Insomnia
Top Cited Papers
Open Access
- 20 February 2013
- journal article
- case report
- Published by American Medical Association (AMA) in JAMA
- Vol. 309 (7), 706-716
- https://doi.org/10.1001/jama.2013.193
Abstract
How does one diagnose and treat insomnia in adults? Summary of meta-analyses of chronic insomnia treatments. Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. The prevalence of insomnia disorder is approximately 10-20%, with approximately 50% having a chronic course. Insomnia is a risk factor for impaired function, the development of other medical and mental disorders, and increased health care costs. The etiology and pathophysiology of insomnia involve genetic, environmental, behavioral, and physiological factors culminating in hyperarousal. Efficacious treatments for insomnia include behavioral, cognitive, and pharmacologic interventions. Simple behavioral interventions are feasible in primary care settings, but lack of training in these techniques limits their use. Among pharmacologic interventions, the most evidence exists for benzodiazepine receptor agonist drugs, although persistent concerns focus on their safety relative to modest efficacy. Behavioral treatments should be used whenever possible, and medications should be limited to the lowest necessary dose and shortest necessary duration.Keywords
This publication has 62 references indexed in Scilit:
- Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic reviewBMC Family Practice, 2012
- Hypnotics' association with mortality or cancer: a matched cohort studyBMJ Open, 2012
- Efficacy and Safety of Doxepin 3 and 6 mg in a 35-day Sleep Laboratory Trial in Adults with Chronic Primary InsomniaSleep, 2011
- Insomnia and the Performance of US Workers: Results from the America Insomnia SurveySleep, 2011
- Nighttime Insomnia Symptoms and Perceived Health in the America Insomnia Survey (AIS)Sleep, 2011
- Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older AdultsJAMA Internal Medicine, 2011
- Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent InsomniaJAMA, 2009
- Abuse and dependence liability of benzodiazepine-type drugs: GABAA receptor modulation and beyondPharmacology Biochemistry and Behavior, 2008
- The Efficacy and Safety of Drug Treatments for Chronic Insomnia in Adults: A Meta-analysis of RCTsJournal of General Internal Medicine, 2007
- Sleep Problems, Comorbid Mental Disorders, and Role Functioning in the National Comorbidity Survey ReplicationBiological Psychiatry, 2006