Insomnia, alcohol, and over-the-counter drug use in old-old urban women

Treating Insomnia: A Review of Patient Perceptions Toward Treatment

Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients' global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients' perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed.

Workforce Disengagement Stressors and Retiree Alcohol Misuse: The Mediating Effects of Sleep Problems and the Moderating Effects of Gender

We generate and test a moderated mediation model of the effects of two retirement-related stressors (namely, financial and marital) on the severity of alcohol misuse among retirees. We posit that in addition to using alcohol to cope with stressors in retirement, alcohol may also be used to self-medicate the secondary, sleep-related effects of such stressors, and that gender serves as a key boundary condition, moderating the impact of such stressors on sleep-related problems, and of sleep-related problems on alcohol misuse. Using longitudinal data collected from a sample of 292 retirees, our findings generally support this model, suggesting that both stressors are associated with the severity of alcohol misuse among male retirees. Moreover, our findings demonstrate that -- for male retirees -- the effect of both stressors on the severity of alcohol misuse is to a large extent secondary to the stressors themselves, mediated by the sleep-related problems they may generate.

A critique of the evidence base for non-pharmacological sleep interventions for persons with dementia

Disordered sleep in persons with dementia is a contributing factor for a range of health problems. The evidence base for non-pharmacological interventions has not been evaluated and clearly presented in the literature. This paper provides a structured Critical Literature Review of the evidence for non-pharmacological interventions to reduce disordered sleep in persons with dementia. The systematic search retrieved 29 studies that were evaluated for methodological quality. The quality of evidence ranged from conclusive for light therapy and activity to inconclusive for most other interventions. There is a paucity of conclusive research for non-pharmacological sleep interventions for persons with dementia. Most of the evidence about effective interventions is anecdotal and untested. There is a need for rigorous scientific inquiry, coupled with tacit knowledge to build a strong evidence base on non-pharmacological interventions for disordered sleep for persons with dementia.

Effects of common medications used for sleep disorders

Sleep disorders are common and their diagnosis is becoming more widespread with improved awareness among clinicians and patients. The armamentarium for the pharmacologic treatment of sleep disorders is rapidly growing, demanding that clinicians be aware of their indications, adverse effects, and interactions. As disorders, such as narcolepsy, shift-work sleep disorder, and RLS are more readily identified, pharmacologic treatments for these conditions will also become more common.

Disturbed sleep and its relationship to alcohol use

STUDY OBJECTIVES

To review evidence of an association between disturbed sleep and alcohol use.

DESIGN

We searched MEDLINE, PSYCHINFO, ETOH, BIBLIOSLEEP and the Rutgers Alcohol Studies databases between January 1966 and August 2002. Search terms included alcohol-related disorders or alcoholism in combination with sleep, sleep initiation and maintenance disorders, or sleep apnea syndromes. The search produced over 440 citations. We reviewed 107 relevant articles, of which 60 included quantitative measures of both alcohol use and sleep.

MEASUREMENTS AND RESULTS

Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promotes sleep, but these effects diminish in as few as 3 days of continued use. Clinical investigations support a relationship between sleep disturbance and alcohol use, but variability in the definition and measurement of these domains and a preponderance of cross-sectional studies make uncertain the strength and direction of the association.

CONCLUSIONS

The association of insomnia with alcohol use disorders suggests that the clinical evaluation of patients with sleep problems should include a careful assessment of alcohol use. Future studies of this relationship should employ prospective designs with standardized, validated measures of both sleep and alcohol use. Rigorous treatment studies for chronic insomnia in alcohol dependent patients are also needed.

Switching of Prescription Drugs to Over-the-Counter Status

Prescription medicines are increasingly being switched to over-the-counter (OTC, nonprescription) status in the developed world, with the support of government policy. These changes may provide greater choice for individuals and offer potential savings in government spending on health while expanding the market for pharmaceutical companies. However, there is concern regarding the safety of these reclassifications. Elderly people are the largest consumers of prescription and OTC medicines and are more vulnerable to drug adverse effects and the risks of multiple or inappropriate medications. Commonly purchased agents such as NSAIDs have recognised adverse effects which have been shown to be more common in the elderly. Furthermore, all sedatives, including antihistamines, have a propensity to cause falls in older people. As many doctors do not ask patients about OTC medicine use, problems related to use of these drugs may go undetected. Furthermore, the increased availability of OTCs may result in a delay in patients consulting medical practitioners for potentially serious conditions, although this has not so far been investigated. In the UK, the recent switch of a low-dose HMG-CoA reductase inhibitor (statin) to OTC status has caused concern. Although there might theoretically be some benefits from improved access to medications used in primary and secondary prevention of heart disease, the actual outcomes of use of this reduced dose of the statin will be difficult or impossible for patients or practitioners to monitor. OTC drug use implies a mutual responsibility for communication between patients and health professionals that in practice is not always achieved. Epidemiological research is needed to investigate patterns of OTC use and evaluate the potential risks of OTC medicines in elderly people. Governments, regulatory bodies, professionals and the drug industry have a responsibility to ensure that robust systems are in place if the increased use of OTC medicines by elderly people is to be safe and effective.

Spectral analyses of sleep EEG in depressed offspring of fathers with or without a positive history of alcohol abuse or dependence: a pilot study

The current study was designed to examine the effects of family history of alcohol use disorders on spectral electroencephalographic (EEG) sleep measures obtained in a sample of youth with depression. We evaluated sleep in 32 depressed youth (8-16 years of age) with and without a family history of alcohol use disorders. Eighteen of the participants (10 males and 8 females) reported a positive paternal history of alcohol use disorders and made up the family history positive (FHP) group. Power-spectral analyses revealed that increased power in the 7.50-11.00 Hz band (slow alpha) was associated with boys in the FHP group for the first and second non-rapid eye movement (REM) periods, second REM period, awake during the night, and entire night period. Results also showed increased power in the higher alpha frequencies (11.00-12.25 Hz) for non-REM, REM, and awake periods. A significant increase in spectral power was also observed in boys in the FHP group in the delta frequencies (0.75-4.50 Hz) during the second REM period. These findings are consistent with results from previous studies, demonstrating that EEG alpha power is positively associated with a family history of alcohol use disorders.

Gender differences in insomnia--a study in the Hong Kong Chinese population

OBJECTIVE

To study the epidemiology of insomnia in the adult Chinese population in Hong Kong and to examine the potential gender-related demographic and lifestyle factors in insomnia.

METHODS

A population study via random telephone survey with a structured questionnaire was carried out for noninstitutionalized Chinese adults aged 18-65 by trained lay interviewers. The questionnaire included demographic data, sleep habits and problems, insomnia symptoms and lifestyle questions.

RESULTS

A total of 9851 subjects (46.4% male; 53.6% female) were included in the final analysis. The overall prevalence of Hong Kong Chinese as suffering from insomnia during the preceding month (with a frequency of sleep disturbance of at least three times per week) was 11.9% (95% CI 11.2-12.6), including difficulty in initiating sleep (DIS) (4.5%; 95% CI 4.1-5.0), difficulty in maintaining sleep (DMS) (6.9%; 95% CI 6.4-7.5) and early morning awakening (EMA) (4.0%; 95% CI 3.6-4.4). Females were about 1.6 times at higher risk for insomnia than males. The prevalence of insomnia was also shown to increase with age. Multivariate analysis showed that unemployment, lower economic status, alcohol consumption, regular medication and psychiatric disturbance were all associated with higher risks of insomnia in both sexes. Furthermore, lower education level and being retired was associated with a higher risk of insomnia in males, but being a housewife, divorced/widowed, and complaining of a nocturnal noisy environment were associated with a higher risk of insomnia in females. Among all these factors, psychiatric disturbance was the most influential risk factor for insomnia in both sexes. The reasons for gender differences of insomnia may include their differences in the prevalence of psychiatric morbidities, symptom endorsement, gonadal steroids, sociocultural factors and coping strategies.

CONCLUSIONS

Overall, 11.9% of the Hong Kong Chinese adult population complained of frequent insomnia in the preceding month. There was a higher prevalence of insomnia in females. Although there were common risk factors for insomnia in both sexes, there existed gender-specific risk factors.

Acute performance-impairing and subject-rated effects of triazolam and temazepam, alone and in combination with ethanol, in humans

The acute behavioural effects of triazolam (0.125 and 0.25 mg), temazepam (15 and 30 mg), and placebo, alone and in combination with ethanol (0 and 0.5 g/kg), were assessed in 10 volunteers. Ethanol alone did not impair performance and produced only a few subject-rated drug effects. Triazolam and temazepam alone produced some performance impairment and a few subject-rated drug effects. These effects tended to be dose-dependent and were comparable for the two drugs across the range of doses tested. The triazolam-ethanol and temazepam-ethanol combinations produced robust performance impairment and sedative-like subject-rated drug effects that were similar in magnitude. The findings of the present study suggest that even a moderate amount of ethanol in combination with a clinical dose of triazolam or temazepam can cause performance impairment that might diminish an individual's ability to respond adequately to unexpected demands (e.g. smoke alarms or middle-of-the-night child care).

Insomnia, self-medication, and relapse to alcoholism

OBJECTIVE

This study was an investigation of the frequencies of insomnia and its self-medication with alcohol in a group of alcoholic patients, as well as the relationship of these variables to alcoholic relapse.

METHOD

The subjects were 172 men and women receiving treatment for alcohol dependence. They completed a sleep questionnaire, measures of alcohol problem severity and depression severity, and polysomnography after at least 2 weeks of abstinence.

RESULTS

On the basis of eight items from the Sleep Disorders Questionnaire, 61% of the subjects were classified as having symptomatic insomnia during the 6 months before treatment entry. Compared to patients without insomnia, patients with insomnia were more likely to report frequent alcohol use for sleep (55% versus 28%), had significantly worse polysomnographic measures of sleep continuity, and had more severe alcohol dependence and depression. Among 74 alcoholics who were followed a mean of 5 months after treatment, 60% with baseline insomnia versus 30% without baseline insomnia relapsed to any use of alcohol, a significant difference. Insomnia remained a robust predictor of relapse after application of logistic regression analysis to control for other variables. A history of self-medicating insomnia with alcohol did not significantly predict subsequent relapse.

CONCLUSIONS

The majority of alcoholic patients entering treatment reported insomnia symptoms. Given the potential link between insomnia and relapse, routine questions about sleep in clinical and research settings are warranted.