor daytime performance. About Theratechnologies A leader in the biopharmaceutical field in Canada, Theratechnologies holds innovative technological platforms in the field of therapeutic peptides and targets numerous applications relating to endocrine and metabolic disorders. In light of promising clinical results and the commercial potential of its lead peptide ThGRF, Theratechnologies has implemented an aggressive strategy, consisting of pursuing several indications addressing largely unmet clinical needs, using novel delivery systems. Through its subsidiary, Celmed BioSciences, the Company is also active in the field of cell therapy using adult stem cells. Invitation To Conference Call Analysts are invited to a conference call hosted by Theratechnologies at 8:45 a.m. EST today. All other interested parties are invited to participate in the conference call in a listen-only mode. The dial-in number is 1-888434- 1242. For those unable to listen to the call live, a replay will be available for one week beginning at 11 a.m. today. The replay phone number is 1-800-558- 5253 and the access code is 20643766(pound key).
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Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to insomnia. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “insomnia” (or synonyms). The following was recently listed in this archive for insomnia: ·
Half of chronically ill patients have insomnia Source: Reuters Health eLine Date: April 08, 2002 http://www.reuters.gov/archive/2002/04/08/eline/links/20020408elin 020.html
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Insomnia greatly affects quality of life in patients with chronic illness Source: Reuters Medical News Date: April 05, 2002 http://www.reuters.gov/archive/2002/04/05/professional/links/20020 405clin017.html
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Police officers' insomnia due to daily grind Source: Reuters Health eLine Date: April 01, 2002 http://www.reuters.gov/archive/2002/04/01/eline/links/20020401elin 016.html
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Neurocrine outlines phase III schedule for insomnia drug Source: Reuters Industry Breifing Date: March 19, 2002 http://www.reuters.gov/archive/2002/03/19/business/links/20020319 drgd003.html
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Pfizer starts phase I trial of Neurogen insomnia agent Source: Reuters Industry Breifing Date: March 11, 2002 http://www.reuters.gov/archive/2002/03/11/business/links/20020311 drgd001.html
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High prevalence of insomnia in patients with sleep-disordered breathing Source: Reuters Medical News Date: January 15, 2002 http://www.reuters.gov/archive/2002/01/15/professional/links/20020 115epid002.html
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·
Many experience insomnia after September 11th Source: Reuters Health eLine Date: November 29, 2001 http://www.reuters.gov/archive/2001/11/29/eline/links/20011129elin 014.html
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Neurocrine launches phase III trial for potential insomnia drug Source: Reuters Industry Breifing Date: November 16, 2001 http://www.reuters.gov/archive/2001/11/16/business/links/20011116 drgd001.html
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Kava, valerian may fight stress-related insomnia Source: Reuters Health eLine Date: October 04, 2001 http://www.reuters.gov/archive/2001/10/04/eline/links/20011004elin 005.html
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Insomniacs have hyperactive stress system Source: Reuters Health eLine Date: August 16, 2001 http://www.reuters.gov/archive/2001/08/16/eline/links/20010816elin 018.html
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New approach recommended to treatment of chronic insomnia Source: Reuters Medical News Date: August 14, 2001 http://www.reuters.gov/archive/2001/08/14/professional/links/20010 814clin007.html
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Neurocrine's insomnia agent performs well in phase II studies Source: Reuters Industry Breifing Date: July 17, 2001 http://www.reuters.gov/archive/2001/07/17/business/links/20010717 drgd003.html
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Insomnia is a strong predictor of relapse in alcoholics Source: Reuters Medical News Date: April 13, 2001 http://www.reuters.gov/archive/2001/04/13/professional/links/20010 413clin004.html
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Cognitive behavioral therapy a viable treatment option for insomnia Source: Reuters Medical News Date: April 12, 2001 http://www.reuters.gov/archive/2001/04/12/professional/links/20010 412clin009.html
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New behavioral therapy helps treat insomnia Source: Reuters Health eLine Date: April 10, 2001 http://www.reuters.gov/archive/2001/04/10/eline/links/20010410elin 008.html
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Cessation of medication misuse alleviates insomnia in migraine patients Source: Reuters Industry Breifing Date: February 01, 2001 http://www.reuters.gov/archive/2001/02/01/business/links/20010201 clin007.html
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Lack of daylight may explain older people's insomnia Source: Reuters Health eLine Date: January 25, 2001 http://www.reuters.gov/archive/2001/01/25/eline/links/20010125elin 018.html
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High prevalence of insomnia found in Chinese women Source: Reuters Medical News Date: January 22, 2001 http://www.reuters.gov/archive/2001/01/22/professional/links/20010 122epid004.html
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Lundbeck insomnia drug enters new trials Source: Reuters Industry Breifing Date: November 15, 2000 http://www.reuters.gov/archive/2000/11/15/business/links/20001115 drgd007.html
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Melatonin no cure for jet lag, but may fight insomnia Source: Reuters Health eLine Date: November 08, 2000 http://www.reuters.gov/archive/2000/11/08/eline/links/20001108elin 014.html
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Short-term zaleplon use effective in older patients with chronic insomnia Source: Reuters Industry Breifing Date: October 11, 2000 http://www.reuters.gov/archive/2000/10/11/business/links/20001011 drgd002.html
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·
Sepracor's insomnia treatment (S)-zopiclone set to begin phase III trials Source: Reuters Industry Breifing Date: August 29, 2000 http://www.reuters.gov/archive/2000/08/29/business/links/20000829 drgd003.html
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Melatonin helps patients discontinue benzodiazepine treatment for insomnia Source: Reuters Medical News Date: November 16, 1999 http://www.reuters.gov/archive/1999/11/16/professional/links/19991 116clin003.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “insomnia” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “insomnia” (or synonyms). If you know the name of a company that is relevant to insomnia, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “insomnia” (or synonyms).
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “insomnia” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on insomnia: ·
Prescribed Medications Source: Fibromyalgia Frontiers. 9(3): 17-22. 2001. Contact: Available from National Fibromyalgia Partnership, Inc. 140 Zinn Way, Linden, VA 22642-5609. (866) 725-4404 toll-free. Fax (540) 622-2998. E-mail:
[email protected]. Website: www.fmpartnership.org.
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Summary: This newsletter article provides health professionals and people who have fibromyalgia (FM) with information on prescription and nonprescription medications that can relieve pain and improve sleep and mood. Categories of drugs used in the treatment of fibromyalgia are analgesics, antiinflammatory drugs, antidepressant medications, muscle relaxants, sleep modifiers, antianxiety medicines, and other medicines used to treat chronic pain. Analgesics are pain killers and can include nonprescription medicines such as aspirin and acetaminophen or prescription strength pain pills such as narcotics, codeine, Vicodin, Darvocet, Oxycontin, and Percocet. Antiinflammatory medicines include aspirin, nonsteroidal antiinflammatory drugs, and corticosteroids. Antidepressant medications include tricyclics and selective serotonin reuptake inhibitors. Muscle relaxants can decrease pain in people who have FM and include Flexeril, Soma, Skelaxin, and Robaxin. Various medications can be used to treat insomnia, including benzodiazepines and hypnotic nonbenzodiazepines. Anxiety is a common problem in FM, but various medicines, including antidepressants and muscle relaxants, can treat it. Other medicines used to treat pain include antiseizure medicines, headache medications, and antibiotics. The article highlights the beneficial and adverse effects of each drug category. In addition, the article presents basic strategies regarding medication use and discusses the use of trigger point injections to manage pain. ·
Night-Eating Syndrome Source: The Weight Control Digest. 6(3):523; May/June 1996. Contact: Weight Control Digest, 1555 W. Mockingbird Lane, Suite 203, Dallas, TX 75235. (800) 736-7323. Summary: Researchers at the University of Pennsylvania School of Medicine recently reported on a study done at their center analyzing the frequency of "night-eating syndrome." This little-known eating pattern consists of insomnia occurring with binge eating. It was found to occur at a rate of 8.9 to 15.0 percent of the study participants, all of whom were obese. The authors conclude that this is a syndrome requiring further examination.
Academic Periodicals covering Insomnia Academic periodicals can be a highly technical yet valuable source of information on insomnia. We have compiled the following list of periodicals known to publish articles relating to insomnia and which are currently
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indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on insomnia published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on insomnia: ·
Behavior Modification. (Behav Modif) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Be havior+Modification&dispmax=20&dispstart=0
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Biological Psychiatry. (Biol Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ological+Psychiatry&dispmax=20&dispstart=0
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Bmj (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
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Journal of Clinical Psychology. (J Clin Psychol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Psychology&dispmax=20&dispstart=0
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Physiology & Behavior. (Physiol Behav) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ph ysiology+&+Behavior&dispmax=20&dispstart=0
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Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0
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·
The Annals of Pharmacotherapy. (Ann Pharmacother) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Annals+of+Pharmacotherapy&dispmax=20&dispstart=0
Vocabulary Builder Absenteeism: Chronic absence from work or other duty. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Antibiotic: A drug that kills or inhibits the growth of bacteria. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Corticosteroids: Drugs that mimic the action of a group of hormones produced by adrenal glands; they are anti-inflammatory and act as bronchodilators. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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The NHLBI, in particular, suggests the following publications to physicians: Sleep Disorders ·
Restless Legs Syndrome: Detection and Management in Primary Care: http://www.nhlbi.nih.gov/health/prof/sleep/rls_gde.htm
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Sleep Apnea: Is Your Patient at Risk?: http://www.nhlbi.nih.gov/health/prof/sleep/slpaprsk.htm
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Insomnia: Assessment and Management in Primary Care: http://www.nhlbi.nih.gov/health/prof/sleep/insom_pc.htm
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Problem Sleepiness in Your Patient: http://www.nhlbi.nih.gov/health/prof/sleep/pslp_pat.htm
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Working Group Report on Problem Sleepiness: http://www.nhlbi.nih.gov/health/prof/sleep/pslp_wg.htm
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National Center on Sleep Disorders Pamphlet: http://www.nhlbi.nih.gov/health/prof/sleep/sleep.txt Sleep in Youth
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Awake At the Wheel Materials: http://www.nhlbi.nih.gov/health/public/sleep/aaw/awake.htm
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Educating Youth About Sleep and Drowsy Driving: http://www.nhlbi.nih.gov/health/prof/sleep/dwydrv_y.htm
·
Drowsy Driving and Automobile Crashes: http://www.nhlbi.nih.gov/health/prof/sleep/drsy_drv.htm Additional Resources
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National Center on Sleep Disorders Research Web Site: http://www.nhlbi.nih.gov/about/ncsdr/index.htm
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Trans-NIH Sleep Research Coordinating Committee Annual Report: http://www.nhlbi.nih.gov/health/prof/sleep/sleep00.htm
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Sleep Disorders Research Advisory Board (SDRAB): http://www.nhlbi.nih.gov/meetings/sdrab/index.htm
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National Sleep Disorders Research Plan: http://www.nhlbi.nih.gov/health/prof/sleep/reschpln.htm
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List of Publications: http://www.nhlbi.nih.gov/health/pubs/index.htm
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·
Information Center: http://www.nhlbi.nih.gov/health/infoctr/index.htm
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Sleep Information for Patients/Public: http://www.nhlbi.nih.gov/health/public/sleep/index.htm
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs,
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27
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fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html ·
Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat insomnia, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and insomnia using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By
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making these selections and typing “insomnia” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with insomnia. The following is a sample result: ·
Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia Source: Kensington, MD: NIH Consensus Program Information Center. October 1995. 38 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; International phone: (301) 519-3153; TTY: (866) 4643615; FAX: (866) 464-3616; E-mail:
[email protected]. Price: Free. Publication Number: D031. Summary: This consensus statement provides physicians with a responsible assessment of the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. After the introduction, the report answers five major research questions: (1) What behavioral and relaxation approaches are used for conditions such as chronic pain and insomnia? (2) How successful are these approaches? (3) How do these approaches work? (4) Are there barriers to the appropriate integration of these approaches into health care? and (5) What are the significant issues for future research and applications? The report ends with a list of experts who served as members of the technology assessment panel and planning committee. 86 references.
The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families,
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
29 30
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and the public.31 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “insomnia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 6190 Books / Periodicals / Audio Visual 144 Consumer Health 133 Meeting Abstracts 48 Other Collections 1 Total 6516
HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as
Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 32 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 33 The HSTAT URL is http://hstat.nlm.nih.gov/. 31
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AHRQ’s Put Prevention Into Practice.34 Simply search by “insomnia” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 35 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 36 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 34
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·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Insomnia With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to insomnia. In the following section, we will discuss databases and references used by physicians and scientists who work in this area. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
38
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Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “insomnia” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for insomnia: ·
Familial Fatal Insomnia Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600072
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-
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Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html ·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
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·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “insomnia” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 40 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 39
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mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “insomnia” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in insomnia (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Clinical Companion to Sleep Disorders Medicine Second Edition by Sudhansu Chokroverty; Paperback - 232 pages, 2nd edition (April 2000), Butterworth-Heinemann Medical; ISBN: 0750696877; http://www.amazon.com/exec/obidos/ASIN/0750696877/icongroupinterna · Concise Guide to Evaluation and Management of Sleep Disorders (Concise Guides) by Martin Reite, et al; Paperback 3rd edition (April 2002), American Psychiatric Press; ISBN: 1585620459; http://www.amazon.com/exec/obidos/ASIN/1585620459/icongroupinterna · The Encyclopedia of Sleep and Sleep Disorders, Second Edition by Michael J. Thorpy, M.D, Jan Yager; Library Binding - 352 pages, 2nd Updated edition (May 2001), Facts on File, Inc.; ISBN: 0816040893; http://www.amazon.com/exec/obidos/ASIN/0816040893/icongroupinterna
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· Sleep Disorders (Encyclopedia of Psychological Disorders) by Linda N. Bayer, et al; Library Binding (October 2000), Chelsea House Pub (Library); ISBN: 0791053148; http://www.amazon.com/exec/obidos/ASIN/0791053148/icongroupinterna · Sleep Disorders: Diagnosis and Treatment by J. Steven Poceta (Editor), Merrill Morris Mitler (Editor); Hardcover - 232 pages, 1st edition (June 15, 1998), Humana Press; ISBN: 0896035271; http://www.amazon.com/exec/obidos/ASIN/0896035271/icongroupinterna · Sleep Disorders and Neurological Disease by Antonio Culebras (Editor); Hardcover - 422 pages, 1st edition (October 15, 1999), Marcel Dekker; ISBN: 0824776054; http://www.amazon.com/exec/obidos/ASIN/0824776054/icongroupinterna · Sleep Disorders Handbook by Peretz Lavie, M.D., et al; Paperback (March 2002), Boston Medical Pub Inc; ISBN: 1841840556; http://www.amazon.com/exec/obidos/ASIN/1841840556/icongroupinterna · Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects by Sudhansu Chokroverty (Editor), Robert B. Daroff (Introduction); Hardcover - 781 pages, 2nd edition (January 15, 1999), Butterworth-Heinemann Medical; ISBN: 075069954X; http://www.amazon.com/exec/obidos/ASIN/075069954X/icongroupinterna
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CHAPTER 10. DISSERTATIONS ON INSOMNIA Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to insomnia. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Insomnia ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to insomnia. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with insomnia: ·
A Comparison of Relaxation and 'structured Day' As Treatment for Insomnia by Lynch, Eileen Marie, Phd from Boston College, 1988, 142 pages http://wwwlib.umi.com/dissertations/fullcit/8922250
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·
An Examination of Effectiveness of a Sleep Induction Audiotape in Conjunction with a Standardized Behavioral Treatment Protocol on Anxiety, Depression, Psychosocial Functioning, and Sleep among a Clinical Population with Insomnia by Dunn, Jeffrey Allan; Phd from The Florida State University, 2001, 304 pages http://wwwlib.umi.com/dissertations/fullcit/3021555
·
Attitudes and Beliefs about Insomnia and Insomnia Treatment among Older Adults with Chronic Insomnia by Macleod, Mary Annet Krista; Msc from University of Calgary (canada), 2000, 230 pages http://wwwlib.umi.com/dissertations/fullcit/MQ49638
·
Cognitive Behavioral Therapy for Insomnia in a Primary Care Setting by Sampson, William Simpson; Phd from The University of North Carolina at Chapel Hill, 2001, 60 pages http://wwwlib.umi.com/dissertations/fullcit/3022310
·
Critical Insomnia: Reading and Rereading Joyce, Proust, and Beckett (ireland; France; Great Britain) by Nesbitt, Lois Ellen, Phd from Princeton University, 1988, 261 pages http://wwwlib.umi.com/dissertations/fullcit/8800321
·
Heart Rate Variability during Sleep in Fibromyalgia and Insomnia by Mcmillan, Diana E.; Phd from University of Washington, 2001, 79 pages http://wwwlib.umi.com/dissertations/fullcit/3014004
·
Insomnia (original Writing) by Minerva, Elizabeth Anne, Phd from The Florida State University, 1997, 290 pages http://wwwlib.umi.com/dissertations/fullcit/9729709
·
Insomnia: Prevalence, Longitudinal Course and Health Consequences. a Twelve Year Perspective by Mallon, Lena Ingalill Marie; Phd from Uppsala Universitet (sweden), 2000, 66 pages http://wwwlib.umi.com/dissertations/fullcit/f1172129
·
Locus-of-control and Adjustment Related to Outcome of Two Treatments for Insomnia. by Koffmann, Andrew, Phd from The University of Connecticut, 1976, 177 pages http://wwwlib.umi.com/dissertations/fullcit/7714474
·
The Effects of Exogenously Administered Melatonin (mt) on Sleep Maintenance Insomnia (smi) by D'ambrosio, Paul; Phd from City University of New York, 2001, 88 pages http://wwwlib.umi.com/dissertations/fullcit/3024778
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to insomnia is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with insomnia and related conditions.
Researching Your Medications 149
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with insomnia. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for insomnia. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of insomnia. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
150 Insomnia
Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of insomnia. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with insomnia take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
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Ask about the risks and benefits of each medicine or other treatment you might receive.
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Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for insomnia. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
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How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
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If you can get a refill, and how often.
41
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 151
·
About any terms or directions you do not understand.
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What to do if you miss a dose.
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If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for insomnia). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
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Reason taken
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Dosage
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Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for insomnia. One such source is
152 Insomnia
the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of insomnia. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to insomnia:
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
42
Researching Your Medications 153
Benzodiazepines ·
Systemic - U.S. Brands: Alprazolam Intensol; Ativan; Dalmane; Diastat; Diazepam Intensol; Dizac; Doral; Halcion; Klonopin; Librium; Lorazepam Intensol; Paxipam; ProSom; Restoril; Serax; Tranxene T-Tab; Tranxene-SD; Tranxene-SD Half Strength; Valium; Xanax http://www.nlm.nih.gov/medlineplus/druginfo/benzodiazepine ssystemic202084.html
Caffeine ·
Systemic - U.S. Brands: Cafcit; Caffedrine Caplets; Dexitac Stay Alert Stimulant; Enerjets; Keep Alert; Maximum Strength SnapBack Stimulant Powders; NoDoz Maximum Strength Caplets; Pep-Back; Quick Pep; Ultra Pep-Back; Vivarin http://www.nlm.nih.gov/medlineplus/druginfo/caffeinesystemic 202105.html
Ethchlorvynol ·
Systemic - U.S. Brands: Placidyl http://www.nlm.nih.gov/medlineplus/druginfo/ethchlorvynolsy stemic202230.html
Levodopa ·
Systemic - U.S. Brands: Atamet; Larodopa; Sinemet; Sinemet CR http://www.nlm.nih.gov/medlineplus/druginfo/levodopasystem ic202326.html
Nicotine ·
Systemic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/levodopasystem ic202326.html
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Systemic - U.S. Brands: Habitrol; Nicorette; Nicotrol; Prostep http://www.nlm.nih.gov/medlineplus/druginfo/nicotinesystemi c202407.html
Zaleplon ·
Systemic - U.S. Brands: Sonata http://www.nlm.nih.gov/medlineplus/druginfo/zaleplonsystemi c500042.html
154 Insomnia
Zolpidem ·
Systemic - U.S. Brands: Ambien http://www.nlm.nih.gov/medlineplus/druginfo/zolpidemsystem ic202707.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with insomnia (including those with contraindications):43 ·
Albuterol http://www.reutershealth.com/atoz/html/Albuterol.htm
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Alprazolam http://www.reutershealth.com/atoz/html/Alprazolam.htm
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Amantadine HCl http://www.reutershealth.com/atoz/html/Amantadine_HCl.htm
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Amiloride HCl http://www.reutershealth.com/atoz/html/Amiloride_HCl.htm
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Aminophylline http://www.reutershealth.com/atoz/html/Aminophylline.htm
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Aminophylline(Theophylline Ethylenediamine) http://www.reutershealth.com/atoz/html/Aminophylline(Theophyllin e_Ethylenediamine).htm
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Amiodarone http://www.reutershealth.com/atoz/html/Amiodarone.htm
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Amitriptyline HCl http://www.reutershealth.com/atoz/html/Amitriptyline_HCl.htm
43
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 155
·
Amobarbital Secobarbital http://www.reutershealth.com/atoz/html/Amobarbital_Secobarbital.htm
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Amobarbital Sodium http://www.reutershealth.com/atoz/html/Amobarbital_Sodium.htm
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Amoxapine http://www.reutershealth.com/atoz/html/Amoxapine.htm
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Amoxicillin http://www.reutershealth.com/atoz/html/Amoxicillin.htm
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Amphetamine http://www.reutershealth.com/atoz/html/Amphetamine.htm
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Amphetamine (Racemic Amphetamine Sulfate) http://www.reutershealth.com/atoz/html/Amphetamine_(Racemic_A mphetamine_Sulfate).htm
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Ampicillin http://www.reutershealth.com/atoz/html/Ampicillin.htm
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Ampicillin Sodium Sulbactam Sodium http://www.reutershealth.com/atoz/html/Ampicillin_Sodium_Sulbact am_Sodium.htm
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Amyl Nitrite http://www.reutershealth.com/atoz/html/Amyl_Nitrite.htm
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Atenolol http://www.reutershealth.com/atoz/html/Atenolol.htm
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Atorvastatin Calcium http://www.reutershealth.com/atoz/html/Atorvastatin_Calcium.htm
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Atovaquone http://www.reutershealth.com/atoz/html/Atovaquone.htm
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Atropine Sulfate Scopolamine Hydrobromide Hyoscyamine Sulfate Phenobarbital http://www.reutershealth.com/atoz/html/Atropine_Sulfate_Scopolami ne_Hydrobromide_Hyoscyamine_Sulfate_Phenobarbital.htm
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Butalbital Acetaminophen Caffeine http://www.reutershealth.com/atoz/html/Butalbital_Acetaminophen_ Caffeine.htm
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Butalbital Acetaminophen Caffeine Codeine Phosphate http://www.reutershealth.com/atoz/html/Butalbital_Acetaminophen_ Caffeine_Codeine_Phosphate.htm
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Butalbital Aspirin Caffeine http://www.reutershealth.com/atoz/html/Butalbital_Aspirin_Caffeine. htm
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Butalbital Aspirin Caffeine Codeine Phosphate http://www.reutershealth.com/atoz/html/Butalbital_Aspirin_Caffeine _Codeine_Phosphate.htm
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Carbenicillin Indanyl Sodium http://www.reutershealth.com/atoz/html/Carbenicillin_Indanyl_Sodiu m.htm
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Carisoprodol http://www.reutershealth.com/atoz/html/Carisoprodol.htm
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Carteolol HCl http://www.reutershealth.com/atoz/html/Carteolol_HCl.htm
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Caspofungin Acetate http://www.reutershealth.com/atoz/html/Caspofungin_Acetate.htm
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Cefotaxime Sodium http://www.reutershealth.com/atoz/html/Cefotaxime_Sodium.htm
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Cefprozil http://www.reutershealth.com/atoz/html/Cefprozil.htm
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Celecoxib http://www.reutershealth.com/atoz/html/Celecoxib.htm
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Cerivastatin Sodium http://www.reutershealth.com/atoz/html/Cerivastatin_Sodium.htm
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Cetirizine http://www.reutershealth.com/atoz/html/Cetirizine.htm
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Chloral Hydrate http://www.reutershealth.com/atoz/html/Chloral_Hydrate.htm
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Citalopram http://www.reutershealth.com/atoz/html/Citalopram.htm
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Clarithromycin http://www.reutershealth.com/atoz/html/Clarithromycin.htm
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Clomipramine HCl http://www.reutershealth.com/atoz/html/Clomipramine_HCl.htm
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Clonazepam http://www.reutershealth.com/atoz/html/Clonazepam.htm
Researching Your Medications 157
·
Clonidine HCl http://www.reutershealth.com/atoz/html/Clonidine_HCl.htm
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Clorazepate Dipotassium http://www.reutershealth.com/atoz/html/Clorazepate_Dipotassium.htm
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Clozapine http://www.reutershealth.com/atoz/html/Clozapine.htm
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Cortisone http://www.reutershealth.com/atoz/html/Cortisone.htm
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Cortisone (Cortisone Acetate) http://www.reutershealth.com/atoz/html/Cortisone_(Cortisone_Acetat e).htm
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Dantrolene Sodium http://www.reutershealth.com/atoz/html/Dantrolene_Sodium.htm
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Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm
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Desipramine HCl http://www.reutershealth.com/atoz/html/Desipramine_HCl.htm
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Desmopressin Acetate (1-Deamino-8-D-Arginine Vasopressin) http://www.reutershealth.com/atoz/html/Desmopressin_Acetate_(1Deamino-8-D-Arginine_Vasopressin).htm
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Dexamethasone http://www.reutershealth.com/atoz/html/Dexamethasone.htm
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Dextroamphetamine Sulfate http://www.reutershealth.com/atoz/html/Dextroamphetamine_Sulfate .htm
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Diazepam http://www.reutershealth.com/atoz/html/Diazepam.htm
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Diazoxide Oral http://www.reutershealth.com/atoz/html/Diazoxide_Oral.htm
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Dicloxacillin Sodium http://www.reutershealth.com/atoz/html/Dicloxacillin_Sodium.htm
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Dicyclomine HCl http://www.reutershealth.com/atoz/html/Dicyclomine_HCl.htm
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Diethylpropion HCI http://www.reutershealth.com/atoz/html/Diethylpropion_HCI.htm
158 Insomnia
·
Dronabinol http://www.reutershealth.com/atoz/html/Dronabinol.htm
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Efavirenz http://www.reutershealth.com/atoz/html/Efavirenz.htm
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Enalapril Maleate Hydrochlorothiazide http://www.reutershealth.com/atoz/html/Enalapril_Maleate_Hydroch lorothiazide.htm
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Enoxacin http://www.reutershealth.com/atoz/html/Enoxacin.htm
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Ephedrine http://www.reutershealth.com/atoz/html/Ephedrine.htm
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Epinephrine http://www.reutershealth.com/atoz/html/Epinephrine.htm
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Esmolol HCl http://www.reutershealth.com/atoz/html/Esmolol_HCl.htm
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Estradiol http://www.reutershealth.com/atoz/html/Estradiol.htm
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Estropipate http://www.reutershealth.com/atoz/html/Estropipate.htm
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Estropipate (Piperazine Estrone Sulfate) http://www.reutershealth.com/atoz/html/Estropipate_(Piperazine_Est rone_Sulfate).htm
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Ethchlorvynol http://www.reutershealth.com/atoz/html/Ethchlorvynol.htm
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Etodolac http://www.reutershealth.com/atoz/html/Etodolac.htm
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Famotidine http://www.reutershealth.com/atoz/html/Famotidine.htm
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Felbamate http://www.reutershealth.com/atoz/html/Felbamate.htm
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Felodipine http://www.reutershealth.com/atoz/html/Felodipine.htm
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Fenofibrate http://www.reutershealth.com/atoz/html/Fenofibrate.htm
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Flecainide Acetate http://www.reutershealth.com/atoz/html/Flecainide_Acetate.htm
Researching Your Medications 159
·
Flumazenil http://www.reutershealth.com/atoz/html/Flumazenil.htm
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Fluoxetine HCl http://www.reutershealth.com/atoz/html/Fluoxetine_HCl.htm
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Fluphenazine http://www.reutershealth.com/atoz/html/Fluphenazine.htm
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Flurazepam HCl http://www.reutershealth.com/atoz/html/Flurazepam_HCl.htm
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Fluvastatin http://www.reutershealth.com/atoz/html/Fluvastatin.htm
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Fluvoxamine Maleate http://www.reutershealth.com/atoz/html/Fluvoxamine_Maleate.htm
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Formoterol Fumarate http://www.reutershealth.com/atoz/html/Formoterol_Fumarate.htm
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Foscarnet Sodium http://www.reutershealth.com/atoz/html/Foscarnet_Sodium.htm
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Foscarnet Sodium (Phosphonoformic Acid) http://www.reutershealth.com/atoz/html/Foscarnet_Sodium_(Phosph onoformic_Acid).htm
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Galantamine Hydrobromide http://www.reutershealth.com/atoz/html/Galantamine_Hydrobromid e.htm
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Gatifloxacin http://www.reutershealth.com/atoz/html/Gatifloxacin.htm
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Glycopyrrolate http://www.reutershealth.com/atoz/html/Glycopyrrolate.htm
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Goserelin Acetate http://www.reutershealth.com/atoz/html/Goserelin_Acetate.htm
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Griseofulvin http://www.reutershealth.com/atoz/html/Griseofulvin.htm
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Guanfacine HCl http://www.reutershealth.com/atoz/html/Guanfacine_HCl.htm
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Haloperidol http://www.reutershealth.com/atoz/html/Haloperidol.htm
160 Insomnia
·
Hydrochlorothiazide Triamterene(HCTZ Triamterene) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide_Triamt erene(HCTZ_Triamterene).htm
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Hydrochlorothiazide(HCTZ) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide(HCTZ) .htm
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Hydrocortisone (Cortisol) http://www.reutershealth.com/atoz/html/Hydrocortisone_(Cortisol).htm
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Hydroxyzine HCl http://www.reutershealth.com/atoz/html/Hydroxyzine_HCl.htm
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Imipramine HCl http://www.reutershealth.com/atoz/html/Imipramine_HCl.htm
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Indapamide http://www.reutershealth.com/atoz/html/Indapamide.htm
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Indinavir Sulfate http://www.reutershealth.com/atoz/html/Indinavir_Sulfate.htm
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Interferon Alfacon-I http://www.reutershealth.com/atoz/html/Interferon_Alfacon-I.htm
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Interferon Alfa-n3 http://www.reutershealth.com/atoz/html/Interferon_Alfa-n3.htm
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Interferon Beta-1b (rIFN-B) http://www.reutershealth.com/atoz/html/Interferon_Beta-1b_(rIFNB).htm
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Interferon Beta-1b(rIFN-B) http://www.reutershealth.com/atoz/html/Interferon_Beta-1b(rIFNB).htm
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Interferon Gamma-1b http://www.reutershealth.com/atoz/html/Interferon_Gamma-1b.htm
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Iodine http://www.reutershealth.com/atoz/html/Iodine.htm
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Ipratropium Bromide Albuterol Sulfate http://www.reutershealth.com/atoz/html/Ipratropium_Bromide_Albu terol_Sulfate.htm
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Isoetharine http://www.reutershealth.com/atoz/html/Isoetharine.htm
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Isoproterenol http://www.reutershealth.com/atoz/html/Isoproterenol.htm
Researching Your Medications 161
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Isosorbide Dinitrate http://www.reutershealth.com/atoz/html/Isosorbide_Dinitrate.htm
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Isosorbide Mononitrate http://www.reutershealth.com/atoz/html/Isosorbide_Mononitrate.htm
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Itraconazole http://www.reutershealth.com/atoz/html/Itraconazole.htm
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Lamivudine http://www.reutershealth.com/atoz/html/Lamivudine.htm
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Lamivudine Zidovudine http://www.reutershealth.com/atoz/html/Lamivudine_Zidovudine.htm
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Lamotrigine http://www.reutershealth.com/atoz/html/Lamotrigine.htm
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Leuprolide Acetate http://www.reutershealth.com/atoz/html/Leuprolide_Acetate.htm
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Levodopa http://www.reutershealth.com/atoz/html/Levodopa.htm
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Lopinavir Ritonavir http://www.reutershealth.com/atoz/html/Lopinavir_Ritonavir.htm
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Lovastatin http://www.reutershealth.com/atoz/html/Lovastatin.htm
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Naproxen http://www.reutershealth.com/atoz/html/Naproxen.htm
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Nefazodone Hydrochloride http://www.reutershealth.com/atoz/html/Nefazodone_Hydrochloride. htm
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Nelfinavir Mesylate http://www.reutershealth.com/atoz/html/Nelfinavir_Mesylate.htm
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Nevirapine http://www.reutershealth.com/atoz/html/Nevirapine.htm
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Nicotine http://www.reutershealth.com/atoz/html/Nicotine.htm
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Nifedipine http://www.reutershealth.com/atoz/html/Nifedipine.htm
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Nitroglycerin http://www.reutershealth.com/atoz/html/Nitroglycerin.htm
162 Insomnia
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Norepinephrine http://www.reutershealth.com/atoz/html/Norepinephrine.htm
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Nortriptyline HCl http://www.reutershealth.com/atoz/html/Nortriptyline_HCl.htm
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Ofloxacin http://www.reutershealth.com/atoz/html/Ofloxacin.htm
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Olanzapine http://www.reutershealth.com/atoz/html/Olanzapine.htm
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Oseltamivir Phosphate http://www.reutershealth.com/atoz/html/Oseltamivir_Phosphate.htm
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Oxacillin Sodium http://www.reutershealth.com/atoz/html/Oxacillin_Sodium.htm
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Oxazepam http://www.reutershealth.com/atoz/html/Oxazepam.htm
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Oxybutynin Chloride http://www.reutershealth.com/atoz/html/Oxybutynin_Chloride.htm
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Pamidronate Disodium http://www.reutershealth.com/atoz/html/Pamidronate_Disodium.htm
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Paroxetine HCl http://www.reutershealth.com/atoz/html/Paroxetine_HCl.htm
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Peginterferon Alfa-2B http://www.reutershealth.com/atoz/html/Peginterferon_Alfa-2B.htm
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Pemoline http://www.reutershealth.com/atoz/html/Pemoline.htm
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Penbutolol Sulfate http://www.reutershealth.com/atoz/html/Penbutolol_Sulfate.htm
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Penicillin G http://www.reutershealth.com/atoz/html/Penicillin_G.htm
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Penicillin V http://www.reutershealth.com/atoz/html/Penicillin_V.htm
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Pentobarbital Sodium http://www.reutershealth.com/atoz/html/Pentobarbital_Sodium.htm
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Pentoxifylline http://www.reutershealth.com/atoz/html/Pentoxifylline.htm
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Pergolide Mesylate http://www.reutershealth.com/atoz/html/Pergolide_Mesylate.htm
Researching Your Medications 163
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Perphenazine http://www.reutershealth.com/atoz/html/Perphenazine.htm
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Perphenazine Amitriptyline http://www.reutershealth.com/atoz/html/Perphenazine_Amitriptyline .htm
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Phenelzine Sulfate http://www.reutershealth.com/atoz/html/Phenelzine_Sulfate.htm
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Phenobarbital http://www.reutershealth.com/atoz/html/Phenobarbital.htm
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Phenylephrine HCl http://www.reutershealth.com/atoz/html/Phenylephrine_HCl.htm
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Phenylpropanolamine HCl http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl. htm
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Phenylpropanolamine HCl Guaifenesin http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl_ Guaifenesin.htm
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Phenytoin http://www.reutershealth.com/atoz/html/Phenytoin.htm
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Piperacillin Sodium http://www.reutershealth.com/atoz/html/Piperacillin_Sodium.htm
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Pirbuterol Acetate http://www.reutershealth.com/atoz/html/Pirbuterol_Acetate.htm
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Piroxicam http://www.reutershealth.com/atoz/html/Piroxicam.htm
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Pramipexole Dihydrochloride http://www.reutershealth.com/atoz/html/Pramipexole_Dihydrochlori de.htm
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Prednisolone http://www.reutershealth.com/atoz/html/Prednisolone.htm
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Prednisone http://www.reutershealth.com/atoz/html/Prednisone.htm
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Prochlorperazine http://www.reutershealth.com/atoz/html/Prochlorperazine.htm
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Progesterone http://www.reutershealth.com/atoz/html/Progesterone.htm
164 Insomnia
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Promethazine HCl http://www.reutershealth.com/atoz/html/Promethazine_HCl.htm
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Propafenone http://www.reutershealth.com/atoz/html/Propafenone.htm
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Propantheline Bromide http://www.reutershealth.com/atoz/html/Propantheline_Bromide.htm
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Propoxyphene http://www.reutershealth.com/atoz/html/Propoxyphene.htm
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Propoxyphene Acetaminophen http://www.reutershealth.com/atoz/html/Propoxyphene_Acetaminop hen.htm
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Propoxyphene HCl Acetaminophen http://www.reutershealth.com/atoz/html/Propoxyphene_HCl_Acetam inophen.htm
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Protriptyline HCl http://www.reutershealth.com/atoz/html/Protriptyline_HCl.htm
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Pseudoephedrine http://www.reutershealth.com/atoz/html/Pseudoephedrine.htm
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Quazepam http://www.reutershealth.com/atoz/html/Quazepam.htm
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Raloxifene HCl http://www.reutershealth.com/atoz/html/Raloxifene_HCl.htm
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Raloxifene Hydrochloride http://www.reutershealth.com/atoz/html/Raloxifene_Hydrochloride.htm
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Ranitidine http://www.reutershealth.com/atoz/html/Ranitidine.htm
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Rifabutin http://www.reutershealth.com/atoz/html/Rifabutin.htm
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Rizatriptan http://www.reutershealth.com/atoz/html/Rizatriptan.htm
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Rofecoxib http://www.reutershealth.com/atoz/html/Rofecoxib.htm
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Ropinirole Hydrochloride http://www.reutershealth.com/atoz/html/Ropinirole_Hydrochloride.htm
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Salmeterol http://www.reutershealth.com/atoz/html/Salmeterol.htm
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Saquinavir Mesylate http://www.reutershealth.com/atoz/html/Saquinavir_Mesylate.htm
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Secobarbital Sodium http://www.reutershealth.com/atoz/html/Secobarbital_Sodium.htm
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Selegiline HCl http://www.reutershealth.com/atoz/html/Selegiline_HCl.htm
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Sertraline HCl http://www.reutershealth.com/atoz/html/Sertraline_HCl.htm
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Sibutramine Hydrochloride http://www.reutershealth.com/atoz/html/Sibutramine_Hydrochloride. htm
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Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
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Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
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Sparfloxacin http://www.reutershealth.com/atoz/html/Sparfloxacin.htm
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Sucralfate http://www.reutershealth.com/atoz/html/Sucralfate.htm
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Sulfasalazine http://www.reutershealth.com/atoz/html/Sulfasalazine.htm
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Tamsulosin Hydrochloride http://www.reutershealth.com/atoz/html/Tamsulosin_Hydrochloride. htm
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Thalidomide http://www.reutershealth.com/atoz/html/Thalidomide.htm
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Theophylline http://www.reutershealth.com/atoz/html/Theophylline.htm
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Thioridazine HCl http://www.reutershealth.com/atoz/html/Thioridazine_HCl.htm
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Thiothixene http://www.reutershealth.com/atoz/html/Thiothixene.htm
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Thyroid Desiccated http://www.reutershealth.com/atoz/html/Thyroid_Desiccated.htm
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Tiagabine Hydrochloride http://www.reutershealth.com/atoz/html/Tiagabine_Hydrochloride.htm
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Tiludronate Disodium http://www.reutershealth.com/atoz/html/Tiludronate_Disodium.htm
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Timolol Maleate http://www.reutershealth.com/atoz/html/Timolol_Maleate.htm
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Tinzaparin Sodium http://www.reutershealth.com/atoz/html/Tinzaparin_Sodium.htm
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Topiramate http://www.reutershealth.com/atoz/html/Topiramate.htm
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Torsemide http://www.reutershealth.com/atoz/html/Torsemide.htm
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Tranylcypromine Sulfate http://www.reutershealth.com/atoz/html/Tranylcypromine_Sulfate.htm
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Trazodone HCl http://www.reutershealth.com/atoz/html/Trazodone_HCl.htm
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Triazolam http://www.reutershealth.com/atoz/html/Triazolam.htm
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Trifluoperazine HCl http://www.reutershealth.com/atoz/html/Trifluoperazine_HCl.htm
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Trimethoprim Sulfamethoxazole http://www.reutershealth.com/atoz/html/Trimethoprim_Sulfamethox azole.htm
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Valganciclovir http://www.reutershealth.com/atoz/html/Valganciclovir.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions
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reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with insomnia--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat insomnia or potentially create deleterious side effects in patients with insomnia. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a
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medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with insomnia. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with insomnia. The FDA warns patients to watch out for44: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H.
44
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna ·
The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna
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Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna
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Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna
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Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna
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PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna
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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna
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Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna
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Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters:
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Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Amyl Nitrite: A vasodilator that is administered by inhalation. It is also used recreationally due to its supposed ability to induce euphoria and act as an aphrodisiac. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety medication. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and
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prevents peptide chain elongation. [NIH] Clorazepate Dipotassium: A water-soluble benzodiazepine derivative effective in the treatment of anxiety. It has also muscle relaxant and anticonvulsant actions. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Enoxacin: An orally administered broad-spectrum fluoroquinolone antibacterial agent active against most gram-negative and gram-positive bacteria. Its clinical efficacy has been confirmed in a variety of systemic infections and particularly in urinary tract infections. The drug is well tolerated by adults, but should not be used in children and pregnant women. [NIH]
Ephedrine: A sympathomimetic drug that stimulates thermogenesis in laboratory animals and humans. Animal studies show that it may reduce fat content and, therefore, body weight by mechanisms that probably involve increased expenditure and reduced food intake. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethchlorvynol: A sedative and hypnotic that has been used in the shortterm management of insomnia. Its use has been superseded by other drugs. [NIH]
Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Felodipine: A dihydropyridine calcium antagonist with positive inotropic effects. It lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance
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vessels. [NIH] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Griseofulvin: An antifungal antibiotic. Griseofulvin may be given by mouth in the treatment of tinea infections. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Isoetharine: Adrenergic beta-2 agonist used as bronchodilator for emphysema, bronchitis and asthma. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of
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rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Nevirapine: A potent, non-nucleoside reverse transcriptase inhibitor used in combination with nucleoside analogues for treatment of HIV infection and AIDS. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oxazepam: A benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia. [NIH] Penicillin G: A penicillin derivative commonly used in the form of its sodium or potassium salts in the treatment of a variety of infections. It is effective against most gram-positive bacteria and against gram-negative cocci. It has also been used as an experimental convulsant because of its actions on GABA mediated synaptic transmission. [NIH] Penicillin V: A broad-spectrum penicillin antibiotic used orally in the treatment of mild to moderate infections by susceptible gram-positive organisms. [NIH] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH]
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Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Piroxicam: 4-Hydroxy-2-methyl-N-2-pyridyl-2H-1,2-benzothiazine-3carboxamide 1,1-dioxide. A non-steroidal anti-inflammatory agent that is well established in the treatment of rheumatoid arthritis and osteoarthritis. Its usefulness has also been demonstrated in the treatment of musculoskeletal disorders, dysmenorrhea, and postoperative pain. Its long half-life enables it to be administered once daily. The drug has also been shown to be effective if administered rectally. Gastrointestinal complaints are the most frequently reported side effects. [NIH] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Propafenone: An antiarrhythmia agent that is particularly effective in ventricular arrhythmias. It also has weak beta-blocking activity. The drug is generally well tolerated. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Rifabutin: A broad-spectrum antibiotic that is being used as prophylaxis against disseminated Mycobacterium avium complex infection in HIVpositive patients. [NIH] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as
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antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Sulbactam: A beta-lactamase inhibitor with very weak antibacterial action. The compound prevents antibiotic destruction of beta-lactam antibiotics by inhibiting beta-lactamases, thus extending their spectrum activity. Combinations of sulbactam with beta-lactam antibiotics have been used successfully for the therapy of infections caused by organisms resistant to the antibiotic alone. [NIH] Systemic: Relating to a process that affects the body generally; in this instance, the way in which blood is supplied through the aorta to all body organs except the lungs. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to insomnia. Finally, at the conclusion of this chapter, we will provide a list of readings on insomnia from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
46
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47
47
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Insomnia Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for insomnia. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “insomnia” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Bright Light Treatment for Night-Time Insomnia and Daytime Sleepiness in Elderly People: Comparison With Short-Acting Hypnotic Source: Psychiatry and Clinical Neurosciences. 54: 374-376. 2000.
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Summary: This journal article describes a study comparing the effects of bright light (BL) treatment and a short-acting hypnotic on nighttime sleep, naps, and daytime sleepiness in elderly people. Three older people (aged 64-80 years) who did not complain of nighttime insomnia participated. Following a 3-day baseline period, participants were either exposed to 2 hours of BL (approximately 2,500 lx) at nighttime or given triazolam (0.125 mg/day) for 4 days. Participants received no treatment for the next 3 days, and then were crossed over to the other treatment for a further 4 days. They completed a daytime sleepiness test seven times daily and maintained a sleep log for 14 days. In addition, activity of the nondominant wrist was monitored with a actigraph. Subjectively, BL increased daytime sleepiness and naps and decreased nighttime sleep. Triazolam decreased daytime sleepiness and naps and increased nighttime sleep. Similar results were found for actigraphic nighttime sleep and naps. However, on the fourth day nighttime insomnia induced by BL had recovered and naps were shorter than during baseline. Triazolam increased actigraphic naps as the days passed. The article has 2 figures and 4 references. ·
Holistic Approaches to Insomnia Source: Positive Health. (No. 37): 26-27. February 1999. Summary: This journal article describes holistic approaches to insomnia. According to the author, insomnia usually is caused by depression or stress. She offers some general suggestions for relieving these problems, and then suggests specific strategies for improving sleep. These include avoiding electric blankets and clocks with an electronic display, having an aromatherapy bath at bedtime, drinking chamomile tea or honey and lemon, making a list of worries, using the meditation practice of focusing on one's breathing, drinking an infusion of valerian or passion flower, using homeopathic remedies, and eating a healthy diet. The article includes a list of essential oils for a calming bedtime bath, a descriptive list of homeopathic remedies for insomnia, resource information, and 6 references.
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Subjective and Polysomnographic Evaluation of a Herbal Preparation in Insomnia Source: Phytomedicine. 5(4): 253-257. 1998. Summary: This journal article describes a study of the clinical efficacy and safety of an herbal remedy for insomnia. The remedy was a mixture of 'Nardostachys jatamansi,' Rauwolfia serpentina,' and 'Tinospora cordifolia' prepared in tablet form. After a 3-week placebo run-in period, 39 patients took 2 tablets daily at bedtime for 21 days. They were given a
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diary card to record sleep parameters such as onset, duration, quality, number of awakenings, and feelings of hangover and daytime drowsiness. In addition, polysomnography was performed in 10 patients at the beginning and end of the treatment period. The participants demonstrated significant improvements in sleep quality, duration of sleep, and total sleep time, and reductions in sleep latency and number of awakenings with the herbal therapy. The treatment was well tolerated, and no major side effects were observed. Eleven patients complained of mild epigastric distress. Reports of hangover and daytime sedation were absent. The authors conclude that this herbal formula appears to have good hypnotic activity and may be useful in insomnia. The article has 3 figures, 1 table, and 23 references. ·
Panel Recommends Integrating Behavioral and Relaxation Approaches into Medical Treatment of Chronic Pain, Insomnia Source: Alternative Therapies in Health and Medicine. 2(1): 18-20, 22, 24, 26, 28. 1996. Summary: This journal article highlights proceedings from an expert panel convened by the National Institutes of Health (NIH) to examine the integration of behavioral and relaxation techniques such as meditation, hypnosis, and biofeedback into the medical treatment of chronic pain and insomnia. The NIH Office of Alternative Medicine and the Office of Medical Applications of Research sponsored a 3-day Technology Assessment Conference on October 16-18, 1995, to review the data on the relative merits of behavioral and relaxation interventions in the treatment of chronic pain and insomnia, and to examine the mechanisms by which these approaches could be integrated into medical practice. The panel focused on five areas of concern: (1) the types of behavioral and relaxation approaches used for conditions such as chronic pain and insomnia, (2) how these approaches work, (3) the quality of the evidence for their efficacy, (4) barriers to their integration into health care, and (5) significant issues for future research and applications. The panel concluded that conventional medical treatments for chronic pain and insomnia have had limited success, and that integrating behavioral and relaxation therapies can lead to better patient care and clinical efficacy. The article includes abstracts of the research data presented at the conference.
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Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia Source: JAMA. Journal of the American Medical Association. 276(4): 313318. July 24/31, 1996.
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Summary: This journal article presents the findings of an independent, non-Federal panel weighing the scientific evidence regarding the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. The panel developed a draft statement addressing questions about the behavioral and relaxation approaches used for conditions such as chronic pain and insomnia, their effectiveness, how they work, potential barriers to their successful integration into health care, and significant issues for future research and applications. The panel concluded that a number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions, and for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. The panel found that behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant. (AA-M). ·
Acupuncture Treatment for Insomnia and Acupuncture Analgesia Source: Psychiatry and Clinical Neurosciences. 49(2): 119-120. 1995. Summary: This journal article reviews evidence suggesting that acupuncture treatment for insomnia and acupuncture analgesia share a similar mechanism of action. According to the author, acupuncture is the most simple and effective treatment for insomnia in traditional Chinese medicine, with an estimated effectiveness rate of about 90 percent. The acupuncture points vary depending on the doctor and the case, but the most common points are Shenmen (HT7) and Anmian (extrapoint). Although the mechanism of acupuncture treatment for insomnia is not well elucidated, this author suggests that research into the general mechanism for acupuncture analgesia may provide some guidance. This research indicates that many of the sites where the acupuncture signals are integrated also participate in sleep-waking regulation, and that some of the neurotransmitters that are released have parallel effects in analgesia and sleep. This article describes the general mechanism proposed for acupuncture analgesia and explains why it may be similar to the mechanism of acupuncture treatment for insomnia. The article has 17 references.
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National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to insomnia and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “insomnia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to insomnia: ·
"Brain music" in the treatment of patients with insomnia. Author(s): Levin YaI. Source: Neuroscience and Behavioral Physiology. 1998 May-June; 28(3): 330-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9682240&dopt=Abstract
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46 cases of insomnia treated by semiconductor laser irradiation on auricular points. Author(s): Yao S. Source: J Tradit Chin Med. 1999 December; 19(4): 298-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10921138&dopt=Abstract
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A breathing-retraining procedure in treatment of sleep-onset insomnia: theoretical basis and experimental findings. Author(s): Choliz M. Source: Percept Mot Skills. 1995 April; 80(2): 507-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7675582&dopt=Abstract
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Acupuncture treatment for insomnia and acupuncture analgesia. Author(s): Lin Y. Source: Psychiatry and Clinical Neurosciences. 1995 May; 49(2): 119-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8726127&dopt=Abstract
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An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Author(s): Krakow B, Johnston L, Melendrez D, Hollifield M, Warner TD, Chavez-Kennedy D, Herlan MJ. Source: The American Journal of Psychiatry. 2001 December; 158(12): 2043-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11729023&dopt=Abstract
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An untenable rationale for treating insomnia. Author(s): van den Hout M, Kroeze S. Source: Percept Mot Skills. 1995 August; 81(1): 316-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8532474&dopt=Abstract
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Behavioral treatment for chronic insomnia. Author(s): Arnedt JT, Martin JL, Posner DA. Source: Med Health R I. 2002 March; 85(3): 90-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11917751&dopt=Abstract
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Behavioral treatment of chronic insomnia in psychiatrically ill patients. Author(s): Dashevsky BA, Kramer M. Source: J Clin Psychiatry. 1998 December; 59(12): 693-9; Quiz 700-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9921709&dopt=Abstract
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Behavioral treatment of insomnia: the Wilford Hall Insomnia Program. Author(s): Hryshko-Mullen AS. Source: Mil Med. 2000 March; 165(3): 200-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10741083&dopt=Abstract
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Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Author(s): Wagner J, Wagner ML, Hening WA. Source: The Annals of Pharmacotherapy. 1998 June; 32(6): 680-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9640488&dopt=Abstract
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Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Author(s): Poyares DR, Guilleminault C, Ohayon MM, Tufik S. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 April; 26(3): 539-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11999905&dopt=Abstract
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Can we mix behavioral therapy with hypnotics when treating insomniacs? Author(s): Hauri PJ. Source: Sleep. 1997 December; 20(12): 1111-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9493920&dopt=Abstract
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Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. Author(s): Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Source: Jama : the Journal of the American Medical Association. 2001 April 11; 285(14): 1856-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11308399&dopt=Abstract
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Comparative studies on the effects of the combination drug lorazepam plus diphenhydramine (Somnium) versus lorazepam on the noopsyche, thymopsyche and psychophysiology in nonorganic insomnia related to generalized anxiety disorder. Author(s): Grunberger J, Saletu B, Linzmayer L, Bock G, Weissgram S, Brandstaatter N, Frey R, Saletu-Zyhlarz G. Source: Methods Find Exp Clin Pharmacol. 1997 November; 19(9): 645-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9500129&dopt=Abstract
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Consensus for the pharmacological management of insomnia in the new millennium. Author(s): Roth T, Hajak G, Ustun TB. Source: Int J Clin Pract. 2001 January-February; 55(1): 42-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11219318&dopt=Abstract
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Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? Author(s): Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Source: Sleep. 2001 August 1; 24(5): 591-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11480656&dopt=Abstract
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Effect of a fixed valerian-Hop extract combination (Ze 91019) on sleep polygraphy in patients with non-organic insomnia: a pilot study. Author(s): Fussel A, Wolf A, Brattstrom A. Source: European Journal of Medical Research. 2000 September 18; 5(9): 385-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11003973&dopt=Abstract
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Effects of passive body heating on the sleep of older female insomniacs. Author(s): Dorsey CM, Lukas SE, Teicher MH, Harper D, Winkelman JW, Cunningham SL, Satlin A. Source: Journal of Geriatric Psychiatry and Neurology. 1996 April; 9(2): 83-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8736588&dopt=Abstract
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Evaluation and management of insomnia in menopause. Author(s): Jones CR, Czajkowski L. Source: Clinical Obstetrics and Gynecology. 2000 March; 43(1): 184-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10694999&dopt=Abstract
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Evaluation of short-term nonpharmacological treatment of insomnia in a clinical setting. Author(s): Verbeek I, Schreuder K, Declerck G. Source: Journal of Psychosomatic Research. 1999 October; 47(4): 369-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10616231&dopt=Abstract
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Experience in differentiation and treatment of stubborn insomnia. Author(s): Qian Y.
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Source: J Tradit Chin Med. 2001 September; 21(3): 168-73. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11789318&dopt=Abstract ·
Herbal treatment of insomnia. Author(s): Wing YK. Source: Hong Kong Medical Journal = Hsiang-Kang I Hsueh Tsa Chih / Hong Kong Academy of Medicine. 2001 December; 7(4): 392-402. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11773674&dopt=Abstract
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How useful is cognitive behavioral therapy (CBT) for the treatment of chronic insomnia? Author(s): Phillips TG, Holdsworth J, Cook S. Source: The Journal of Family Practice. 2001 July; 50(7): 569. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11485698&dopt=Abstract
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Identifying effective psychological treatments for insomnia: a metaanalysis. Author(s): Murtagh DR, Greenwood KM. Source: J Consult Clin Psychol. 1995 February; 63(1): 79-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7896994&dopt=Abstract
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Immunity and depression: insomnia, retardation, and reduction of natural killer cell activity. Author(s): Cover H, Irwin M. Source: Journal of Behavioral Medicine. 1994 April; 17(2): 217-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8035453&dopt=Abstract
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Impulse magnetic-field therapy for insomnia: a double-blind, placebocontrolled study. Author(s): Pelka RB, Jaenicke C, Gruenwald J. Source: Adv Ther. 2001 July-August; 18(4): 174-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11697020&dopt=Abstract
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Insomnia in HIV and its management: one clinician's perspective. Author(s): Samiuddin Z. Source: Res Initiat Treat Action. 2000 December; 6(4): 5-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11708174&dopt=Abstract
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Insomnia in the elderly. Author(s): Woodward M. Source: Aust Fam Physician. 1999 July; 28(7): 653-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10431419&dopt=Abstract
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Insomnia, hypnotic ability, negative affectivity, and the high risk model of threat perception. Author(s): Perlstrom JR, Wickramasekera I. Source: J Nerv Ment Dis. 1998 July; 186(7): 437-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9680046&dopt=Abstract
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Insomnia: costs to lose sleep over. Author(s): Smith MD, McGhan WF. Source: Bus Health. 1997 June; 15(6): 57-8, 60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10168151&dopt=Abstract
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Kava and valerian in the treatment of stress-induced insomnia. Author(s): Wheatley D. Source: Phytotherapy Research : Ptr. 2001 September; 15(6): 549-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11536390&dopt=Abstract
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Management of chronic insomnia in the elderly. Author(s): Ring D. Source: Clin Excell Nurse Pract. 2001; 5(1): 13-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11154388&dopt=Abstract
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Management of insomnia. Author(s): Kirkwood CK.
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Source: J Am Pharm Assoc (Wash). 1999 September-October; 39(5): 68896; Quiz 713-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10533351&dopt=Abstract ·
Management of insomnia. Author(s): Mahendran R. Source: Singapore Med J. 1995 February; 36(1): 80-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7570143&dopt=Abstract
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Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors. Author(s): Davidson JR, Waisberg JL, Brundage MD, MacLean AW. Source: Psycho-Oncology. 2001 September-October; 10(5): 389-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11536417&dopt=Abstract
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Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Author(s): Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Source: Sleep. 1999 December 15; 22(8): 1134-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10617176&dopt=Abstract
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Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Author(s): Morin CM, Culbert JP, Schwartz SM. Source: The American Journal of Psychiatry. 1994 August; 151(8): 1172-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8037252&dopt=Abstract
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Nonpharmacological treatment of late-life insomnia. Author(s): Morin CM, Mimeault V, Gagne A. Source: Journal of Psychosomatic Research. 1999 February; 46(2): 103-16. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10098820&dopt=Abstract
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Non-pharmacological treatments of insomnia. Author(s): Lushington K, Lack L.
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Source: Isr J Psychiatry Relat Sci. 2002; 39(1): 36-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12013709&dopt=Abstract ·
Polysomnographic evaluation of the hypnotic effect of Valeriana edulis standardized extract in patients suffering from insomnia. Author(s): Herrera-Arellano A, Luna-Villegas G, Cuevas-Uriostegui ML, Alvarez L, Vargas-Pineda G, Zamilpa-Alvarez A, Tortoriello J. Source: Planta Medica. 2001 November; 67(8): 695-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11731907&dopt=Abstract
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Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Author(s): Chesson AL Jr, Anderson WM, Littner M, Davila D, Hartse K, Johnson S, Wise M, Rafecas J. Source: Sleep. 1999 December 15; 22(8): 1128-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10617175&dopt=Abstract
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Prediction of outcome in behaviorally based insomnia treatments. Author(s): Bliwise DL, Friedman L, Nekich JC, Yesavage JA. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1995 March; 26(1): 17-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7642756&dopt=Abstract
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Prof. Kong Lingxu's experience in TCM treatment of insomnia. Author(s): Peng J. Source: J Tradit Chin Med. 1999 September; 19(3): 175-81. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10921145&dopt=Abstract
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Psychological treatment of secondary insomnia. Author(s): Lichstein KL, Wilson NM, Johnson CT. Source: Psychol Aging. 2000 June; 15(2): 232-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10879578&dopt=Abstract
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Psychophysiological insomnia: combined effects of pharmacotherapy and relaxation-based treatments. Author(s): Rosen RC, Lewin DS, Goldberg L, Woolfolk RL. Source: Sleep Med. 2000 October 1; 1(4): 279-288. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11040460&dopt=Abstract
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Relaxation and sleep compression for late-life insomnia: a placebocontrolled trial. Author(s): Lichstein KL, Riedel BW, Wilson NM, Lester KW, Aguillard RN. Source: J Consult Clin Psychol. 2001 April; 69(2): 227-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11393600&dopt=Abstract
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Relaxation therapy for insomnia: nighttime and day time effects. Author(s): Means MK, Lichstein KL, Epperson MT, Johnson CT. Source: Behaviour Research and Therapy. 2000 July; 38(7): 665-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10875189&dopt=Abstract
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Replacement of drug treatment for insomnia by ambient odour. Author(s): Hardy M, Kirk-Smith MD, Stretch DD. Source: Lancet. 1995 September 9; 346(8976): 701. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7658836&dopt=Abstract
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Sleep disorders in Chinese culture: experiences from a study of insomnia in Taiwan. Author(s): Lee YJ. Source: Psychiatry and Clinical Neurosciences. 1995 May; 49(2): 103-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8726123&dopt=Abstract
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Some basic features of the new sleep-aid tea (SAT) for the treatment of insomnia. Author(s): Shiyi L. Source: Sleep Res Online. 2000; 3(2): 49-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11382900&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to insomnia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Insomnia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm Insomnia Source: Integrative Medicine Communications; www.onemedicine.com
196 Insomnia
Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/ins omnia.html Insomnia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Sleeplessness Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html ·
Alternative Therapy Acupressure Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,662, 00.html Aromatherapy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Aromat herapycm.html Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672, 00.html Bach flower remedies Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,673, 00.html Biofeedback Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Biofeedback.htm Crystal healing Alternative names: crystal therapeutics crystal therapy crystal work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Feldenkrais Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,695, 00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705, 00.html Light therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,713, 00.html Macrobiotics Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,714, 00.html Magnet therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,715, 00.html Meditation Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
198 Insomnia
Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,717, 00.html Qigong Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,729, 00.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730, 00.html Relaxation Techniques Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Relaxat ionTechniquescm.html Repressed memory therapy Alternative names: RMT Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733, 00.html ·
Chinese Medicine Ankun Zanyu Wan Alternative names: (An Kun Zan Yu Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Ankun%20Zanyu% 20Wan&mh=10&sb=---&view_records=View+Records
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Anshen Buxin Wan Alternative names: Anshen Buxin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Anshen%20Buxin% 20Wan&mh=10&sb=---&view_records=View+Records Baihe Alternative names: Lily Bulb; Baihe (Bai He); Bulbus Lilii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Baizi Yangxin Wan Alternative names: Baizi Yangxin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Baizi%20Yangxin% 20Wan&mh=10&sb=---&view_records=View+Records Baiziren Alternative names: Chinese Arborvitae Kernel; Semen Platycladi Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Bushen Yinao Pian Alternative names: Bushen Yinao Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Bushen%20Yinao% 20Pian&mh=10&sb=---&view_records=View+Records Cishi Alternative names: Magnetite; Magnetitum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Colla Corii Asini Alternative names: Donkey-hide Glue; %Colla Corii Asini%%
200 Insomnia
Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Colla%20Corii%20 Asini&mh=10&sb=---&view_records=View+Records Dandouchi Alternative names: Fermented Soybean; Semen Sojae Preparatum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Danshen Alternative names: Danshen Root; Radix Salviae Miltiorrhizae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Dengxincao Alternative names: Common Rush; Medulla Junci Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Fuling Alternative names: Indian Bread; Poria Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gengnian'an Pian Alternative names: Gengnian'an Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Gengnian%27an%2 0Pian&mh=10&sb=---&view_records=View+Records Hamayou Alternative names: Forest Frog's Oviduct; Oviductus Ranae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hehuanhua Alternative names: Albizia Flower; Flos Albiziae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
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Hehuanpi Alternative names: Silktree Albizia Bark; Cortex Albiziae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Huanglian Alternative names: Golden Thread; Rhizoma Coptidis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Huashanshen Alternative names: Funneled Physochlaina Root; Radix Physochlainae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Lianzi Alternative names: Szechwan Chinaberry Fruit; Chuanlianzi; Fructus Toosendan Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Lianzixin Alternative names: Lotus Plumule; Plumula Nelumbinis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Longyanrou Alternative names: Longan Aril; Longyanrou (Long Yan Rou); Arillus Longan Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Luobumaye Alternative names: Dogbane Leaf; Folium Apocyni Veneti Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Maidong Alternative names: Liriope Root Tuber; Shanmaidong; Radix Liriopes Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
202 Insomnia
Mayou Alternative names: Castor Oil; Bimayou; Oleum Ricini Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Muli Alternative names: Oyster Shell; Concha Ostreae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Naolejing Alternative names: Naolejing Syrup Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Naolejing&mh=10 &sb=---&view_records=View+Records Qingnao Jiangya Pian Alternative names: Qingnao Jiangya Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qingnao%20Jiangy a%20Pian&mh=10&sb=---&view_records=View+Records Qiwei Guangzao Wan Alternative names: Qiwei Guangzao Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qiwei%20Guangza o%20Wan&mh=10&sb=---&view_records=View+Records Renshen Alternative names: Ginseng Leaf; Renshenye (Ren Shen Ye); Folium Ginseng Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Sangshen Alternative names: Mulberry Fruit; Fructus Mori Source: Chinese Materia Medica
Researching Alternative Medicine 203
Hyperlink: http://www.newcenturynutrition.com/ Shanmaidong Alternative names: Liriope Root Tuber; Radix Liriopes Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shouwuteng Alternative names: Tuber Fleeceflower Stem; Caulis Polygoni Multiflori Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Suanzaoren Alternative names: Spine Date Seed; Semen Ziziphi Spinosae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tianwang Buxin Wan Alternative names: Tianwang Buxin Pills; Tianwang Buxin Wan
(Ti An Wang Bu Xin Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Tianwang%20Buxi n%20Wan&mh=10&sb=---&view_records=View+Records Wuweizi Alternative names: Chinese Magnoliavine Fruit; Fructus Schisandrae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Yuanzhi Alternative names: Thinleaf Milkwort Root; Radix Polygalae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhenzhu Alternative names: Nacre; Zhenzhumu; Concha Margaritifera Usta Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhenzhumu Alternative names: Nacre; Concha Margaritifera Usta
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Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhuru Alternative names: Bamboo Shavings; Caulis Bambusae in Taeniam Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhusha Alternative names: Cinnabar; Cinnabaris Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zishiyin Alternative names: Fluorite; Fluoritum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ ·
Herbs and Supplements 5-Hydroxytryptophan (5-HTP) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/5Hy droxytryptophan5HTPcs.html Acanthopanax senticosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Activated charcoal Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Adrenal Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Adrenal_Extract.htm American Ginseng Alternative names: Panax quinquefolius
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginseng_American.htm American Scullcap Alternative names: Scutellaria lateriflora Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Scullcap_American.htm Amino acids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Amino Acids Overview Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Amino_Acids.htm Anise Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Antibiotic Combination: Sulfa Drugs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsSulfaDrugscl.html Antidepressants Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Antioxidants Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Antituberculosis Agents Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsAntituberculosisAgentscl.html
206 Insomnia
Arctostaphylos uva ursi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Ashwagandha Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000099.html Asian Ginseng Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Aspirin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Astragalus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000101.html Ativan Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Ava Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/KavaKavac h.html Barbiturates Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Barbiturates.htm Barbiturates Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Bearberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Beargrape Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Benzodiazepines Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Benzodiazepines.htm Benzodiazepines Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Benzodiazepines Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000323.html Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm
208 Insomnia
Black Cohosh Alternative names: Cimicifuga racemosa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Black_Cohosh.htm Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTeach .html Catnip Alternative names: Nepeta cataria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Catnip.htm Centella Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Cephalosporins Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsCephalosporinscl.html Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Chamomile.htm
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Chamomile Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm Clonazepam Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Coleus Alternative names: Coleus forskohlii Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Coleus.htm CoQ10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Corydalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm Cyproheptadine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Diazepam Source: Healthnotes, Inc.; www.healthnotes.com
210 Insomnia
Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm Diphenhydramine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diphenhydramine.htm DMAE Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 23,00.html Dong Quai Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000148.html Doxylamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Doxylamine.htm Eleuthero Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Eleuthero.htm Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Eleutherococcus senticosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html English Lavendar Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Lavenderch. html Ephedra Alternative names: Ephedra sinica, Ephedra intermedia, Ephedra equisetina Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ephedra.htm Ephedrine and Pseudoephedrine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Estrogen Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Evening Primrose Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Forskolin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html French Lavendar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Lavenderch. html Gaba Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Gaba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 27,00.html
212 Insomnia
Ginseng Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000100.html Glutamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 30,00.html Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Green Tea Alternative names: Camellia sinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Green_Tea.htm Halcion Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html He Shou Wu Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000160.html Herbal decongestant Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,949, 00.html Hops Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm
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Hydantoin Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antico nvulsantMedicationsHydantoinDerivativescl.html Hydrocotyle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Indian Pennywort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Inhalant, Systemic, and Topical Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antiinfla mmatoryMedicationsInhalantSystemicandTopicalCorticosteroidscl.html Insulin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Jamaica Dogwood Alternative names: Piscidia erythrina, Piscidia piscipula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/JamaicaDog woodch.html Kava Kava Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html
214 Insomnia
Kola Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Lavandula angustifolia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Lavenderch. html Lavender Alternative names: Lavandula officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Lavender.htm Lobelia inflata Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Loop Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diureti csLoopDiureticscl.html Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Macrolides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsMacrolidescl.html Mad-dog Skullcap Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcapch. html Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GotuKolach .html Melatonin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm Melatonin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Melatonin.htm Mullein Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm NADH Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 47,00.html Oxazepam Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Oxazepam.htm Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Panax quinquefolium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAm ericanch.html Passiflora incarnata Alternative names: Passionflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interactions /Passionflowerch.html Passion Flower Alternative names: Passiflora incarnata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Passion_Flower.htm Penicillin Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsPenicillinDerivativescl.html Phenelzine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Phenelzine.htm Phenobarbital Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Phenobarbital.htm Phosphatidylserine (PS) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,813, 00.html Piper methysticum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/KavaKavac h.html Piscidia erythrina Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/JamaicaDog woodch.html Piscidia piscipula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/JamaicaDog woodch.html Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Pramipexole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm Prednisone Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Pregnenolone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pregnenolone.htm
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Quinolones Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsQuinolonescl.html Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Reishi.htm Restoril Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818, 00.html Schisandra Alternative names: Schisandra chinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Schisandra.htm Scutellaria lateriflora Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcapch. html Selective Serotonin Reuptake Inhibitors Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Siberian Ginseng Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus, Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengSibe rianch.html Skullcap Alternative names: Scutellaria lateriflora, Mad-dog Skullcap Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Skullcapch. html St. John's Wort Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000237.html Tetracycline Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antibio ticMedicationsTetracyclineDerivativescl.html Theophylline Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Asthm aMedicationscl.html Triazolam Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Triazolam.htm Uva Ursi Alternative names: Arctostaphylos uva ursi, Bearberry, Beargrape Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursich.h tml Valerian Alternative names: Valeriana officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Valerian.htm
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Valium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Vasodilators Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cardio vascularMedicationsVasodilatorscl.html Wormwood Alternative names: Artemisia absinthium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Wormwood.htm Xanax Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000296.html Yerba Santa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Yohimbe.htm Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Zolpidem Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Zolpidem.htm
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
·
Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
·
Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna
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For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with insomnia. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with insomnia may be given different recommendations. Some recommendations may be directly related to insomnia, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of insomnia. We will then show you how to find studies dedicated specifically to nutrition and insomnia.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
48
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
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RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49
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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Insomnia The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
52
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found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “insomnia” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “insomnia” (or a synonym): ·
Acupuncture treatment for insomnia and acupuncture analgesia. Author(s): Department of Physiology, Shanghai Second Medical University, China. Source: Lin, Y Psychiatry-Clin-Neurosci. 1995 May; 49(2): 119-20 13231316
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Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Author(s): College of Pharmacy, Rutgers State University of New Jersey, Piscataway 08854, USA. Source: Wagner, J Wagner, M L Hening, W A Ann-Pharmacother. 1998 June; 32(6): 680-91 1060-0280
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Caffeine use as a model of acute and chronic insomnia. Author(s): Dayton Veterans Administration Medical Center, Ohio. Source: Bonnet, M H Arand, D L Sleepage 1992 December; 15(6): 526-36 0161-8105
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Clinical observation of 62 cases of insomnia treated by auricular point imbedding therapy. Source: Yang, C L J-Tradit-Chin-Med. 1988 September; 8(3): 190-2 02546272
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Effect of a fixed valerian-Hop extract combination (Ze 91019) on sleep polygraphy in patients with non-organic insomnia: a pilot study. Author(s): Zeller AG, Seeblickstr. 4, CH-8590 Romanshorn, Switzerland. axel.
[email protected] Source: Fussel, A Wolf, A Brattstrom, A Eur-J-Med-Res. 2000 September 18; 5(9): 385-90 0949-2321
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Evaluation and management of insomnia in menopause. Author(s): Department of Neurology, University of Utah School of Medicine, Salt Lake City 84132, USA. Source: Jones, C R Czajkowski, L Clin-Obstet-Gynecol. 2000 March; 43(1): 184-97 0009-9201
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Insomnia treated by auricular pressing therapy. Author(s): Department of TCM, General PLA Hospital of Chengdu Military Region. Source: Lian, N Yan, Q J-Tradit-Chin-Med. 1990 September; 10(3): 174-5 0254-6272
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Insomnia. Get a good night's sleep. Source: Anonymous Harv-Health-Lett. 1998 December; 24(2): 1-3 10521577
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Kava and valerian in the treatment of stress-induced insomnia. Source: Wheatley, D. PTR,-Phytother-res. West Sussex : John Wiley & Sons Ltd. Sept 2001. volume 15 (6) page 549-551. 0951-418X
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Lectures on formulating acupuncture prescriptions--selection and matching of acupoints. Acupuncture treatment of insomnia. Source: Zhao, C X J-Tradit-Chin-Med. 1987 June; 7(2): 151-2 0254-6272
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Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Author(s): Department of Psychiatry and Psychotherapy, AlbertLudwigs-University, Freiburg, Germany. Source: Hornyak, M Voderholzer, U Hohagen, F Berger, M Riemann, D Sleepage 1998 August 1; 21(5): 501-5 0161-8105
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Melatonin add-on in manic patients with treatment resistant insomnia. Author(s): Department of Psychiatric Science and Psychological Medicine, University of Rome La Sapienza, Italy.
[email protected] Source: Bersani, G Garavini, A Prog-Neuropsychopharmacol-BiolPsychiatry. 2000 February; 24(2): 185-91 0278-5846
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Melatonin and insomnia. Author(s): University Department of Neurology, King's College School of Medicine and Dentistry, London, UK. Source: Ellis, C M Lemmens, G Parkes, J D J-Sleep-Res. 1996 March; 5(1): 61-5 0962-1105
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Melatonin as a chronobiotic for circadian insomnia. Clinical observations and animal models. Author(s): Brain Sciences Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia. Source: Armstrong, S M Adv-Exp-Med-Biol. 1999; 460283-97 0065-2598
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Melatonin treatment for age-related insomnia. Author(s): Department of Brain and Cognitive Sciences, Clinical Research Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA.
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Source: Zhdanova, I V Wurtman, R J Regan, M M Taylor, J A Shi, J P Leclair, O U J-Clin-Endocrinol-Metab. 2001 October; 86(10): 4727-30 0021972X ·
Prof. Kong Lingxu's experience in TCM treatment of insomnia. Author(s): Institute of TCM Basic Theories, China Academy of Traditional Chinese Medicine, Beijing. Source: Peng, J J-Tradit-Chin-Med. 1999 September; 19(3): 175-81 02546272
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Reversibility of para-chlorophenylalanine-induced insomnia by intrahypothalamic microinjection of L-5-hydroxytryptophan. Author(s): Departement de Medecine Experimentale, INSERM U52, CNRS UA1195, Faculte de Medecine, Universite Claude Bernard, Lyon, France. Source: Denoyer, M Sallanon, M Kitahama, K Aubert, C Jouvet, M Neuroscience. 1989; 28(1): 83-94 0306-4522
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Sleep disorders in Chinese culture: experiences from a study of insomnia in Taiwan. Author(s): Department of Psychiatry, School of Medicine, National Taiwan University, Taipei, Taiwan. Source: Lee, Y J Psychiatry-Clin-Neurosci. 1995 May; 49(2): 103-6 13231316
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The role of melatonin and circadian phase in age-related sleepmaintenance insomnia: assessment in a clinical trial of melatonin replacement. Author(s): Department of Psychiatry, School of Medicine, Oregon Health Sciences University, Portland, USA. Source: Hughes, R J Sack, R L Lewy, A J Sleepage 1998; 21(1): 52-68 01618105
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The therapeutic effect of mulberry in the treatment of constipation and insomnia in the elderly. Source: Weng, M H Chen, Z J-Tradit-Chin-Med. 1989 June; 9(2): 93-4 0254-6272
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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to insomnia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Niacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Pyridoxine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 67,00.html Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Vitamin C Source: Prima Communications, Inc.
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Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,905, 00.html ·
Minerals Alpha-Tocopherol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Bromocriptine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Calci umcs.html Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884, 00.html Calcium/magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,937, 00.html Clorazepate Dipotassium Source: Healthnotes, Inc.; www.healthnotes.com
Researching Nutrition 235
Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clorazepate_Dipotassiu m.htm Copper Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Folate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm Iron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm L-Carnitine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Quercetin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html ·
Food and Diet Buffalo Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Chocolate Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Chocolate.htm Coffee Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm Crackers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Fish Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Garlic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000164.html Hypoglycemia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Restless_Legs_Syndr ome.htm Lavender Flowers Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm Magnesium Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Insomnia.htm
Researching Nutrition 237
Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Insom niacc.html Oats Alternative names: Avena sativa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oats.htm Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Omega-3 Fatty Acids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/COPD.htm Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Tea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000266.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Weight Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html
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Yogurt Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,97,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Cholesterol: A soft, waxy substance manufactured by the body and used in the production of hormones, bile acid, and vitamin D and present in all parts of the body, including the nervous system, muscle, skin, liver, intestines, and heart. Blood cholesterol circulates in the bloodstream. Dietary cholesterol is found in foods of animal origin. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Fetus: Unborn offspring from 7 or 8 weeks after conception until birth. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH]
Finding Medical Libraries 239
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53
53
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
54
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 241
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 243
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 245
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
·
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
·
Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 247
APPENDIX E. NIH CONSENSUS STATEMENT ON THE TREATMENT OF SLEEP DISORDERS OF OLDER PEOPLE Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.55 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”56 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in March 1990.57 55 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 56 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 57 The Treatment of Sleep Disorders of Older People. NIH Consensus Statement Online 1990 Mar 26-28 [cited 2002 February 21];8(3):1-22. http://consensus.nih.gov/cons/078/078_statement.htm
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Abstract The National Institutes of Health Consensus Development Conference on the Treatment of Sleep Disorders of Older People brought together clinical specialists in pulmonology, psychiatry, and psychology, geriatrics, internal medicine, other health care providers, and the public to address the cause, diagnosis, assessment, and specific treatments of sleep disorders of older people. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the scientific evidence and prepared a consensus statement. Among their findings, the panel concluded that although sleep patterns change during the aging process most older people with sleep disturbances suffer from any of a variety of medical and psychosocial disorders. The panel recommended that the diagnostic evaluation of sleep disorders begin with a careful clinical evaluation performed by an informed primary care physician. When necessary, referrals should be made to individuals or centers with specialized skills and tools for therapy. The panel recognized two types of disorders for which treatment may be beneficial: obstructive sleep apnea and insomnia. The mainstay for treatment for sleep apnea is the use of nasal continuous positive airway pressure. A thorough medical evaluation is essential prior to initiating treatment for insomnia, as its causes may be of psychiatric, pharmacological, or medical origin. The panel recommended that hypnotic medications not be the mainstay of treatment for insomnia as they may have habit forming potential if overused. The full text of the consensus panel’s statement follows.
What Is the Treatment of Sleep Disorders of Older People? The increase in the number of people over 65 and the rise in the proportion of older people represent a marked change in the demographic patterns in this country that will have profound social, economic, medical, and personal consequences. Individuals over 65 constituted 4 percent of the American population in 1900 and nearly 10 percent in 1972. By the year 2000, it is estimated that they will comprise over 13 percent of the population and by 2050 will represent more than 21 percent of Americans. A large proportion of older people are at risk for disturbances of sleep that may be caused by many factors such as retirement and changes in social patterns, death of spouse and close friends, increased use of medications,
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 249
concurrent diseases and changes in circadian rhythms. While changes in sleep patterns have been viewed as part of the normal aging process, new information indicates that many of these disturbances may be related to pathological processes that are associated with aging. Although the exact numbers are not yet known, it has been estimated that disturbances of sleep afflict more than half of the people 65 and older who live at home and about two-thirds of those who live in long-term care facilities. Problems in sleep and daytime wakefulness disrupt not only the lives of older persons but also those of their families and caregivers. People over 65 years of age now constitute almost 13 percent of the American population but consume over 30 percent of all dispensed prescription drugs, as well as an unknown percentage of over-the-counter medicines. A large proportion of these drugs are sedatives and hypnotic agents, the safety and efficacy of which have not been established for older people. Nor has it been established to what extent drugs contribute to or alleviate problems of sleep. It is necessary to understand the causes of these disorders and to develop better treatment strategies, including non-pharmacological methods. In addition to affecting the quality of life, troubled sleep has been implicated with excess mortality. Controversy also exists concerning the causes, diagnosis, assessment, and specific treatments of sleep disorders in older people. In an effort to assess the current state of knowledge and determine what changes in sleep are clinically important, how sleep disorders are best diagnosed and treated, and how the public can establish good sleep practices, the National Institute on Aging, the Office of Medical Applications of Research, the National Institute of Neurological Disorders and Stroke, and the National Heart, Lung, and Blood Institute of the National Institutes of Health and the National Institute of Mental Health, convened this conference. Following 1-1/2 days of presentations by experts in the relevant fields, a consensus panel consisting of representatives from neurology, psychiatry, internal medicine, geriatric medicine, pulmonology, otolaryngology--head and neck surgery, epidemiology, biostatistics, pharmacology, and the public considered evidence and formulated a consensus statement responding to these key questions: ·
What are the changes in sleep and wakefulness as functions of aging and of diseases of older people? What are the diagnostic criteria that establish clinical abnormalities? Which are clinically and epidemiologically important?
250 Insomnia
·
What are the indications for a diagnostic evaluation? What sequence of assessment methods should be used to determine if the diagnostic criteria are met?
·
What are the indications for the treatment of sleep disorders?
·
What are the common medical practices and lay treatment practices and their health implications?
·
What should the medical profession and general public know about good sleep hygiene and treatment of sleep disorders, and what should be done to increase awareness?
·
What are the directions for future research?
Sleep and Wakefulness of Older People Sleep is a distinctive and essential component of human behavior. Nearly a third of the life of a normal adult is spent sleeping. Sleep is divided into rapid eye movement (REM) and non-REM sleep. REM sleep is characterized by a low amplitude pattern in the EEG, an associated loss of muscle tone, and the presence of rapid eye movements. Non-REM sleep is characterized by sleep spindles and slow wave activity in the EEG. Sleep is differentially distributed into the dark portion of the daily cycle of light and dark. This regulation of sleep reflects basic brain mechanisms that provide the circadian organization of both behavioral and physiological processes. During aging there are typical changes in the pattern of sleep. The amount of time spent in deeper levels of sleep diminishes. There is an associated increase in awakenings during sleep and in the total amount of time spent awake during the night. In part, these changes appear to represent a loss of effective circadian regulation of sleep. In carefully screened, medically healthy, older subjects, there are relatively few individuals who have symptoms related to these changes in sleep and in the distribution of sleep and waking behaviors. Many older individuals, however, suffer from a variety of medical and psychosocial problems and these are very often associated with disturbances of sleep. These include psychiatric illnesses, particularly depression; Alzheimer’s disease and other neurodegenerative diseases; cardiovascular disease; upper airway incompetence; pulmonary disease; arthritis; pain syndromes; prostatic disease; endocrinopathies; and other illnesses.
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 251
The diagnostic categories that establish clinical abnormalities of sleep arise from two sets of data. The first is derived from evaluation of the patient’s history, which is classified into syndromes as have been described in the International Classification of Sleep Disorders. None of the disorders are specific for older people, but nearly all occur in this population. The second set comes from electrophysiological studies. Both provide valuable information, but each has its own limitations. There is little agreement among workers in the field about what is clinically normal and what is clinically abnormal, except in extreme cases (for example, high values of indices of sleep disordered breathing). Also, measurements are not obtained in a standardized way. Much needs to be learned, and an important first step is to decide upon a standardized approach to data collection. The new classification scheme is an important first step in the standardization process. In the assessment of the behavioral aspects of sleep, standardization is needed before epidemiological subpopulations can be defined and surveyed. The validity (including face validity) and reliability of standardized instruments and settings must be determined before sensitivity, specificity, and prevalence are assessed. Additional considerations are cost and ease of measurement. With standardized, agreed-upon instruments intra- and intersubject variability can be measured and linked with other clinical observations. Standardized approaches to data collection for both the clinician and the researcher are particularly important in the measurement of variations over time. In many situations clinical action is based on an inference that the patient’s condition has changed. If this judgment is guided by a psychometric instrument, then the reliability of the estimated change, in the presence of intrasubject variability, must be established. The rapid and thorough evaluation of new and existing technology will aid in the development of standardized approaches to data collection. The evaluation begins with the specification of the clinical need. Comparisons with competing technology must be made as objectively as possible, and the ideal research design for accomplishing this is the randomized double-blind clinical trial. It is difficult to answer questions about changes in sleep and wakefulness as functions of aging or of disease in older people because basic epidemiologic descriptive studies have not yet been carried out. Studies of the distribution of sleeping patterns and “disorders” need to be conducted in the
252 Insomnia
“community” utilizing a representative sampling scheme so that the relationship of sleep patterns to possibly pertinent cultural, demographic, and other variables can be explored. There is a need for epidemiological studies of sleep disorders: international and cross-cultural comparisons and case-control studies may confirm and generate etiological hypotheses. The natural history of certain sleep disorders is not well described: Do they spontaneously remit? What is the relationship to cardiovascular disease and life expectancy? Cohort studies may help advance our understanding of the natural history of these disorders. Similarly, it is difficult to determine which diagnostic criteria are important in establishing clinical abnormalities. The field of sleep disorder research has largely approached this problem by attempting to separate “normal” from “abnormal” or “diseased.” However, population distributions of the phenomena employed as diagnostic criteria (e.g., periodic movements in sleep or apneic episodes) are not well described. Current threshold values are usually not validated; and test characteristics (sensitivity, specificity, predictive values) are largely unavailable. Furthermore, inter- and intraobserver variation in test interpretation has been rarely studied. While the severe forms of clinical entities, such as sleep apnea, are generally accepted and criteria agreed upon, mild and moderate forms are not well distinguished. Study of the distribution of these phenomena in populations, linking them to clinical outcomes, is lacking. For example, persons with a mild degree of periodic movements in sleep or apnea may be asymptomatic and not suffer any appreciable morbidity. It will be difficult to establish diagnostic criteria if the frequency of these events is not linked to natural history studies and eventual health outcomes and functional impairment.
Diagnostic Evaluation Diagnostic evaluation begins with the recognition of a potential disorder by patient history or physician suspicion. Screening questions should include: 1) patient satisfaction with his or her sleep; 2) intrusion of sleep or fatigue into daily activities; and 3) complaint by bed partner or other observers of unusual behavior during sleep. A positive response to these questions should trigger a more detailed history of the onset, severity, duration, and pattern of the complaint, and lead to a differential diagnosis.
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 253
Three major types of sleep complaints are excessive sleepiness (hypersomnia), difficulty in initiating or maintaining sleep (insomnia), and strange or unusual behavior during sleep (parasomnias). A careful medical history is needed to determine the presence and severity of concomitant disease. The history of snoring, breathing pauses, or periodic movements during sleep is sometimes better described by the bed partner or other observers. Prescribed medications, especially sedatives, alcohol use, and self medication can have a significant effect on sleep and may impair cardiopulmonary mechanisms during sleep. Psychiatric history and evaluation identify anxiety, depression, or major life events which are known to affect sleep habits or hygiene. In some cases the use of a patient sleep log to evaluate sleep/wakefulness patterns will serve to identify rhythmic or circadian disturbances or to document the magnitude of sleep intrusion into daily activities. Appropriate physical examination will depend upon the nature of the complaint and history elicited from the patient. For example, heavy snoring may necessitate a detailed examination of the nose and throat. Appropriate laboratory tests may be similarly indicated. Given additional training and education, primary care physicians should be capable of initial assessment and management of the majority of sleep disorders presenting in the older population. When necessary, referrals should be made to individuals or a center with recognized skills in the indications for and application of more specialized tools, such as polysomnography or multiple sleep latency tests for diagnosis and recommendations for therapy. Polysomnography is indicated when a sleep related breathing disorder is suspected and may be useful for certain behavior or movement disorders during sleep. Polysomnography followed by a multiple sleep latency test is useful for establishing the diagnosis of narcolepsy and for quantitating daytime sleepiness. At present, there are insufficient data to assess the value of polysomnography in the routine evaluation of insomnia, depression, or dementia. Limited monitoring on an ambulatory basis may be useful to assess efficacy of therapy for sleep apnea. Technologic advances, standardization of variables, and cost-effectiveness need to be addressed before incorporating ambulatory monitors into epidemiologic studies or the clinical practice of sleep disorders medicine.
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Treatment of Sleep Disorders The goals of therapy of sleep disorders can be classified as: ·
Reducing morbidity;
·
Reducing excess mortality; and
·
Improving quality of life for patient and family.
Sleep disorders have been classified extensively. The major focus of this conference could, however, be summarized as dealing with two primary types of complaints or disorders, for which there is evidence to suggest that treatment is beneficial. These consist of: ·
The hypersomnias, primarily represented by obstructive sleep apnea; and
·
The insomnia complaints, which can be due to a variety of psychiatric and medical disorders. Indications for Treatment of Obstructive Sleep Apnea
Obstructive sleep apnea is a potentially reversible cause of daytime hypersomnia, which may be associated with comorbid conditions and even excess mortality. Effective treatment is available for many patients. Development of better and more effective treatment strategies should, however, be encouraged. Treatment is recommended for more severe degrees of this disorder. Objective indices of severity elicited by polysomnography should include a high index of respiratory disturbances per hour, repetitive episodes of hypoxemia, and an abnormally shortened sleep latency. Strict guidelines for therapy have not been adequately validated to dictate thresholds for distinguishing less severely affected patients. At the present time, considerable reliance is made on clinical judgment to initiate a therapeutic trial or regimen.
Indications for Treatment of Insomnia Complaints Complaints of insomnia are very common in the older patient. Insomnia is a symptomatic expression of a constellation of medical conditions that are not entirely related one to another. Insomnia may be of psychiatric (e.g., depression, anxiety), physiological (e.g., central apnea, limb movement), pharmacological (e.g., prescribed or unprescribed drugs or alcohol), or of
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 255
medical origin. It may coexist with other sleep disorders (such as apnea), but this may be merely coincidental. Since insomnia has many causes, the indications for treatment are dependent on the etiology. A thorough medical evaluation is essential prior to initiating treatment. Indications for therapy will be driven by the underlying cause and severity of symptoms. Attention was given to periodic movements in sleep which appear to be very common in the older patient. Certain pharmacological treatments appear to be effective in patients who find this condition distressing. There is, however, insufficient evidence at this time to indicate whether or not the disease state or its treatment affect morbidity in the older patient. Moreover, the long-term benefits and risks of treatment of periodic movements in sleep are unknown, and, therefore, further investigations are recommended. Insomnia may also be related to circadian rhythm disorders. Amplitude and phase relationships are often altered in the older person. These changes may produce a variety of somatic complaints and sleep disturbances. Such alterations occur during shift work, transmeridian travel, or changes in daily routine or sleep patterns (earlier arousal and earlier bedtime tendency), or they may occur spontaneously. Therapy should be directed toward appropriate control of the environment and adequate counseling of the patient and the employer. It may include appropriately timed bright light exposure. Insomnia resulting from medical or psychiatric causes should be managed primarily by appropriate treatment of the underlying condition.
Common Medical Practices Insomnia Although hypnotic medication is frequently prescribed by physicians for insomnia and secured either across the counter or “extralegally,” hypnotic medication should not be the mainstay of management for most of the causes of disturbed sleep. Since a large proportion of individuals with chronic insomnia have psychiatric complaints, particularly depression, but also anxiety, panic states, alcoholism, and others, treatment should be directed toward the
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underlying disorder. In the case of depression the tricyclic antidepressants are frequently useful in the absence of contraindications. One can take advantage of the sedative effect of some of these agents in addition to their more specific effect on the depression. Some agents may actually cause sleeplessness and should be used in the morning. Other diseases and conditions which cause or contribute to insomnia, such as congestive heart failure, hyperthyroidism, pulmonary disease, esophageal reflux, and arthritis, should be treated specifically with the reminder that medications such as steroids and theophylline may cause sleep disturbance, as can the timing of administration of diuretics. Pharmacologic therapy may be helpful if it is determined that periodic movements in sleep are contributing to insomnia and require treatment. The long-term benefits of treatment have yet to be determined. Other general measures such as sleep hygiene can be used as adjuncts to treatment of the specific causes of insomnia and tried when the cause is not clear or is unspecified. Sleep hygiene measures include regularization of bedtime (generally later rather than earlier); the use of the bedroom primarily for sleeping and sexual activity; exercise; avoidance of alcohol and caffeine; reduced evening fluid intake; and in the case of esophageal reflux, elevation of the head of the bed. Short-term intermittent use of hypnotics and sedative tricyclics may be useful for temporary problems such as bereavement, dislocation, and situational anxiety. There are no studies that demonstrate their long term effectiveness. Given the changes in drug metabolism associated with increasing age, all medication should be used with caution, especially those with long half-lives. Older people should avoid over-the-counter sleep medication due to their anticholinergic effects and questionable efficacy. LTryptophan (another commonly used over-the-counter sleep-inducing agent) has been associated with eosinophilic myalgia syndrome and has been withdrawn from the market. The role of pharmacological, behavioral, and phototherapeutic management of disorders of circadian rhythm regulation is currently under investigation. Hypersomnia When treatment is indicated for hypersomnia due to obstructive sleep apnea, certain general measures, if successfully initiated, may suffice. These include
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 257
weight loss; avoidance of alcohol, sedatives and hypnotics; the avoidance of the supine sleeping position; and management of nasal and nasopharyngeal disease. The mainstay of treatment is the use of nasal continuous positive airway pressure (CPAP), which is frequently successful. It and other devices (including tongue retaining and jaw advancing appliances and cervical collars) need further study. Where other measures, including nasal CPAP, fail or are unacceptable, surgical procedures may become an appropriate alternative treatment. Uvulopalatopharyngoplasty has been reported to be successful. There is evidence that the procedure may have better success when tailored to a demonstrated site of obstruction. Tracheostomy may be required if other procedures are unacceptable or fail. In all therapeutic interventions there should be long-term outcome assessment.
Good Sleep Hygiene and Treatment The answer to this question involves defining the target audience, determining what information should be conveyed, and deciding how best to transmit the information. Physicians and medical students, nurses, social workers and counselors, rehabilitation and respiratory therapists, discharge planners, and pharmacists and other allied health professionals are the groups to be approached first. We anticipate particular interest from providers of services to the older people including area agencies on aging, senior centers, and nursing homes. Other special groups that are affected by sleep disorder issues include employers, pharmaceutical companies, members of the legal profession, and developers of technology. Funders of research, both public and private, must be involved in this developing field. Education also must be directed toward decision makers at local, state and national levels, including regulatory and legislative groups. There are also key decision makers in the private sector such as those in the insurance industry and health care systems.
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Educational efforts must include the very groups we wish to help: the older persons, their families, and caregivers. The information to be conveyed will differ in content, style, and depth depending on the audience--professionals, patients, and media. A particular educational emphasis is desirable for new physicians and researchers, even while it is recognized that there are many unanswered questions. Nevertheless there are general concepts that could be useful for all groups. The content should include concepts of sleep physiology and pathophysiology, and assessment and differential diagnosis. Discussion of treatment approaches including technological devices, drugs, and lifestyle should address disadvantages as well as advantages. For audiences unfamiliar with the issue of sleep and the older person, the magnitude of the personal and societal toll in accidents, health, and unhappiness must be conveyed. Other key points include proper use of medications, preventive health measures, and good sleep hygiene practices. Individuals may satisfactorily cope with insomnia, and it may be transient. On the other hand, persistent insomnia may reflect major disease, and competent clinical consultation may be desirable. Imagination and sustained effort are at the heart of the many educational efforts. For health professionals one goal is to include information on sleep in the curriculum of schools--not an easy task. More standard educational efforts include appropriate lay and professional publications, professional conferences, and continuing education. Lay or advocacy groups can contribute to the total educational effort, as well as benefit from it. Reaching the public can be facilitated by utilizing existing networks, for example, state and area agencies on aging, coordinated through the Administration on Aging. There are opportunities for communicating information in newsletters published by churches, hospitals, and senior centers. There is particular need to involve citizen groups who direct their efforts toward the older person. All media groups should be encouraged to discuss these issues. The Public Health Service must take a more active role in educating and disseminating information to the public. Without such effort, this consensus report may not receive the wide dissemination it deserves.
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 259
Future Research The conference presentations emphasized the problem of sleep disorders in older age due to the demographic shift in the American population to an increasing proportion in the over-65 age group, and to the public awareness of the interest of the medical community in diagnosis and treatment of these disorders. The study of sleep and sleep disorders has advanced rapidly in the past 30 years. This advance has been most prominent in studies of normal sleep throughout the life span. However, the classification, diagnostic criteria, understanding of the basic mechanisms, natural history, and the efficacy of treatment in sleep disorders are still in early stages so that further research in all these areas is necessary. This is particularly true for the older population in whom these conditions may be more frequent and disruptive. It is always difficult to define classification and diagnostic criteria in a relatively new area where clinical descriptions and observations predominate and where the interpretation of objective measures, even with existing and new technology, is hampered. Certainly, large studies of control populations with proper sampling methods are necessary. This is particularly the situation in older populations where controls without confounding disease are more difficult to obtain. It is often necessary in alleviating illness to press forward with clinical descriptions and treatment even without knowledge of the basic mechanisms. However, it is only with elucidation of these mechanisms that rational approaches to therapy can be effected. The study of these disorders in older patients, who often have other diseases, affords some unusual opportunities. For example, how does the dopamine depletion in Parkinson’s disease patients affect sleep architecture and cardiopulmonary adaptation? Also, older patients may take one or more drugs for other conditions, and this may afford an opportunity for clinical observations. There have been extensive studies of sleep mechanisms in experimental animals. Efforts should be made to identify appropriate animal models for sleep disorders. Now it is possible to study old animals, including primates, and these studies should provide insight into the basic mechanisms of sleep changes in aging. The new interest in disordered circadian rhythms as a clinical observation opens up new areas of research. Modern research techniques used in selected human cases might help identify biological markers for some of these disorders. Opportunities for
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clinical and pathological correlation should be encouraged. The application or development of new research techniques should provide added understanding of the neurobiology of sleep and its disorders. The natural history of many sleep disorders has not been well described. Longitudinal studies into older age would clarify the progress of these disorders and their effect on morbidity and mortality. This is also necessary if one is to judge the efficacy of various treatment modalities. Important questions that can only be answered by long-term studies are whether some of the variations noted in the older population are the result of aging or of concomitant disease; whether these variations need to be tested further; and whether these variations are responsible for other medical conditions. This latter point needs clarification because of the questions regarding sleep apnea with oxygen desaturation and various forms of dementia. An important area of study is the disruption of normal circadian rhythms by transmeridian time shifts, dislocation such as moving to a nursing home, and shift work. These may result in sleep disturbances with attendant problems with family, driving, and recreation. It is obvious from the data presented that extensive studies need to be done to settle the question of benefits of treatment in these disorders. Carefully controlled studies of well defined clinical groups will be necessary to establish the benefit of various therapies. It is equally important in clinical trials to look at the efficacy of different means of sleep hygiene practices, not only for therapy but for prevention. Added knowledge about the effectiveness of treatment should spur studies of cost effectiveness of diagnostic methods and therapies. In all the areas mentioned there are many opportunities for basic and clinical research. The enhanced interest in the older population should provide both challenges and opportunities for investigators.
Conclusions and Recommendations There is a need for epidemiologic investigations of sleep disorders: case control, cohort, and cross-cultural studies should be initiated. The information developed in these studies will aid in the understanding of the natural history, etiology, and prevention of sleep disorders.
NIH Consensus Statement on the Treatment of Sleep Disorders of Older People 261
·
Evaluation of sleep disorders begins with careful clinical evaluation performed by an informed primary care physician.
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Standardization of clinical measures and assessment of the specificity and sensitivity of diagnostic procedures is essential.
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Advanced skills and diagnostic tools are available and should be applied in appropriate patients.
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The objective of sleep disorder therapy is to reduce morbidity and mortality and improve the quality of life.
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Obstructive sleep apnea is a potentially severe and treatable cause of daytime hypersomnia.
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Restoration of airway competence is the objective in the treatment of severe sleep apnea.
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Insomnia is a complaint with multiple causes and requires different treatments.
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Hypnotic medications should not be the mainstay of treatment of insomnia, are overused and have habit forming potential.
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The value of good sleep hygiene should not be underestimated in the prevention and treatment of insomnia.
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Widespread knowledge about sleep and its disorders is lacking, and education at all levels is needed.
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The Public Health Service must take an active role in educating the public.
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Powerful new techniques, such as brain imaging, molecular biological tools, and neurochemical analyses, should be used in human studies and animal models to explore the basic mechanisms of sleep and sleep disorders.
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Sleep disorders in older people offer unique opportunities to study integrative neurologic, psychiatric, and cardiopulmonary functions.
·
Current and new therapies and technologies must be evaluated by randomized controlled clinical trials.
·
The Health Care Financing Administration should review current reimbursement policies, and continue to explore clinical data set requirements as these reimbursement policies for sleep disorders evolve.
More on Problem Sleepiness 263
APPENDIX F. MORE ON PROBLEM SLEEPINESS Overview58 Everyone feels sleepy at times. However, when sleepiness interferes with daily routines and activities, or reduces the ability to function, it is called “problem sleepiness.” A person can be sleepy without realizing it. For example, a person may not feel sleepy during activities such as talking and listening to music at a party, but the same person can fall asleep while driving home afterward. The following appendix is reproduced and adapted from the National Heart, Lung, and Blood Institute publication dedicated to problem sleepiness.
What Causes Problem Sleepiness? You may have problem sleepiness if you: ·
Consistently do not get enough sleep
·
Get poor quality sleep
·
Fall asleep while driving
·
Struggle to stay awake when inactive such as when watching television or reading
·
Have difficulty paying attention or concentrating at work, school, or home
·
Have performance problems at work or school
Adapted from the National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/public/sleep/pslp_fs.pdf.
58
264 Insomnia
·
Are often told by others that you are sleepy
·
Have difficulty remembering
·
Have slowed responses
·
Have difficulty controlling your emotions
·
Must take naps on most days
Sleepiness can be due to the body’s natural daily sleep-wake cycles, inadequate sleep, sleep disorders, or certain drugs.
Sleep-Wake Cycle Each day there are two periods when the body experiences a natural tendency toward sleepiness: during the late night hours (generally between midnight and 7 a.m.) and again during the midafternoon (generally between 1 p.m. and 4 p.m.). If people are awake during these times, they have a higher risk of falling asleep unintentionally, especially if they haven’t been getting enough sleep.
Inadequate Sleep The amount of sleep needed each night varies among people. Each person needs a particular amount of sleep in order to be fully alert throughout the day. Research has shown that when healthy adults are allowed to sleep unrestricted, the average time slept is 8 to 8.5 hours. Some people need more than that to avoid problem sleepiness; others need less. If a person does not get enough sleep, even on one night, a “sleep debt” begins to build and increases until enough sleep is obtained. Problem sleepiness occurs as the debt accumulates. Many people do not get enough sleep during the work week and then sleep longer on the weekends or days off to reduce their sleep debt. If too much sleep has been lost, sleeping in on the weekend may not completely reverse the effects of not getting enough sleep during the week.
Sleep Disorders Sleep disorders such as sleep apnea, narcolepsy, restless legs syndrome, and insomnia can cause problem sleepiness. Sleep apnea is a serious disorder in
More on Problem Sleepiness 265
which a person’s breathing is interrupted during sleep, causing the individual to awaken many times during the night and experience problem sleepiness during the day. People with narcolepsy have excessive sleepiness during the day, even after sleeping enough at night. They may fall asleep at inappropriate times and places. Restless legs syndrome (RLS) causes a person to experience unpleasant sensations in the legs, often described as creeping, crawling, pulling, or painful. These sensations frequently occur in the evening, making it difficult for people with RLS to fall asleep, leading to problem sleepiness during the day. Insomnia is the perception of poorquality sleep due to difficulty falling asleep, waking up during the night with difficulty returning to sleep, waking up too early in the morning, or unrefreshing sleep. Any of these sleep disorders can cause problem sleepiness.
Medical Conditions/Drugs Certain medical conditions and drugs, including prescription medications, can also disrupt sleep and cause problem sleepiness. Examples include: ·
Chronic illnesses such as asthma, congestive heart failure, rheumatoid arthritis, or any other chronically painful disorder.
·
Some medications to treat high blood pressure, some heart medications, and asthma medications such as theophylline.
·
Alcohol—Although some people use alcohol to help themselves fall asleep, it causes sleep disruption during the night, which can lead to problem sleepiness during the day. Alcohol is also a sedating drug that can, even in small amounts, make a sleepy person much more sleepy and at greater risk for car crashes and performance problems.
·
Caffeine—Whether consumed in coffee, tea, soft drinks, or medications, caffeine makes it harder for many people to fall asleep and stay asleep. Caffeine stays in the body for about 3 to 7 hours, so even when taken earlier in the day it can cause problems with sleep at night.
·
Nicotine from cigarettes or a skin patch is a stimulant and makes it harder to fall asleep and stay asleep.
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Problem Sleepiness and Adolescents Many U.S. high school and college students have signs of problem sleepiness, such as: ·
Difficulty getting up for school
·
Falling asleep at school
·
Struggling to stay awake while doing homework
The need for sleep may be 9 hours or more per night as a person goes through adolescence. At the same time, many teens begin to show a preference for a later bed time, which may be due to a biological change. Teens tend to stay up later but have to get up early for school, resulting in their getting much less sleep than they need. Many factors contribute to problem sleepiness in teens and young adults, but the main causes are not getting enough sleep and irregular sleep schedules. Some of the factors that influence adolescent sleep include: ·
Social activities with peers that lead to later bedtimes
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Homework to be done in the evenings
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Early wake-up times due to early school start times
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Parents being less involved in setting and enforcing bedtimes
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Employment, sports, or other extracurricular activities that decrease the time available for sleep
Teens and young adults who do not get enough sleep are at risk for problems such as: ·
Automobile crashes
·
Poor performance in school and poor grades
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Depressed moods
·
Problems with peer and adult relationships
Many adolescents have part-time jobs in addition to their classes and other activities. High school students who work more than 20 hours per week have more problem sleepiness and may use more caffeine, nicotine, and alcohol than those who work less than 20 hours per week or not at all.
More on Problem Sleepiness 267
Shift Work And Problem Sleepiness About 20 million Americans (20 to 25 percent of workers) perform shift work. Most shift workers get less sleep over 24 hours than day workers. Sleep loss is greatest for night shift workers, those who work early morning shifts, and female shift workers with children at home. About 60 to 70 percent of shift workers have difficulty sleeping and/or problem sleepiness. The human sleep-wake system is designed to prepare the body and mind for sleep at night and wakefulness during the day. These natural rhythms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested. It is possible that the human body never completely adjusts to nighttime activity and daytime sleep, even in those who work permanent night shifts. In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Because our society is strongly day-oriented, shift workers who try to sleep during the day are often interrupted by noise, light, telephones, family members, and other distractions. In contrast, the nighttime sleep of day workers is largely protected by social customs that keep noises and interruptions to a minimum. Problem sleepiness in shift workers may result in: ·
Increased risk for automobile crashes, especially while driving home after the night shift
·
Decreased quality of life
·
Decreased productivity (night work performance may be slower and less accurate than day performance)
·
Increased risk of accidents and injuries at work
What Can Help? Sleep—There Is No Substitute! Many people simply do not allow enough time for sleep on a regular basis. A first step may be to evaluate daily activities and sleep-wake patterns to determine how much sleep is obtained. If you are consistently getting less than 8 hours of sleep per night, more sleep may be needed. A good approach is to gradually move to an earlier bedtime. For example, if an extra hour of sleep is needed, try going to bed 15 minutes earlier each night for four nights
268 Insomnia
and then keep the last bedtime. This method will increase the amount of time in bed without causing a sudden change in schedule. However, if work or family schedules do not permit the earlier bedtime, a 30- to 60-minute daily nap may help.
Medications/Drugs In general, medications do not help problem sleepiness, and some make it worse. Caffeine can reduce sleepiness and increase alertness, but only temporarily. It can also cause problem sleepiness to become worse by interrupting sleep. While alcohol may shorten the time it takes to fall asleep, it can disrupt sleep later in the night, and therefore add to the problem sleepiness. Medications may be prescribed for patients in certain situations. For example, the short-term use of sleeping pills has been shown to be helpful in patients diagnosed with acute insomnia. Long-term use of sleep medication is recommended only for the treatment of specific sleep disorders.
If You’re Sleepy—Don’t Drive! A person who is sleepy and drives is at high risk for an automobile crash. Planning ahead may help reduce that risk. For example, the following tips may help when planning a long distance car trip: ·
Get a good night’s sleep before leaving
·
Avoid driving between midnight and 7 a.m.
·
Change drivers often to allow for rest periods
·
Schedule frequent breaks
If you are a shift worker, the following may help: ·
Decreasing the amount of night work
·
Increasing the total amount of sleep by adding naps and lengthening the amount of time allotted for sleep
·
Increasing the intensity of light at work
·
Having a predictable schedule of night shifts
·
Eliminating sound and light in the bedroom during daytime sleep
More on Problem Sleepiness 269
·
Using caffeine (only during the first part of the shift) to promote alertness at night
·
Possibly using prescription sleeping pills to help daytime sleep on an occasional basis (check with your doctor)
If you think you are getting enough sleep, but still feel sleepy during the day, check with your doctor to be sure your sleepiness is not due to a sleep disorder.
Online Glossaries 271
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to insomnia and keep them on file. The NIH, in particular, suggests that patients with insomnia visit the following Web sites in the ADAM Medical Encyclopedia:
272 Insomnia
·
Basic Guidelines for Insomnia Insomnia concerns Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002106.htm
·
Signs & Symptoms for Insomnia Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Apnea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003069.htm Drowsiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Insomnia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003210.htm Sleepy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Tiredness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Wakefulness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003210.htm
·
Diagnostics and Tests for Insomnia
Online Glossaries 273
Polysomnography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003932.htm PRA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003698.htm ·
Nutrition for Insomnia Caffeine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm
·
Background Topics for Insomnia Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Alcohol use Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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INSOMNIA GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdominal: Pertaining to the abdomen. [EU] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these
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neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Amyl Nitrite: A vasodilator that is administered by inhalation. It is also used recreationally due to its supposed ability to induce euphoria and act as an aphrodisiac. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antibiotic: A drug that kills or inhibits the growth of bacteria. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antiepileptic: An agent that combats epilepsy. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apathy: Lack of feeling or emotion; indifference. [EU]
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Apnea: A transient absence of spontaneous respiration. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arrhythmia: An irregular heartbeat. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH]
Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Audiology: The study of hearing and hearing impairment. [NIH] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bibliotherapy: A form of supportive psychotherapy in which the patient is given carefully selected material to read. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrates: A nutrient that supplies 4 calories/gram. They may be simple or complex. Simple carbohydrates are called sugars, and complex carbohydrates are called starch and fiber (cellulose). An organic compound—containing carbon, hydrogen, and oxygen—that is formed by photosynthesis in plants. Carbohydrates are heat producing and are classified as monosaccharides, disaccharides, or polysaccharides. [NIH] Cardiopulmonary: Pertaining to the heart and lungs. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU]
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Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety medication. [NIH] Cholesterol: A soft, waxy substance manufactured by the body and used in the production of hormones, bile acid, and vitamin D and present in all parts of the body, including the nervous system, muscle, skin, liver, intestines, and heart. Blood cholesterol circulates in the bloodstream. Dietary cholesterol is found in foods of animal origin. [NIH] Chronic: Of long duration; frequently recurring. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Clorazepate Dipotassium: A water-soluble benzodiazepine derivative effective in the treatment of anxiety. It has also muscle relaxant and anticonvulsant actions. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows
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only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Comorbidity: Two or more diseases or conditions existing together in an individual. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroids: Drugs that mimic the action of a group of hormones produced by adrenal glands; they are anti-inflammatory and act as bronchodilators. [NIH] Criterion: A standard by which something may be judged. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are
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needed. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: A catecholamine neurotransmitter that is found primarily in the basal ganglia of the central nervous system. Major functions include the peripheral inhibition and excitation of certain muscles; cardiac excitation; and metabolic, endocrine and central nervous system actions. [NIH] Dreams: A series of thoughts, images, or emotions occurring during sleep which are dissociated from the usual stream of consciousness of the waking state. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Edema: Abnormal fluid accumulation in body tissues. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] EKG: Measurement of electrical activity during heartbeats. [NIH] Electrocardiogram:
Measurement of electrical activity during heartbeats.
[NIH]
Electroencephalography: The recording of the electric currents developed in the brain, by means of electrodes applied to the scalp, to the surface of the brain (intracranial e.) or placed within the substance of the brain (depth e.). [EU]
Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Enoxacin: An orally administered broad-spectrum fluoroquinolone antibacterial agent active against most gram-negative and gram-positive
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bacteria. Its clinical efficacy has been confirmed in a variety of systemic infections and particularly in urinary tract infections. The drug is well tolerated by adults, but should not be used in children and pregnant women. [NIH]
Ephedrine: A sympathomimetic drug that stimulates thermogenesis in laboratory animals and humans. Animal studies show that it may reduce fat content and, therefore, body weight by mechanisms that probably involve increased expenditure and reduced food intake. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Pertaining to the epigastrium. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethchlorvynol: A sedative and hypnotic that has been used in the shortterm management of insomnia. Its use has been superseded by other drugs. [NIH]
Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fatal: Causing death, deadly; mortal; lethal. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Felodipine: A dihydropyridine calcium antagonist with positive inotropic effects. It lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance vessels. [NIH] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as
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an antidote to benzodiazepine overdoses. [NIH] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Griseofulvin: An antifungal antibiotic. Griseofulvin may be given by mouth in the treatment of tinea infections. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Happiness: Highly pleasant emotion manifestations of gratification; joy. [NIH]
characterized
by
outward
Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH]
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Hunger: The desire for food generated by a sensation arising from the lack of food in the stomach. [NIH] Hyperacusis: An abnormally disproportionate increase in the sensation of loudness in response to auditory stimuli of normal volume. Cochlear diseases; vestibulocochlear nerve diseases; facial nerve diseases; stapes surgery; and other disorders may be associated with this condition. [NIH] Hypertension: High blood pressure (i.e., abnormally high blood pressure tension involving systolic and/or diastolic levels). The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or taking hypertensive medication. The cause may be adrenal, benign, essential, Goldblatt's, idiopathic, malignant pate, portal, postpartum, primary, pulmonary, renal or renovascular. [NIH] Hyperthyroidism: 1. excessive functional activity of the thyroid gland. 2. the abnormal condition resulting from hyperthyroidism marked by increased metabolic rate, enlargement of the thyroid gland, rapid heart rate, high blood pressure, and various secondary symptoms. [EU] Hypoxemia: Too little oxygen in the blood. [NIH] Idiopathic: Results from an unknown cause. [NIH] Illusions: The misinterpretation of a real external, sensory experience. [NIH] Imagination: A new pattern of perceptual or ideational material derived from past experience. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
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Insomnia: Inability to sleep; abnormal wakefulness. [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Isoetharine: Adrenergic beta-2 agonist used as bronchodilator for emphysema, bronchitis and asthma. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]
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Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Lorazepam: An anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. [NIH] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Menopause: The cessation of menstruation in the human female, which begins at about the age of 50. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] Microgram: A unit of mass (weight) of the metric system, being onemillionth of a gram (10-6 gm.) or one one-thousandth of a milligram (10-3 mg.). [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monotherapy: A therapy which uses only one drug. [EU]
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Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal: Pertaining to the nose. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurasthenia: A mental disorder characterized by chronic fatigue and concomitant physiologic symptoms. [NIH] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH]
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Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nevirapine: A potent, non-nucleoside reverse transcriptase inhibitor used in combination with nucleoside analogues for treatment of HIV infection and AIDS. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nortriptyline: A metabolite of amitryptyline that is also used as an antidepressive agent. Nortriptyline is used in major depression, dysthymia, and atypical depressions. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH]
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Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness. [NIH] Osteodystrophy: Defective bone formation. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxazepam: A benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palpitation: The sensation of rapid heartbeats. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paradoxical: Occurring at variance with the normal rule. [EU] Paranoia: A psychotic disorder marked by persistent delusions of persecution or delusional jealousy and behaviour like that of the paranoid personality, such as suspiciousness, mistrust, and combativeness. It differs from paranoid schizophrenia, in which hallucinations or formal thought disorder are present, in that the delusions are logically consistent and that there are no other psychotic features. The designation in DSM III-R is delusional (paranoid) disorders, with five types : persecutory, jealous, erotomanic, somatic, and grandiose. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH] Pathophysiology: Altered functions in an individual or an organ due to
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disease. [NIH] Pemoline: A central nervous system stimulant used in fatigue and depressive states and to treat hyperkinetic disorders in children. [NIH] Penicillin G: A penicillin derivative commonly used in the form of its sodium or potassium salts in the treatment of a variety of infections. It is effective against most gram-positive bacteria and against gram-negative cocci. It has also been used as an experimental convulsant because of its actions on GABA mediated synaptic transmission. [NIH] Penicillin V: A broad-spectrum penicillin antibiotic used orally in the treatment of mild to moderate infections by susceptible gram-positive organisms. [NIH] Pentamidine: Antiprotozoal agent effective in trypanosomiasis, leishmaniasis, and some fungal infections; used in treatment of Pneumocystis carinii pneumonia in HIV-infected patients. It may cause diabetes mellitus, central nervous system damage, and other toxic effects. [NIH]
Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Placebos:
Any dummy medication or treatment. Although placebos
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originally were medicinal preparations having no specific pharmacological activity against a targeted condition, the concept has been extended to include treatments or procedures, especially those administered to control groups in clinical trials in order to provide baseline measurements for the experimental protocol. [NIH] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Propafenone: An antiarrhythmia agent that is particularly effective in ventricular arrhythmias. It also has weak beta-blocking activity. The drug is generally well tolerated. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Pulmonary: Relating to the lungs. [NIH]
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Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Rauwolfia: A genus of the Apocynaceae or dogbane family of tropical trees and shrubs containing alkaloids. These alkaloids have been used as tranquilizers and antihypertensive agents. Reserpine is derived from R. serpentina. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Reflux: A backward or return flow. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Rheumatoid: Resembling rheumatism. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rifabutin: A broad-spectrum antibiotic that is being used as prophylaxis against disseminated Mycobacterium avium complex infection in HIVpositive patients. [NIH] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Secobarbital: A barbiturate that is used as a sedative. Secobarbital is reported to have no anti-anxiety activity. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a
Glossary 291
sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Sulbactam: A beta-lactamase inhibitor with very weak antibacterial action. The compound prevents antibiotic destruction of beta-lactam antibiotics by inhibiting beta-lactamases, thus extending their spectrum activity. Combinations of sulbactam with beta-lactam antibiotics have been used successfully for the therapy of infections caused by organisms resistant to the antibiotic alone. [NIH] Surgical: Of, pertaining to, or correctable by surgery. [EU]
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Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Thalamus: Either of two large, ovoid masses, consisting chiefly of grey substance, situated one on each side of and forming part of the lateral wall of the third ventricle. It is divided into two major parts : dorsal and ventral, each of which contains many nuclei. [EU] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thermoregulation: Heat regulation. [EU] Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Tone: 1. the normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. a particular quality of sound or of voice. 3. to make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. producing and restoring the normal tone. 2. characterized by continuous tension. 3. a term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU]
Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU]
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Triamterene: A pteridine that is used as a mild diuretic. [NIH] Triazolam: A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries. [NIH]
Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trimipramine: Tricyclic antidepressant similar to imipramine, but with more antihistaminic and sedative properties. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to
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more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 295
INDEX A Abdominal....................................109, 276 Absenteeism........................................120 Acetaminophen....................................126 Adolescence ................................266, 274 Adverse ..40, 80, 126, 171, 174, 278, 288, 293 Agoraphobia ..........................................83 Albuterol ......................................170, 274 Algorithms..............................................59 Amitriptyline ...........................................86 Analgesic ....128, 171, 172, 174, 274, 278, 280, 285, 289 Anemia ................................................138 Antibiotic .......80, 170, 172, 173, 174, 175, 275, 277, 281, 288, 290, 291 Anticholinergic .......95, 170, 256, 274, 277 Anticonvulsant 46, 78, 171, 174, 277, 284, 288 Antidepressant.........93, 95, 126, 274, 293 Anxiety..... 12, 15, 63, 65, 73, 77, 82, 88, 92, 95, 114, 170, 171, 173, 188, 253, 254, 255, 256, 277, 284, 287, 290 Apathy .........................................110, 285 Apnea .....4, 11, 13, 14, 18, 20, 25, 26, 27, 58, 248, 252, 253, 254, 256, 260, 261, 264 Artery .................................22, 56, 61, 290 Asymptomatic ......................................252 Audiology.............................................106 Autonomic........................66, 83, 173, 286 B Bacteria ....... 47, 80, 128, 170, 171, 173, 224, 275, 277, 280, 286, 288, 291, 293 Benzodiazepines ......40, 82, 88, 126, 172, 187, 229, 280 Bereavement .......................................256 Bibliotherapy..........................................61 Biochemical ...........................................82 C Capsules..................................86, 94, 227 Carbohydrates .......................21, 224, 276 Cardiac ............78, 83, 171, 279, 280, 287 Cardiopulmonary ...........15, 253, 259, 261 Cardiovascular.............108, 250, 252, 275 Cataract .......................................109, 277 Catecholamines.....................................53 Causal ...................................................64 Cervical................................................257 Chloral Hydrate............................170, 277 Cholesterol ..................224, 226, 238, 277
Codeine............................................... 126 Cognition... 40, 85, 87, 106, 110, 120, 285 Comorbidity..................................... 63, 65 Concomitant................ 110, 253, 260, 285 Confounding ................................. 66, 259 Confusion.................... 109, 111, 279, 285 Consciousness ...... 27, 34, 109, 128, 275, 278, 279 Constipation ............................ 90, 98, 231 Coronary ......................... 56, 61, 173, 286 Cortex ................................. 171, 174, 280 Corticosteroids .................... 126, 174, 289 Criterion ................................................ 59 D Delusions .................................... 111, 287 Dementia............................... 40, 253, 260 Deprivation.......................... 11, 25, 84, 87 Diarrhea .............................................. 224 Diphenhydramine................................ 188 Dislocation .................................. 256, 260 Disorientation ................................ 95, 279 Dizziness............................................... 90 Dopamine..... 78, 108, 170, 171, 172, 259, 275, 278, 283, 286 Dyskinesia............................................. 40 E Efficacy .... 40, 46, 54, 55, 56, 60, 61, 120, 171, 183, 184, 192, 247, 249, 253, 256, 259, 260, 279, 280 Electrophysiological ............................ 251 Epidemiological..................... 53, 251, 252 Epigastric ............................................ 184 Epinephrine........................... 78, 173, 286 F Fatal ...................................................... 34 Fatigue ... 21, 55, 110, 111, 252, 275, 285, 288 Fetus ................................... 109, 225, 280 G Ginseng................................................. 93 Glucose............................... 115, 281, 283 H Herpes .................... 19, 22, 108, 274, 281 Hormones ..... 79, 128, 238, 277, 278, 290 Hypertension............................... 110, 282 Hyperthyroidism .............. 13, 22, 256, 282 Hypnotic ...... 59, 60, 70, 72, 76, 77, 126, 170, 171, 175, 183, 184, 191, 193, 248, 249, 255, 277, 279, 280, 284, 292 Hypothalamic ........................................ 53 Hypotonia.............................................. 27
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Hypoxemia...........................................254 I Idiopathic ...............................76, 110, 282 Impotence..............................................98 Incompetence ......................................250 Incontinence ................................175, 290 Infertility .................................................90 Influenza ..............................................119 Infusion ................................................183 Ingestion ........................................89, 227 Insulin ..................................115, 281, 283 L Lesion ............................................47, 292 Libido .....................................................98 Lithium ...........................................46, 283 Lorazepam...........................................188 M Manic .....................................46, 230, 283 Manifest .................................................54 Melanoma......................................46, 284 Menopause......................13, 98, 189, 229 Mentors..................................................62 Molecular ....... 11, 79, 112, 131, 135, 136, 261, 290, 293 N Narcotic .......................................174, 289 Nasal ...........................128, 248, 257, 282 Neural ..................................................225 Neurasthenia .......................................103 Neuroanatomy .......................................64 Neuroleptic ..................................171, 278 Neurology ............................................249 Neurons .................54, 172, 173, 283, 286 Neurotransmitter............78, 173, 279, 286 Niacin...................................................225 Nicotine................................................266 Nifedipine.....................................173, 286 Norepinephrine 78, 95, 170, 274, 275, 286 Nortriptyline ...........................................84 O Odour...................................................194 Osteoarthritis .....61, 64, 98, 171, 174, 280 Osteoporosis ...................................18, 98 Otolaryngology ....................................249 Overdose .............................................225 P Pacemaker ..............................64, 78, 287 Panic..............................................83, 255 Paradoxical....................................72, 106 Paroxetine .............................................93 Pathogenesis.........................................53 Pathophysiology ............................57, 258 Peptic...........................................175, 291 Pharmacists.........................................257 Pharmacotherapy ....................62, 63, 194 Placebos ..................................47, 76, 288
Precursor .................................... 172, 283 Prevalence ...... 57, 63, 66, 79, 106, 121, 123, 251 Progressive ........... 34, 69, 70, 72, 73, 278 Prostate................................................. 98 Proteins....................................... 224, 226 Psychiatric...... 57, 65, 248, 250, 254, 255, 261 Psychiatry ................. 26, 47, 62, 248, 249 Psychology.......................................... 248 Psychomotor ....................... 111, 120, 285 Psychopathology .................................. 65 Psychophysiology ............................... 188 Psychotherapy .................. 38, 71, 77, 276 Pulmonary...... 11, 56, 110, 119, 250, 256, 282 R Receptor ... 46, 64, 82, 171, 172, 277, 280 Reflux.................................. 175, 256, 291 Relaxant...................... 171, 174, 277, 288 Remission ............................................. 65 Respiratory.................. 128, 254, 257, 282 Riboflavin ............................................ 224 S Secobarbital .................................... 85, 87 Secretion................. 64, 80, 171, 280, 290 Sedative ...... 59, 77, 78, 80, 89, 95, 128, 170, 171, 172, 256, 274, 277, 278, 279, 280, 284, 290, 293 Seizures .... 27, 34, 46, 174, 277, 288, 291 Selenium ............................................. 226 Sertraline......................................... 63, 93 Snoring.................................... 20, 92, 253 Somatic ........... 58, 83, 111, 255, 274, 287 Spectrum...... 63, 170, 171, 173, 174, 175, 275, 279, 286, 288, 290, 291 Stroke.................................................... 98 Sulbactam ................................... 175, 291 Surgical ....................... 257, 281, 286, 287 Sympathetic .............. 53, 66, 80, 173, 286 Systemic ..... 171, 174, 175, 280, 289, 291 T Tardive .................................................. 40 Thalamus ............................................ 103 Thermoregulation................................ 224 Thyroxine ............................................ 226 Tinnitus ................................. 98, 106, 107 Tolerance .................. 40, 46, 47, 120, 277 Tomography.......................................... 63 Tone.................. 27, 34, 54, 112, 250, 292 Tonic ............................................. 46, 277 Toxicity........................................ 175, 291 Triazolam ........................ 73, 80, 183, 293 Tricyclic ................................. 95, 256, 275 Trimipramine ......................................... 86
Index 297
U Ulcer ............................................175, 291 Urinary ...........54, 110, 171, 175, 280, 290 V Vaccination ..........................................119 Vaccine ........................................128, 293
Valerian...... 122, 183, 188, 189, 191, 229, 230 Vein............................................... 77, 282 W Wakefulness .. 22, 63, 249, 251, 253, 267, 283 Withdrawal .................... 74, 173, 188, 287
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