Cognitive-Behavioral and Pharmacological Treatments for Insomnia: A Combined Approach

Alessandro Cicolin, Alessandra Giordano

DOI: https://doi.org/10.7175/cmi.v14i1.1474

Abstract

Insomnia is the most prevalent sleep disorder (10-40%). It is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep and that results in some form of daytime impairment. Among the typical symptoms, there are fatigue, decreased mood or irritability, general malaise, and cognitive impairment. According to the International Classification of Sleep Disorders 3rd edition, ICSD-3, it has been defined as chronic (lasting more than three months) or short-term insomnia (less than three months).

In clinical practice, the usual therapeutic approach is pharmacological (benzodiazepines, z drugs, slow wave sleep enhancers), even if the American Academy of Sleep Medicine (AASM), the American College of Physicians (ACP), and the European Sleep Research Society (ESRS) guidelines suggest that the first clinical choice should be non-pharmacological (cognitive behavioral therapy). A combined (non-pharmacological and pharmacological)approach could be considered in poor responders to manage drug dependence and to increase compliance to treatment and patients’ quality of life.

Keywords

Sleep; Insomnia; Pharmacological Treatment; Non-pharmacological treatment; CBT-I

Full Text

HTML PDF

References

  • Saper CB, Scammell TE, Lu J. Hypothalamic regulation of sleep and circadian rhythms. Nature 2005; 437: 1257-63; https://doi.org/10.1038/nature04284
  • Pace-Schott EF, Hobson JA. The neurobiology of sleep: genetics, cellular physiology and subcortical networks. Nature Reviews Neuroscience 2002; 3: 591-605; https://doi.org/10.1038/nrn895
  • Bjorness TE, Greene RW. Adenosine and sleep. Curr Neuropharmacol 2009; 7: 238-45; https://doi.org/10.2174/157015909789152182
  • Sforza E, Jouny C, Ibanez V. Cardiac activation during arousal in humans: further evidence for hierarchy in the arousal response. Clin Neurophysiol 2000; 1611-9; https://doi.org/10.1016/S1388-2457(00)00363-1
  • Halász P, Terzano M, Parrino L, et al. The nature of arousal in sleep. J Sleep Res 2004; 13: 1-23; https://doi.org/10.1111/j.1365-2869.2004.00388.x
  • American Academy of Sleep Medicine. International Classification of Sleep Disorders-Third Edition. Darien (USA, IL): American Academy of Sleep Medicine, 2014
  • Owens JA, Dalzell V. Use of the ‘BEARS’ sleep screening tool in a pediatric residents’ continuity clinic: a pilot study. Sleep Med 2005; 6: 63-9; https://doi.org/10.1016/j.sleep.2004.07.015
  • Andreou, G, Vlachos, F, Makanikas, K. Effects of chronic obstructive pulmonary disease and obstructive sleep apnea on cognitive functions: evidence for a common nature. Sleep disorders 2014; 768210; https://doi.org/10.1155/2014/768210
  • Kielb SA, Ancoli-Israel S, Rebok GW, et al. Cognition in obstructive sleep apnea-hypopnea syndrome (OSAS): current clinical knowledge and the impact of treatment. Neuromolecular medicine 2012; 14: 180-93; https://doi.org/10.1007/s12017-012-8182-1
  • Harvey AG. Insomnia: symptom or diagnosis? Clin Psychol Rev 2001; 21: 1037-59; https://doi.org/10.1016/S0272-7358(00)00083-0
  • Primary insomnia. In: Medline Plus Medical Encyclopedia. Bethesda (USA, MD): National Library of Medicine/National Institutes of Health, 2004; http://www.nlm.nih.gov/medlineplus/ency/article/000805.htm (last accessed July 2020)
  • American Sleep Disorders Association. International Classification of Sleep Disorders. Rochester, MN: American Sleep Disorders Association, 1990
  • American Academy of Sleep Medicine. International Classification of Sleep Disorders. 2nd ed. Darien (USA, IL): American Academy of Sleep Medicine, 2005
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington (USA, DC): American Psychiatric Press Inc, 1994; https://doi.org/10.1001/jama.1994.0352010009604
  • Buysse DJ, Reynolds CF 3rd, Hauri PJ, et al. Diagnostic concordance for DSM-IV sleep disorders: a report from the APA/NIMH DSM-IV field trial. Am J Psychiatry 1994; 151: 1351-60; https://doi.org/10.1176/ajp.151.9.1351
  • Edinger JD, Wyatt JK, Stepanski EJ, et al. Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses. Results of a multitrait-multimethod analysis. Arch Gen Psychiatry 2011; 68: 992-1002; https://doi.org/10.1001/archgenpsychiatry.2011.64
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington (USA, DC): Amer Psychiatric Pub Inc., 2013
  • Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014; 146: 1387-94; https://doi.org/10.1378/chest.14-0970
  • Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Med Rev 2010; 14: 19-31; https://doi.org/10.1016/j.smrv.2009.07.003
  • Perlis ML, Giles DE, Mendelson WB, et al. Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res 1997; 6: 179-88; https://doi.org/10.1046/j.1365-2869.1997.00045.x
  • Clinton JM, Davis CJ, Zielinski MR, et al. Biochemical regulation of sleep and sleep biomarkers. J Clin Sleep Med 2011; 7 (5Suppl): S38-S42; https://doi.org/10.5664/JCSM.1360
  • Riemann D, Klein T, Rodenbeck A, et al. Nocturnal cortisol and melatonin secretion in primary insomnia. Psychiatry Res 2002; 113: 17-27; https://doi.org/10.1016/S0165-1781(02)00249-4
  • Seelig E, Keller U, Klarhöfer M, et al. Neuroendocrine regulation and metabolism of glucose and lipids in primary chronic insomnia: a prospective case-control study. PloS one 2013; 8: e61780; https://doi.org/10.1371/journal.pone.0061780
  • Landolt HP. Sleep homeostasis: a role for adenosine in humans? Biochem Pharmacol 2008; 75: 2070-9; https://doi.org/10.1016/j.bcp.2008.02.024
  • Pace-Schott EF, Hobson JA. The neurobiology of sleep: genetics, cellular physiology and subcortical networks. Nat Rev Neurosci 2002; 3: 591-605; https://doi.org/10.1038/nrn895
  • Spielman A, Caruso L, Glovinsky P. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 1987; 10: 541-553
  • Perlis ML, Jungquist C, Smith MT, et al. The conceptual framework for CBT-I. In: Cognitive Behavioral Treatment of Insomnia. A Session-by-Session Guide. New York (USA, NY): Springer-Verlag, 2005
  • Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest 2015; 147: 1179-92; https://doi.org/10.1378/chest.14-1617
  • Hausken AM, Furu, K, Skurtveit S, et al. Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors. Eur J Clin Pharmacol 2009; 65: 295-301; https://doi.org/10.1007/s00228-008-0565-8
  • Soyka M. Treatment of Benzodiazepine Dependence. N Engl J Med 2017; 376: 1147-57; https://doi.org/10.1056/NEJMra1611832
  • Kelly TH, Foltin RW, Serpick E, et al. Behavioral effects of alprazolam in humans. Behav Pharmacol 1997; 8: 47-57
  • Kozená L, Frantik E, Horváth M. Vigilance impairment after a single dose of benzodiazepines. Psychopharmacology 1995; 119: 39-45; https://doi.org/10.1007/bf02246052
  • Beracochea D. Anterograde and retrograde effects of benzodiazepines on memory. ScientificWorldJournal 2006; 1460-5; https://doi.org/10.1100/tsw.2006.243
  • WHO Review Group. Use and abuse of benzodiazepines. Bull World Health Organ 1983; 61: 551-62
  • Pierfitte C, Macouillard G, Thicoïpe M, et al. Benzodiazepines and hip fractures in elderly people: case-control study. BMJ 2001; 322: 704-8; https://doi.org/10.1136/bmj.322.7288.704
  • Pagel JF, Parnes BL. Medications for the Treatment of Sleep Disorders: An Overview. Prim Care Companion J Clin Psychiatry 2001; 3: 118-25; https://doi.org/10.4088/pcc.v03n0303
  • Belleville, G, Morin, CM. Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy. Health 2008; 27: 239-48; https://doi.org/10.1037/0278-6133.27.2.239
  • Mazza M, Losurdo A, Testani E, et al. Polysomnographic findings in a cohort of chronic insomnia patients with benzodiazepine abuse. J Clin Sleep Med 2014; 10: 35-42; https://doi.org/10.5664/jcsm.3354
  • Victorri-Vigneau C, Dailly E, Veyrac G, et al. Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. Br J Clin Pharmacol 2007; 64: 198-209; https://doi.org/10.1111/j.1365-2125.2007.02861.x
  • Wang PS, Bohn RL, Glynn RJ, et al. Zolpidem use and hip fractures in older people. J Am Geriatr Soc 2001; 49: 1685-90; https://doi.org/10.1111/j.1532-5415.2001.49280.x
  • Westerlind B, Östgren CJ, Mölstad S, et al. Use of non-benzodiazepine hypnotics is associated with falls in nursing home residents: a longitudinal cohort study. Aging Clin Exp Res 2019; 31: 1087-95; https://doi.org/10.1007/s40520-018-1056-0
  • Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol 2005; 20: 533-59; https://doi.org/10.1002/hup.726
  • Wichniak A, Wierzbicka A, Walęcka M, et al. Effects of Antidepressants on Sleep. Curr Psychiatry Rep 2017; 19: 63; https://doi.org/10.1007/s11920-017-0816-4
  • Monti JM, Torterolo P, Pandi Perumal SR. The effects of second generation antipsychotic drugs on sleep variables in healthy subjects and patients with schizophrenia. Sleep Med Rev 2017; 33: 51-7; https://doi.org/10.1016/j.smrv.2016.05.002
  • Jain SV, Glauser TA. Effects of epilepsy treatments on sleep architecture and daytime sleepiness: an evidence-based review of objective sleep metrics. Epilepsia 2014; 55: 26-37; https://doi.org/10.1111/epi.12478
  • Ozdemir PG, Karadag AS, Selvi Y, et al. Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety. Int J Psychiatry Clin Pract 2014; 18: 161-8; https://doi.org/10.3109/13651501.2014.907919
  • Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017; 26: 675-700; https://doi.org/10.1111/jsr.12594
  • Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13: 307-49; https://doi.org/10.5664/jcsm.6470
  • Kuriyama A, Tabata H. Suvorexant for the treatment of primary insomnia: A systematic review and meta-analysis. Sleep Med Rev 2017; 35: 1-7; https://doi.org/10.1016/j.smrv.2016.09.004
  • Scholten RM, van Munster BC, van Kempen MF, et al. Physiological melatonin levels in healthy older people: A systematic review. J Psychosom Res 2016; 86: 20-7; https://doi.org/10.1016/j.jpsychores.2016.05.005
  • Qaseem, A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2016; 165: 125-33; https://doi.org/10.7326/M15-2175
  • Chesson AL Jr, Anderson WM, Littner M, et al. 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. Sleep 1999; 22: 1128-33; https://doi.org/10.1093/sleep/22.8.1128
  • Morin CM, Hauri PJ, Espie CA, et al. Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep 1999; 22: 1134-56; https://doi.org/10.1093/sleep/22.8.1134
  • Petit L, Azad N, Byszewski A, et al. Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments. Age Ageing 2003; 32: 19-25; https://doi.org/10.1093/ageing/32.1.19
  • Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994; 151: 1172-80; https://doi.org/10.1176/ajp.151.8.1172
  • Morin CM, Bootzin RR, Buysse DJ, et al. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep 2006; 29: 1398-414; https://doi.org/10.1093/sleep/29.11.1398
  • Trauer JM, Qian MY, Doyle JS, et al. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163: 191-204; https://doi.org/10.7326/M14-2841
  • Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American academy of sleep medicine report. Sleep 2006; 29: 1415-9
  • Morin CM. Cognitive-behavioral approaches to the treatment of insomnia. J Clin Psychiatry 2004; 65 Suppl 16: 33-40
  • Chung KF, Lee CT, Yeung WF, et al. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract 2018; 35: 365-75; https://doi.org/10.1093/fampra/cmx122
  • Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep 1987; 10: 45-56
  • Perlis ML, Jungquist C, Smith MT, et al. Components of therapy. In: Cognitive Behavioral Treatment of Insomnia. A Session-by-Session Guide. New York (USA, NY): Springer-Verlag, 2005
  • Cheng P, Kalmbach D, Fellman-Couture C, et al. Risk of excessive sleepiness in sleep restriction therapy and cognitive behavioral therapy for insomnia: a randomized controlled trial. J Clin Sleep Med 2020; 16: 193-8; https://doi.org/10.5664/jcsm.8164
  • Bootzin RR. Stimulus control treatment for insomnia. Proc Ann Psychol Assoc 1972; 7: 395-6
  • Lichstein KL, Riedel BW, Wilson NM, et al. Relaxation and sleep compression for late-life insomnia: a placebo-controlled trial. J Consult Clin Psychol 2001; 69: 227-39; https://doi.org/10.1037//0022-006x.69.2.227
  • Borkovec TD, Fowles DC. Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia. J Abnorm Psychol 1973; 82: 153-8; https://doi.org/10.1037/h0034970
  • Lichstein KL. Clinical relaxation strategies. New York (USA, NY): Wiley, 1988
  • Schultz JH, Luthe W. Autogenic Training. Autogenic Methods, vol I. New York (USA, NY): Grune & Stratton, 1969
  • Morin CM. Insomnia: Psychological assessment and management. New York (USA, NY): Guilford Press, 1993
  • Morin CM. Issues and challenges in implementing clinical practice guideline for the management of chronic insomnia. J Sleep Res 2017; 26: 673-4; https://doi.org/10.1111/jsr.12639
  • Baglioni C, Altena E, Bjorvatn B, et al. The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. J Sleep Res 2020; 29: e12967; https://doi.org/10.1111/jsr.12967
  • Baglioni C, Altena E, Bjorvatn B, et al. The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. J Sleep Res 2020; 29: e12967; https://doi.org/10.1111/jsr.12967
  • Hassinger AB, Bletnisky N, Dudekula R, et al. Selecting a pharmacotherapy regimen for patients with chronic insomnia [published online ahead of print, 2020 Mar 23]. Expert Opin Pharmacother 2020; 1-9; https://doi.org/10.1080/14656566.2020.1743265
  • Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 2006; 25: 3-14; https://doi.org/10.1037/0278-6133.25.1.3
  • Montgomery P, Dennis J. A systematic review of non-pharmacological therapies for sleep problems in later life. Sleep Med Rev 2004; 8: 47-62; https://doi.org/10.1016/S1087-0792(03)00026-1
  • Murtagh DR, Greenwood KM. Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol 1995; 63: 79-89; https://doi.org/10.1037//0022-006x.63.1.79
  • Wilt TJ, MacDonald R, Brasure M, et al. Pharmacologic Treatment of Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med 2016; 165: 103-12; https://doi.org/10.7326/M15-1781
  • Abad VC, Guilleminault C. Insomnia in Elderly Patients: Recommendations for Pharmacological Management. Drugs Aging 2018; 35: 791-817; https://doi.org/10.1007/s40266-018-0569-8
  • Smith E, Narang P, Enja M, et al. Pharmacotherapy for Insomnia in Primary Care. Prim Care Companion CNS Disord 2016; 18: 10.4088/PCC.16br01930; https://doi.org/10.4088/PCC.16br01930
  • Kay-Stacey M, Attarian H. Advances in the management of chronic insomnia. BMJ (Clinical research ed.) 2016; 354: i2123; https://doi.org/10.1136/bmj.i2123
  • Morin CM. Combined therapeutics for insomnia: Should our first approach be behavioral or pharmacological? Sleep Med 2006; 7 (Suppl 1): S15-S19; https://doi.org/10.1016/j.sleep.2006.03.005
  • Vincent N, Lionberg C. Treatment preference and patient satisfaction in chronic insomnia. Sleep 2001; 24: 411-7; https://doi.org/10.1093/sleep/24.4.411
  • Schutte-Rodin S, Broch L, Buysse D, et al, M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4: 487-504
  • Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006; 295: 2851-8; https://doi.org/10.1001/jama.295.24.2851
  • McClusky HY, Milby JB, Switzer PK, et al. Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia. Am J Psychiatry 1991; 148: 121-6; https://doi.org/10.1176/ajp.148.1.121
  • Mitchell MD, Gehrman P, Perlis M, et al. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice 2012; 13: 40; https://doi.org/10.1186/1471-2296-13-40)
  • Morin CM, Colecchi C, Stone J, et al. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA 1999; 281: 991-9; https://doi.org/10.1001/jama.281.11.991
  • Wu R, Bao J, Zhang C, et al. Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychother Psychosom 2006; 75: 220-8; https://doi.org/10.1159/000092892
  • Morin CM, Vallières A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA 2009; 301: 2005-15; https://doi.org/10.1001/jama.2009.682

Statistics

Abstract: 245 views
HTML: 84 views
PDF: 66 views

Refbacks

  • There are currently no refbacks.




© SEEd srl