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Chinese Acupuncture & Moxibustion ; (12): 1405-1408, 2021.
Article in Chinese | WPRIM | ID: wpr-921066


The published literature of insomnia in the elderly treated with acupuncture was retrieved in CNKI, Wanfang and VIP from the date of establishment to December 31, 2019. Association rule analysis and cluster analysis were used to summarize the acupoint selection rules of insomnia in the elderly treated with acupuncture. A total of 37 articles were included, involving 60 acupuncture prescriptions. The most commonly used acupoints were Sanyinjiao (SP 6), Shenmen (HT 7), Anmian (Extra), Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Xinshu (BL 15) and Taixi (KI 3). The most commonly used acupoint combinations were Sanyinjiao (SP 6)-Anmian (Extra)-Baihui (GV 20)-Sishencong (EX-HN 1)-Shenting (GV 24)-Shenmen (HT 7)-Xinshu(BL 15), Xinshu(BL 15)-Pishu (BL 20)-Shenshu (BL 23)-Shenting (GV 24), Zhaohai (KI 6)-Shenmai (BL 62), Taichong (LR 3)-Ganshu (BL 18), Daling (PC 7)-Taixi (KI 3), Neiguan (PC 6)- Zusanli (ST 36) and Guanyuan (CV 4)-Qihai (CV 6)-Zhongwan (CV 12). On the basis of acupoint selection according to disease differentiation, the acupoint selection rules and characteristics of insomnia in the elderly treated with acupuncture are regulating and supplementing the spleen and kidney and treating according to spleen-kidney.

Acupuncture Points , Acupuncture Therapy , Aged , Cell Differentiation , Humans , Publications , Sleep Initiation and Maintenance Disorders/therapy
Article in Chinese | WPRIM | ID: wpr-887480


OBJECTIVE@#To observe the efficacy of @*METHODS@#A total of 58 participants were included. Of them, 29 patients with insomnia were included into an observation group, and 29 healthy participants were included into a control group. The patients in the observation group were treated with @*RESULTS@#The total effective rate was 89.7% (26/29) in the observation group. In the observation group, the scores of PSQI, ISI and DISS, the A, B speed of NCT were all decreased after treatment (@*CONCLUSION@#The

Acupuncture Therapy , Brain/diagnostic imaging , Emotions , Humans , Magnetic Resonance Imaging , Sleep Initiation and Maintenance Disorders/therapy
Article in Chinese | WPRIM | ID: wpr-877647


OBJECTIVE@#To observe the effect of acupoint application of gel plaster on quality of sleep and life in patients with insomnia.@*METHODS@#A total of 63 patients with insomnia were randomized into a gel plaster group (32 cases, 1 case dropped off) and a placebo plaster group (31 cases). Acupoint application of gel plaster was applied at Yintang (GV 29) and Yongquan (KI 1) in the gel plaster group, placebo plaster was applied at the same acupoints in the placebo plaster group. The treatment was given from bedtime to early moming of the next day, 5 days were as one course, with 2-day interval, totally 4 courses were required in the both groups. Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS) and Flinders fatigue scale were used to evaluate the sleep quality and fatigue level of the patients in the both groups before and after treatment and at 2 weeks of follow-up. The variations of insomnia TCM syndrome score and the 36-item short-form health survey (SF-36) score before and after treatment were observed.@*RESULTS@#Compared before treatment, the scores of PSQI, ESS and FFS after treatment and at follow-up were decreased in the both groups (@*CONCLUSION@#Acupoint application of gel plaster can effectively improve the quality of sleep and life in patients with insomnia.

Acupuncture Points , Acupuncture Therapy , Humans , Sleep , Sleep Initiation and Maintenance Disorders/therapy , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-877646


OBJECTIVE@#To observe the clinical effect of electroacupuncture (EA) on aged insomnia, and explore its possible mechanism.@*METHODS@#A total of 60 patients with aged insomnia were randomly divided into an EA group (30 cases) and a sham EA group (30 cases, 1 case dropped off). The patients in the EA group were treated with acupuncture at Baihui (GV 20), Yintang (GV 29), Shenmen (HT 7), Sanyinjiao (SP 6), Xinshu (BL 15) and Shenshu (BL 23), and EA was used at Baihui (GV 20) and Yintang (GV 29), with intermittent wave, 2 Hz in frequency. In the sham EA group, the acupoints and the EA connection acupoints were the same as those in the EA group, 2-3 mm in depth, but no current was connected. The intervention was given 30 min each time, once every other day, 3 times a week for 4 weeks in the both groups. Before and after treatment, the Pittsburgh sleep quality index (PSQI) and Montreal cognitive assessment (MoCA) scale were used to assess sleep quality and cognitive function, and serum melatonin (MT) and dopamine (DA) levels were detected.@*RESULTS@#After treatment, the total score and sub-item scores of PSQI in the EA group were lower than those before treatment (@*CONCLUSION@#Electroacupuncture can improve sleep quality and cognitive function in aged insomnia patients, and its mechanism may be related to regulating serum MT and DA levels.

Acupuncture Points , Aged , Dopamine , Electroacupuncture , Humans , Melatonin , Sleep Initiation and Maintenance Disorders/therapy
Article in Chinese | WPRIM | ID: wpr-877634


To explore the problems and countermeasures existing in acupuncture and moxibustion clinical studies, in the perspective of the key steps of

Acupuncture , Acupuncture Therapy , Humans , Moxibustion , Reference Standards , Sleep Initiation and Maintenance Disorders/therapy
Chinese Acupuncture & Moxibustion ; (12): 1149-1153, 2020.
Article in Chinese | WPRIM | ID: wpr-877577


OBJECTIVE@#To compare the clinical therapeutic effect and safety on insomnia among three acupuncture combinations, named @*METHODS@#A total of 90 patients with insomnia were randomized into a Tongdu Tiaowei group (30 cases, 1 case dropped off ), a Tongdu Yangxin group (30 cases, 2 cases dropped off ) and a Tongdu Tiaozang group (30 cases, 1 case dropped off ). Besides electroacupuncture (EA) applied to Baihui (GV 20) and Yintang (GV 29) in all of the three groups, acupuncture was added at Shenmai (BL 62) and Zhaohai (KI 6), Shenmen (HT 7) and Sanyinjiao (SP 6) as well as back-@*RESULTS@#After treatment, the score of each of 6 factors, named sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total score of PSQI scale were all reduced as compared with the scores before treatment in the patients of each group (@*CONCLUSION@#All of the three acupuncture combinations, named

Acupuncture Points , Acupuncture Therapy , Humans , Sleep , Sleep Initiation and Maintenance Disorders/therapy , Treatment Outcome
Rev. medica electron ; 41(2): 483-495, mar.-abr. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1004283


RESUMEN El insomnio es el trastorno del sueño más frecuente en la población, se acompaña de un nivel significativo de malestar o deterioro de áreas importantes del funcionamiento humano. Es importante realizar un diagnóstico correcto de este desorden con el objetivo de instaurar un tratamiento adecuado que permita mejorar la calidad de vida de los pacientes que lo padecen. El objetivo de este artículo es ofrecer una revisión actualizada que contribuya al incremento y actualización de la información sobre este tema. Se realizó una revisión en artículos, principalmente de los últimos cinco años y se sistematizan los resultados para de esta forma contribuir a la superación de los profesionales.

ABSTRACT Insomnia is the most frequently sleep disorder in the population. It is linked to a significant discomfort and an impairment of important areas of the human functioning. The correct diagnosis of this disorder is important with the objective of prescribing an adequate treatment for improving the life quality of the patients suffering it. The aim of this article is offering an up-dated review contributing to increase and update the information on this topic. The authors carried out a review of articles published mainly during the last five years, and the results were systematized for contributing to the professionals´ upgrading.

Humans , Sleep Initiation and Maintenance Disorders/classification , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/drug therapy , Sleep Initiation and Maintenance Disorders/therapy , Sleep Hygiene
Säo Paulo med. j ; 136(6): 579-585, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-991688


ABSTRACT CONTEXT AND OBJECTIVE: Insomnia is a frequent complaint that generates more than five million visits to doctors per year in the United States. This study summarizes all Cochrane systematic reviews (SRs) that evaluated interventions to treat insomnia. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A sensitive search was carried out in the Cochrane Database of Systematic Reviews to identify Cochrane SRs that assessed the effects of any type of intervention for people with insomnia. The results, main characteristics of the SRs and the certainty of the evidence obtained from them were synthesized and discussed. RESULTS: Seven SRs were included. They addressed the benefits and harm of acupuncture (n = 1), behavioral interventions (n = 1), music (n = 1), pharmacotherapy (n = 2), phototherapy (n = 1) and physical exercise (n = 1). The certainty of the evidence ranged from moderate to very low. CONCLUSION: Acupuncture, music, physical exercise, paroxetine, doxepin, trimipramine and trazodone seem to present some benefit for patients with insomnia. However, the uncertainty around these results means that no robust and definitive recommendations for clinical practice can be made until the benefits and harms from each intervention for patients with insomnia have been confirmed through further studies.

Humans , Evidence-Based Medicine , Systematic Reviews as Topic , Sleep Initiation and Maintenance Disorders/therapy , Sleep/physiology , Exercise , Acupuncture Therapy/standards , Randomized Controlled Trials as Topic , Sleep Initiation and Maintenance Disorders/drug therapy , Music Therapy/standards , Antidepressive Agents/therapeutic use
Rev. latinoam. enferm. (Online) ; 26: e3079, 2018. tab, graf
Article in English | SES-SP, LILACS, BDENF, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-978626


ABSTRACT Objective: to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure. Method: pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group. Results: all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week. Conclusion: the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm

RESUMO Objetivo: estimar os efeitos de intervenções não farmacológicas para melhora da qualidade de sono e de vida de pacientes com insuficiência cardíaca. Método: estudo piloto de um ensaio controlado aleatorizado com 32 indivíduos alocados em quatro grupos. Sono foi avaliado pelo Pittsburgh Sleep Quality Inventory e qualidade de vida relacionada à saúde avaliada pelo Minnessota Living with Heart Failure Questionnaire, no início e nas semanas 12 e 24 do estudo. As médias dos desfechos por grupo de intervenção foram comparadas por análise de covariância, e os tamanhos dos efeitos calculados para cada grupo. Resultados: todos os grupos apresentaram melhora na qualidade de sono e de vida relacionada à saúde no final do período de intervenção (12 semanas) e no seguimento de 24 semanas, mas as diferenças não foram estatisticamente significantes (p entre 0,22 e 0,40). Em 12 semanas, os efeitos das intervenções variaram entre -2,1 e -3,8 na qualidade de sono e de -0,8 e -1,7 na qualidade de vida, com valores similares em 24 semanas. Conclusão: os efeitos obtidos neste estudo podem servir de base para cálculos de tamanho amostral e poder estatístico em estudos confirmatórios. Registro Brasileiro de Ensaios Clínicos - RBR 7jd2mm

RESUMEN Objetivo: estimar los efectos de intervenciones no farmacológicas para mejoría de la calidad de sueño y de vida de pacientes con insuficiencia cardíaca. Método: estudio piloto de un ensayo controlado aleatorizado con 32 individuos asignados a cuatro grupos. El sueño fue evaluado por el Pittsburgh Sleep Quality Inventory y la calidad de vida relacionada a la salud fue evaluada por el Minnessota Living with Heart Failure Questionnaire, en el inicio y en las semanas 12 y 24 del estudio. Las medias de los resultados por grupo de intervención fueron comparadas con análisis de covariancia y los tamaños de los efectos fueron calculados para cada grupo. Resultados: todos los grupos presentaron mejoría en la calidad de sueño y de vida relacionada a la salud al final del período de intervención (12 semanas) y en el seguimiento de 24 semanas; sin embargo, las diferencias no fueron estadísticamente significativas (p entre 0,22 y 0,40). En 12 semanas, los efectos de las intervenciones variaron entre -2,1 y -3,8 en la calidad de sueño y de -0,8 a -1,7 en la calidad de vida, con valores similares en 24 semanas. Conclusión: los efectos obtenidos en este estudio pueden servir de base para calcular el tamaño de la muestra y del poder estadístico en estudios confirmatorios. Registro Brasileño de Ensayos Clínicos - RBR 7jd2mm.

Humans , Animals , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/therapy , Socioeconomic Factors , Severity of Illness Index , Statistics, Nonparametric , Sleep Hygiene/physiology
Braz. j. med. biol. res ; 51(6): e7070, 2018. tab, graf
Article in English | LILACS | ID: biblio-889098


Insomnia is highly prevalent in children and adolescents. However, the efficacy of cognitive behavioral therapy for insomnia (CBT-i) in children and adolescents remains controversial. Therefore, this systematic review and meta-analysis aimed to assess the efficacy of CBT-i in children and adolescents. We conducted a search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO to select primary studies evaluating CBT-i in children and adolescents that were primarily diagnosed through standardized diagnostic criteria. The primary outcomes of the meta-analysis included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). Six randomized controlled trials and four open-label trials met all inclusion criteria. A total of 464 participants (ranging from 5-19 years of age) were included. Based on the results from sleep logs, a significant pooled effect size was observed for SOL and SE%. However, no significant pooled effect size was found for WASO or TST. Results from actigraphy were consistent with the sleep logs. A significant pooled effect size was observed for SOL and SE%, and no significant pooled effect size was found for WASO or TST. CBT-i might be effective in the treatment of children and adolescents with insomnia.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Cognitive Behavioral Therapy/methods , Sleep Initiation and Maintenance Disorders/therapy , Randomized Controlled Trials as Topic , Treatment Outcome
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 15(1): 73-79, abr. 2017. tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1008644


El insomnio es un trastorno que puede presentarse en cualquier edad y hasta un 30% de la población mundial lo padece en algún momento; puede ser síntoma de un sinnúmero de patologías médicas que incluye muchos trastornos psiquiátricos. El objetivo de este estudio observacional analítico de corte transversal fue determinar el grado de conocimiento sobre insomnio en médicos residentes de Asunción-Paraguay; se incluyeron 54 médicos residentes entre 26-39 años de edad de las Cátedras de Medicina Interna (26), Medicina Familiar (11) y Psiquiatría (17). Significativamente mayor proporción de residentes de Psiquiatría (47,1%) y de Medicina Familiar (45,5%) tuvieron buen conocimiento comparado a los de Medicina Interna (7,7%). El 59,3% de los residentes (Psiquiatría: 58,8%, Medicina Familiar: 75,0% y Medicina Interna: 53,8%) había diagnosticado alguna vez insomnio primario y la mayoría de ellos registra ≤20% de los pacientes con insomnio en las historias clínicas. Sobre el tratamiento instaurado, el 57,4% utiliza medidas farmacológicas, el 55,5% medidas de higiene del sueño, mientras que 18,5% recomienda actividad física. Entre los grupos farmacológicos que conocen para el tratamiento del insomnio, el 72,2% de los residentes citó a las benzodiacepinas; hipnóticos no benzodiacepínicos (16,7%); antipsicóticos (35,2%); antihistamínicos (9,3%) y otras medicaciones (27,8%). Los conocimientos de los residentes respecto a la terapéutica del insomnio son suficientes, pero no del nivel deseable. Esto resalta la necesidad de establecer oportunidades educativas sobre el manejo y tratamiento del insomnio y mayor profundización de la teoría y la práctica de la medicina del sueño en estudiantes de grado y posgrado

Insomnia is a global distribution disorder that may occur at any age and up to 30% of the world's population suffers from insomnia at some point in their lives. Insomnia presents the peculiarity of being a symptom of a number of medical pathologies among which are many psychiatric disorders. The objective of this cross-sectional, observational study was to determine the knowledge on insomnia in medical residents in Asunción, Paraguay. The study includes 54 medical residents between 26 and 39 years of age, from the Departments of Internal Medicine (26), Family Medicine (11) and Psychiatry (17). A higher proportion of residents of Psychiatry (47.1%) and Family Medicine (45.5%) had a good knowledge of insomnia compared to Internal Medicine residents (7.7%); 59.3% of residents (Psychiatry: 58.8%, Family Medicine: 75.0% and Internal Medicine: 53,8%) had ever diagnosed primary insomnia and the majority of them recorded ≤20% of the patients with an insomnia diagnosis in the medical records. About the treatment established, 57.4% used pharmacological measures, 55.5% sleep hygiene measures, while 18.5% recommended physical activity. Among the pharmacological groups known for the treatment of insomnia, 72.2% of residents cited benzodiazepines; non-benzodiazepine hypnotics (16.7%); antipsychotics (35.2%); antihistamines (9.3%) and, other medications (27.8%). Residents' knowledge of insomnia therapy is sufficient, but not at the desirable level. This highlights the need to establish educational opportunities on the management and treatment of insomnia and further deepening the theory and practice of sleep medicine in undergraduate and postgraduate students

Humans , Male , Female , Adult , Health Knowledge, Attitudes, Practice , Sleep Initiation and Maintenance Disorders/therapy , Medical Staff, Hospital/education , Paraguay , Cross-Sectional Studies , Surveys and Questionnaires
Rev. bras. med. fam. comunidade ; 11(38): 1-14, jan./dez. 2016. ilus, figura
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-878054


A insônia é uma das perturbações do sono mais comuns, sendo uma das principais queixas dos pacientes que recorrem aos cuidados médicos. A perturbação de insônia está associada a aumento da morbimortalidade por doenças cardiovasculares, psiquiátricas e acidentes, estando igualmente associada a maior absentismo laboral e maiores custos em saúde. Foram pesquisadas normas de orientação clínica, revisões sistemáticas, meta-análises e estudos originais, publicados entre 2010 e 15 de maio de 2015, relacionados com o tratamento da insônia. O tratamento da insônia pode iniciar-se por terapia cognitivo-comportamental, tratamento farmacológico ou associação dos dois. A terapia cognitivo-comportamental é considerada por várias sociedades médicas como tratamento padrão, sendo que os estudos comprovam a sua eficácia no tratamento da insônia sem ou com comorbilidades e com manutenção a longo prazo dos seus efeitos. Esta compreende múltiplas estratégias, como controle de estímulo, restrição do sono, relaxamento, terapia cognitiva e intenção paradoxal. A farmacoterapia deve ser considerada em situações agudas com necessidade de redução imediata dos sintomas. Os fármacos hipnóticos têm indicação no tratamento da insônia quando os sintomas assumem caráter patológico. Os antidepressivos sedativos, apesar de comumente utilizados, não reúnem evidência da sua eficácia, com exceção da insônia associada a sintomas depressivos ou de ansiedade ou em pacientes com abuso de substâncias. Assim, dada a prevalência de queixas de insônia em atenção primária à saúde, o médico de família deve conhecer a melhor abordagem para o seu tratamento, quer seja farmacológico ou não farmacológico, e os critérios de referenciação.

Insomnia is one of the most common sleep disorders and one of the main complaints of patients that search for medical care. Insomnia disorder is associated with increased morbidity and mortality from accidents, cardiovascular and psychiatric diseases and it is associated with increased absenteeism and higher healthcare costs. We conducted a survey of clinical guidelines, systematic reviews, meta-analyzes and original studies published between 2010 and May 15 2015, concerning insomnia treatment. Treatment of insomnia can begin by cognitive behavioral therapy, pharmacologic treatment or a combination of both. Cognitive behavioral therapy is considered by several medical societies as the standard treatment of insomnia, and studies prove its effectiveness in treating insomnia with or without comorbidities and long-term maintenance of its effects. This comprises multiple strategies such as stimulus control, sleep restriction, relaxation, cognitive therapy and paradoxical intention. Pharmacologic therapy should be considered in acute situations requiring immediate reduction of symptoms. Hypnotic drugs are indicated when insomnia symptoms assume pathological nature. Sedative antidepressants, although generally used, lack evidence of effectiveness, with the exception of insomnia associated with depressive symptoms or anxiety or substance abuse users. Thus, given the prevalence of insomnia symptoms in primary health care, the family physician must know the best approach to its treatment, either pharmacologic or non-pharmacologic, and referral criteria.

El insomnio representa uno de los trastornos del sueño más comunes y una de las principales quejas de los pacientes que recurren a la atención médica. El insomnio está asociado al aumento de morbimortalidad por enfermedades cardiovasculares, psiquiátricas y accidentes, estando asociado de la misma forma a mayor absentismo laboral y mayor gasto en salud. Se procedió a la revisión de todas las directrices clínicas, meta-análisis, revisiones sistemáticas y estudios originales, publicados entre 2010 y 15 de mayo de 2015, relacionados con el tratamiento del insomnio. La intervención en el insomnio puede comenzar con la terapia cognitivo-conductual, tratamiento farmacológico o una combinación de ambos. La terapia cognitiva conductual es considerada por varias sociedades médicas como tratamiento estándar del insomnio. Los estudios demuestran su eficacia en el tratamiento de esta condición con o sin comorbilidades asociadas, bien como el mantenimiento a largo plazo de sus efectos. Ella incluye estrategias como el control de estímulos, restricción del sueño, la relajación, la terapia cognitiva y los consejos paradójicos. Por otra parte, la terapia farmacológica se debe considerar en situaciones agudas que requieren reducción inmediata de los síntomas. Fármacos hipnóticos están indicados cuando los síntomas del insomnio asumen carácter patológico. Antidepresivos sedantes, aunque comúnmente utilizados, no tienen pruebas de su eficacia, con la excepción del insomnio asociado con síntomas depresivos, ansiedad o en los consumidores de sustancias. Por este motivo, dada la prevalencia de quejas de insomnio en la atención primaria de salud, el médico de familia debe conocer el mejor enfoque para su tratamiento, ya sea farmacológico o no farmacológico, y criterios de derivación.

Primary Health Care , Sleep Initiation and Maintenance Disorders/therapy
J. pediatr. (Rio J.) ; 91(6,supl.1): S26-S35, nov.-dez. 2015. tab
Article in English | LILACS | ID: lil-769809


Resumo Objetivos: Revisar as características clínicas, as comorbidades e o manejo da insônia na infância e adolescência. Fonte dos dados: Revisão não sistemática da literatura feita na base dados PubMed, na qual foram selecionados artigos publicados nos últimos cinco anos, com o uso da palavra-chave insônia e o filtro faixa etária pediátrica. Adicionalmente foram incluídos artigos e livros-texto clássicos da literatura sobre o tema. Síntese dos dados: Na infância existe predomínio da insônia comportamental na forma de distúrbio de início do sono por associações inadequadas e/ou distúrbio pela falta de estabelecimento de limites. Na adolescência a insônia está mais associada a problemas de higiene do sono e atraso de fase. Transtornos psiquiátricos (ansiedade, depressão) ou do neurodesenvolvimento (transtorno do déficit de atenção, autismo, epilepsias) ocorrem com frequência em associação ou como comorbidade do quadro de insônia. Conclusões: A queixa de insônia nas crianças e nos adolescentes deve ser valorizada e adequadamente investigada pelo pediatra, que levará em consideração a associação com diversas comorbidades, que também devem ser diagnosticas. As causas principais de insônia e fatores desencadeantes variam de acordo com a idade e o nível de desenvolvimento. A abordagem terapêutica deve incluir medidas de higiene do sono e técnicas comportamentais e em casos individualizados tratamento farmacológico.

Abstract Objectives: To review the clinical characteristics, comorbidities, and management of insomnia in childhood and adolescence. Sources: This was a non-systematic literature review carried out in the PubMed database, from where articles published in the last five years were selected, using the key word “insomnia” and the pediatric age group filter. Additionally, the study also included articles and classic textbooks of the literature on the subject. Data synthesis: During childhood, there is a predominance of behavioral insomnia as a form of sleep-onset association disorder (SOAD) and/or limit-setting sleep disorder. Adolescent insomnia is more associated with sleep hygiene problems and delayed sleep phase. Psychiatric (anxiety, depression) or neurodevelopmental disorders (attention deficit disorder, autism, epilepsy) frequently occur in association with or as a comorbidity of insomnia. Conclusions: Insomnia complaints in children and adolescents should be taken into account and appropriately investigated by the pediatrician, considering the association with several comorbidities, which must also be diagnosed. The main causes of insomnia and triggering factors vary according to age and development level. The therapeutic approach must include sleep hygiene and behavioral techniques and, in individual cases, pharmacological treatment.

Adolescent , Child , Child, Preschool , Humans , Infant , Sleep Initiation and Maintenance Disorders/etiology , Central Nervous System Diseases/complications , Depression/complications , Neurodevelopmental Disorders/complications , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/physiopathology , Sleep Initiation and Maintenance Disorders/therapy
Article in Spanish | LILACS | ID: lil-788727


El uso de las benzodiazepinas (BZD) ha ido incrementándose en losúltimos años. Son los fármacos más utilizados en el ámbito médico parael tratamiento de los trastornos del ritmo sueño-vigilia y en los trastornosde ansiedad. Poseen serios efectos adversos en tanto alteran laarquitectura del sueño, provocan tolerancia y dependencia, incoordinaciónmotora y debilidad muscular, y a mediano y largo plazo altera funcionescognitivas tales como la memoria y la atención. Se analizan las posiblesalternativas a éstas medicaciones que pueden dar una respuesta similaro mejorada sin los efectos adversos mencionados.Entre ellas encontramos a las medicinas naturales o fitoterapia. Seplantea como objetivo realizar una revisión bibliográfica que permitadeterminar los actuales usos de plantas medicinales en los cuadros deinsomnio y en los trastornos de ansiedad. Se encontró que ciertasplantas medicinales son una alternativa terapéutica segura y eficaz parasuplantar a las BZD en los trastornos del sueño y la ansiedad, cuandosu uso es responsable y respaldado con evidencia científica.

The use of benzodiazepines (BZD) has been increasing in recent years.They are commonly used in the medical field for the treatment ofdisorders of sleep-wake rhythm and anxiety disorders. BZD presentserious adverse effects like alter sleep architecture, cause tolerance anddependence, motor incoordination and muscle weakness, medium andlong term alter cognitive functions such as memory and attention. Weanalyze possible alternatives to these medications that can give a similarresponse or improved it without the side effects listed. Among them wefound the natural or herbal medicines. We perform a literature review todetermine current uses of medicinal plants in the tables of insomnia andanxiety disorders. It was found that certain herbs are a safe and effectivetherapeutic alternative way to supplant the BZD in sleep disorders andanxiety, when its use is responsible and backed with scientific evidence.

Humans , Anxiety , Benzodiazepines , Phytotherapy , Plants, Medicinal , Sleep Initiation and Maintenance Disorders/therapy , Cedron , Matricaria , Mentha piperita , Melissa/therapeutic use , Passiflora , Tilia , Valerian/administration & dosage
Rev. ter. ocup ; 25(2): 119-125, maio-ago. 2014. tab, graf
Article in Portuguese | LILACS | ID: lil-745368


A insônia é conceituada como a dificuldade de iniciar ou manter o sono ou insatisfação com a qualidade do sono e que pode interferir no desempenho das atividades sociais e cognitivas. Este trabalho teórico buscou estudar a insônia no adulto e suasalterações que acometem o desempenho ocupacional. O estudo desenvolveu revisão bibliográfica do tipo narrativa do período de 2002 a 2012, realizada nas bases de dados eletrônicas utilizando como descritores, em português e em inglês, insônia e desempenho ocupacional. Foram encontrados 398 artigos, e selecionados 16 artigos. As publicações possuem maior frequência no ano de 2012 e apenas artigos científicos na línguainglesa estavam relacionados ao tema de pesquisa. Os principais acometimentos relacionados com o desempenho ocupacional dos indivíduos adultos referem-se aos prejuízos apresentados em diferentes contextos como no ambiente escolar, familiar, social e do trabalho. Dentre esses aspectos que interferem no desempenho ocupacional destacam-se: alterações cognitivas; fadiga duranteo dia; menor produtividade seja no trabalho ou nas atividades diárias de modo geral; absenteísmo, destacando-se esse aspecto relacionado ao trabalho; distúrbios de humor; ansiedade; relações familiares e sociais prejudicadas; e acidentes no trabalho.

Insomnia is conceptualized as a disorder defined by the existence of difficulty initiating or maintaining sleep or dissatisfaction with the quality of sleep and it can interfere with the performance of cognitive and social activities. This theoretical study aimed to study about the insomnia in adults and the changes that affect the occupational performance. The studydeveloped a bibliographic review of narrative’s type of the period 2002 to 2012, held in electronic databases using as descriptors, in Portuguese and in English, insônia and desempenho ocupacional. It was found 398 articles, and selected 16 articles. The publications have a higher frequency in the year 2012 and only scientificarticles in English language were related to the research topic. The main disorders related with the occupational performance of adults relate to losses presented in different contexts such as in the school environment, family, social and work. Among these aspects that interfere in occupational performance stand out: cognitive changes, fatigue during the day; lower productivity at work or in daily activities in general; absenteeism, highlighting related to work; mood disorders; anxiety; family relationshipsand social disadvantage; and accidents at work.

Adult/psychology , Sleep Initiation and Maintenance Disorders/physiopathology , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/therapy , Employment/psychology , Social Environment , Sleep/physiology , Comorbidity
Arq. neuropsiquiatr ; 72(1): 63-71, 01/2014.
Article in English | LILACS | ID: lil-697596


Insomnia involves difficulty in falling asleep, maintaining sleep or having refreshing sleep. This review gathers the existing informations seeking to explain insomnia, including those that focus on psychological aspects and those considered neurobiological. Insomnia has been defined in psychological (cognitive components, such as worries and rumination, and behavioral aspects, such as classic conditioning) and physiological terms (increased metabolic rate, with increased muscle tone, heart rate and temperature). From the neurobiological point of view, there are two perspectives: one which proposes that insomnia occurs in association with a failure to inhibit wakefulness and another that considers hyperarousal as having an important role in the physiology of sleep. The non-pharmacological interventions developed to face different aspects of insomnia are presented.

Insônia é um transtorno que envolve dificuldade em dormir, em manter-se dormindo ou em ter um sono restaurador. Esta revisão reúne informações que buscam explicar a insônia, incluindo aquelas que estudam os aspectos psicológicos e os neurobiológicos. A insônia tem sido definida em termos psicológicos (componentes cognitivos, tais como preocupações e ruminação e aspectos comportamentais, tais como o condicionamento clássico) e em termos fisiológicos (taxa metabólica aumentada, com tônus muscular, frequência cardíaca e temperatura aumentados). Do ponto de vista neurobiológico, há duas perspectivas: uma propondo que a insônia ocorre em associação com uma falha na inibição da vigília e outra que considera o hiperalerta como tendo um papel importante na fisiologia do sono. São apresentadas também as estratégias não farmacológicas desenvolvidas para lidar com os diferentes aspectos da insônia.

Humans , Male , Female , Cognition/physiology , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/therapy , Sleep/physiology , Cognitive Behavioral Therapy/methods , Risk Factors , Depression/physiopathology , Sleep Initiation and Maintenance Disorders/physiopathology
São Paulo; s.n; 2014. 60 p.
Thesis in Portuguese | LILACS | ID: lil-716085


Introdução: A insônia está entre os mais frequentes transtornos que afetam a população na contemporaneidade, devido a mudanças hormonais e psicossociais importantes é muito prevalente na perimenopausa. Há uma relação ainda pouco estudada entre eficiência do sono e prática meditativa. Os tratamentos utilizados para insônia normalmente são de alto custo e paliativos. Objetivo: Avaliar o efeito da meditação na insônia (causada por sintomas característicos da perimenopausa) e qualidade de vida nesta fase da vida. Método: Ensaio clínico controlado para avaliar os efeitos da meditação em mulheres com insônia no período da perimenopausa e o impacto na qualidade de vida em 8 semanas de intervenção. O estudo foi realizado de abril a julho de 2013 com 33 mulheres na perimenopausa de idade entre 40 a 55 anos em 3 unidades de órgão público no município de São Paulo, SP. As participantes foram divididas aleatoriamente em dois grupos, um que praticou somente Higiene do Sono-HS (n=15) e outro que praticou Meditação + Higiene do Sono-M+HS (n=18). Foram realizados encontros semanais com as participantes de ambos os grupos para pratica de meditação em grupo e/ou critérios de higiene do sono. O grupo M+HS também realizou prática diária de meditação. Para avaliar a significância estatística das diferenças de médias antes e depois das intervenções em cada grupo foi utilizado o teste de Wilcoxon. Resultados: Houve melhora da insônia em ambos os grupos, no entanto comparando as diferenças de escore do Índice de Gravidade de Insônia entre os grupos estudados, o grupo M+HS teve um efeito superior em ambas as medições em relação ao grupos HS. No grupo M+HS, houve redução estatisticamente significativa nas categorias do Índice Menopausal de Kupperman: Palpitação, Parestesia e a Pontuação Total já no grupo HS não houve redução significativa em nenhum parâmetro do Índice de Kupperman...

Introduction: Insomnia is one of the most common disorders that affect the population in contemporaneity, because of important hormonal and psychosocial changes is very prevalent in perimenopause. There is a still understudied relationship between sleep efficiency and meditative practice. The treatments for insomnia are usually expensive and palliative. Objective: Evaluate the effects of meditation in insomnia (caused by typical symptoms of perimenopause) and quality of life in this phase of life. Method: controlled clinical trial to evaluate the effects of meditation in women with insomnia during perimenopause and impact on quality of life in 8-week intervention. The study was conducted from April to July 2013 with 33 perimenopausal women aged between 40-55 years in 3 units of public organization in São Paulo, SP, Brazil. The participants were randomly assigned to two groups, one who performed only Sleep Hygiene-HS (n = 15) and another who performed Meditation + Sleep Hygiene - SH + M (n = 18). Weekly meetings were held with the participants of both groups to practice meditation in a group and / or criteria for the sleep hygiene. The M + SH group also performed daily meditation practice. To assess the statistical significance of differences in means before and after the interventions in each group, the Wilcoxon test was applied. Results: Improvement of sleep quality in both groups, however comparing the differences in the scores of the Insomnia Severity Index between groups, group M + SH had a greater effect on both measures compared to the SH group. In M + SH group showed a statistically significant reduction in the categories of the Kupperman Menopausal Index: palpitations, paresthesia and Total Score, already in the SH group there was no significant reduction in any parameter of the Kupperman Index...

Climacteric , Sleep Initiation and Maintenance Disorders/therapy , Meditation , Perimenopause , Quality of Life , Clinical Trials as Topic , Comparative Study , Hygiene , Sleep
Mediciego ; 18(n.esp)dic. 2012. tab
Article in Spanish | LILACS | ID: lil-710844


Se realizó un ensayo clínico fase II, controlado, en el que se demostró el efecto hipnótico del extracto fluido de pasiflora en pacientes con insomnio primario que acudieron a la consulta creada para dichos efectos en el servicio de medicina tradicional del policlínico norte en el periodo comprendido entre los meses de enero–noviembre del año 2010. El universo de estudio quedó constituido por los 92 pacientes que acudieron a la citada consulta aquejados de insomnio primario, entre las edades de 15 a 50 años, de uno y otro sexo, a los que se les aplicaron los instrumentos diseñados y validados para estos fines y se trataron con extracto fluido de pasiflora 46 de ellos pertenecientes al grupo de estudio, a igual número se le suministró nitrazepam, incluidos en el grupo control, terapéutica en ambos casos que se cumplió por 21 días. La pasiflora ha demostrado ser igualmente efectiva en el tratamiento del insomnio que las modalidades terapéuticas alopáticas con nitrazepam, en menos consultas se obtuvo la mejoría, asociadas a muchas ventajas y a ningún efecto adverso, los que aparecen con carácter absoluto en las terapias convencionales, lo que indica que la relación riesgo-beneficio, con la utilización de la pasiflora, justifica el uso de esta terapia.

Humans , Male , Female , Passiflora , Phytotherapy , Sleep Initiation and Maintenance Disorders/therapy , Sleep Wake Disorders/therapy