ABSTRACT
Elderly people often suffer from insomnia which is responsible for high comorbidity and lower quality of life in this population. Somatic and psychiatric pathologies must be screened as primary sleep disorders. Chronic sleep disorders and benzodiazepine abuse might be avoided by an early treatment of causal factors. We wished to propose here a practical approach of the insomnia in the elderly going from the diagnosis to the treatment by advancing the not pharmacological approaches, while specifying at best the place of different drugs available and their limits.
Subject(s)
Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/therapy , Aged , Decision Trees , HumansABSTRACT
Chronic pain and sleep disorder can put the patient in a vicious circle (bidirectional relation between those two morbid entities). Clinical management must be global. The physiopathology includes chronic sleep deficit, mainly in deep sleep (the "restoring" sleep) generated principally by the prefrontal regions. These areas are also implicated in the modulation of pain. To break this "loops", we advocate an approach based on three main components: hygiene principles, cognitive and behavioral therapy, medications with analgesic and hypnotic proprieties.
Subject(s)
Analgesics/therapeutic use , Anticonvulsants/therapeutic use , Brain/physiopathology , Cognitive Behavioral Therapy , Hypnotics and Sedatives/therapeutic use , Pain/drug therapy , Sleep Initiation and Maintenance Disorders/drug therapy , Analgesics, Non-Narcotic/therapeutic use , Analgesics, Opioid/therapeutic use , Animals , Behavior Therapy , Chronic Disease , Drug Therapy, Combination , Evidence-Based Medicine , Humans , Life Style , Melatonin/therapeutic use , Pain/physiopathology , Pain Management , Placebos/therapeutic use , Sleep Initiation and Maintenance Disorders/physiopathology , Sleep Initiation and Maintenance Disorders/therapy , Sodium Oxybate/therapeutic use , Treatment OutcomeABSTRACT
Restless legs syndrome (RLS) is a common sleep disorder characterized by dysesthesias and paresthesias in the legs, occurring at rest, worsening at evening and night and alleviated by movements. Apart from idiopathic cases, RLS and psychiatric diseases share a common association and recent studies have shown a strong association between RLS and antidepressants. The effects of antidepressants such as selective serotonin reuptake inhibitors and venlafaxine on worsening RLS have been widely studied and their use should be avoided. The clinical spectrum of RLS and the physiopathological link with antidepressant will be discussed in this review in order to provide new preventive strategy in clinical practice to improve diagnosis, orientating therapeutic decision and evaluating efficacy of treatment.
Subject(s)
Antidepressive Agents/adverse effects , Restless Legs Syndrome/chemically induced , Humans , Mental Disorders/complications , Mental Disorders/drug therapy , Restless Legs Syndrome/complicationsABSTRACT
The authors present clinical, sleep, and neuroendocrine features of a patient with genetically confirmed fatal familial insomnia (D178N mutation with heterozygosity at codon 129 of the prion protein gene). The patient exhibited pseudohypersomnia behavior instead of insomnia. There was profound alteration in the sleep-wake cycle with a clear dissociation in the disappearance of circadian and neuroendocrine rhythms, findings unrelated to abnormalities in the hypocretinergic system.
