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Avram R. Gold - One of the best experts on this subject based on the ideXlab platform.
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Chronic Insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series
Journal of Medical Case Reports, 2019Co-Authors: Michael Proothi, Victor J. R. Grazina, Avram R. GoldAbstract:BackgroundChronic Insomnia and obstructive sleep apnea are both common sleep disorders. Chronic Insomnia is thought to result from stress-related physiologic hyperarousal ( somatic arousal ) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other’s response to treatment; they interact. This report of three cases describes patients with both Chronic Insomnia and obstructive sleep apnea in whom the Chronic Insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement.Case presentationsOur three Caucasians patients each presented with severe, Chronic Insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, Insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for Insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, Chronic Insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively.ConclusionsThese three cases lend support to the hypothesis that Chronic Insomnia and obstructive sleep apnea share a pathophysiology of Chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when Chronic Insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in Chronic stress that causes the patient’s Chronic Insomnia to remit.
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Chronic Insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series
Journal of Medical Case Reports, 2019Co-Authors: Michael Proothi, Victor J. R. Grazina, Avram R. GoldAbstract:Chronic Insomnia and obstructive sleep apnea are both common sleep disorders. Chronic Insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other’s response to treatment; they interact. This report of three cases describes patients with both Chronic Insomnia and obstructive sleep apnea in whom the Chronic Insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. Our three Caucasians patients each presented with severe, Chronic Insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, Insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for Insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, Chronic Insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. These three cases lend support to the hypothesis that Chronic Insomnia and obstructive sleep apnea share a pathophysiology of Chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when Chronic Insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in Chronic stress that causes the patient’s Chronic Insomnia to remit.
James K Walsh - One of the best experts on this subject based on the ideXlab platform.
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Chronic Insomnia quality of life and utility scores comparison with good sleepers in a cross sectional international survey
Sleep Medicine, 2012Co-Authors: Damien Leger, Charles M. Morin, Makoto Uchiyama, Zalmai Hakimi, Sandrine Cure, James K WalshAbstract:Abstract Background Chronic Insomnia has a recognized impact on health-related quality-of-life (HRQoL) but data on utility scores across countries are lacking. The objective of the present study was to assess health related quality of life (HRQoL) and utility scores in individuals from three different countries (USA, France, and Japan), comparing sufferers of Chronic Insomnia to good sleepers. Methods A cross-sectional survey (SLEEPI-i) of 4067 persons in the US ( n =1298; 478 good sleepers and 820 patients with Insomnia), France ( n =1858; 998 good sleepers and 860 patients with Insomnia) and Japan ( n =911; 506 good sleepers and 405 patients with Insomnia). Enrollment and data collection using consumer panels were web-based in the US and France, and gathered via a postal survey in Japan. People with Chronic Insomnia (>6months) were selected based on Insomnia Severity Index scores (ISI). Severity of Insomnia was assessed using the ISI score and HRQoL was assessed using the self-administered Short-Form SF-36 Health Survey. Utility scores were derived using the algorithm developed by Brazier et al. Multivariate analyses were used to adjust for potential confounding factors. Results In all countries, people with Chronic Insomnia (40% treated) reported lower SF-36 scores in each of eight domains compared with good sleepers ( P P Conclusions This survey suggests that Chronic Insomnia is associated with significant impairment of HRQoL and decreased utilities across the different geographical regions studied.
David Cunnington - One of the best experts on this subject based on the ideXlab platform.
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Cognitive behavioral therapy for Chronic Insomnia: In response
Annals of Internal Medicine, 2016Co-Authors: James M. Trauer, David CunningtonAbstract:This systematic review of 20 randomized trials assessed the effects of face-to-face cognitive behavioral therapy (CBT) on overnight sleep in adults with Chronic Insomnia not due to medical or psych...
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cognitive behavioral therapy for Chronic Insomnia a systematic review and meta analysis
Annals of Internal Medicine, 2015Co-Authors: James M. Trauer, Mary Y Qian, Joseph Doyle, Shanthakumar M W Rajaratnam, David CunningtonAbstract:Background Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for Insomnia (CBT-i) is now commonly recommended as first-line treatment for Chronic Insomnia. Purpose To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with Chronic Insomnia. Data sources Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening. Study selection Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with Chronic Insomnia. Studies of Insomnia comorbid with medical, sleep, or psychiatric disorders were excluded. Data extraction Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). Data synthesis Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64% female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95% CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE% improved by 9.91% (CI, 8.09% to 11.73%). Changes seemed to be sustained at later time points. No adverse outcomes were reported. Limitation Narrow inclusion criteria limited applicability to patients with comorbid Insomnia and other sleep problems, and accuracy of estimates at later time points was less clear. Conclusion CBT-i is an effective treatment for adults with Chronic Insomnia, with clinically meaningful effect sizes. Primary funding source None. (PROSPERO registration number: CRD42012002863).
Michael Proothi - One of the best experts on this subject based on the ideXlab platform.
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Chronic Insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series
Journal of Medical Case Reports, 2019Co-Authors: Michael Proothi, Victor J. R. Grazina, Avram R. GoldAbstract:BackgroundChronic Insomnia and obstructive sleep apnea are both common sleep disorders. Chronic Insomnia is thought to result from stress-related physiologic hyperarousal ( somatic arousal ) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other’s response to treatment; they interact. This report of three cases describes patients with both Chronic Insomnia and obstructive sleep apnea in whom the Chronic Insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement.Case presentationsOur three Caucasians patients each presented with severe, Chronic Insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, Insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for Insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, Chronic Insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively.ConclusionsThese three cases lend support to the hypothesis that Chronic Insomnia and obstructive sleep apnea share a pathophysiology of Chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when Chronic Insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in Chronic stress that causes the patient’s Chronic Insomnia to remit.
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Chronic Insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series
Journal of Medical Case Reports, 2019Co-Authors: Michael Proothi, Victor J. R. Grazina, Avram R. GoldAbstract:Chronic Insomnia and obstructive sleep apnea are both common sleep disorders. Chronic Insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other’s response to treatment; they interact. This report of three cases describes patients with both Chronic Insomnia and obstructive sleep apnea in whom the Chronic Insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. Our three Caucasians patients each presented with severe, Chronic Insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, Insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for Insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, Chronic Insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. These three cases lend support to the hypothesis that Chronic Insomnia and obstructive sleep apnea share a pathophysiology of Chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when Chronic Insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in Chronic stress that causes the patient’s Chronic Insomnia to remit.
Michael L. Perlis - One of the best experts on this subject based on the ideXlab platform.
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Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do with It?
Brain Sciences, 2020Co-Authors: Ivan Vargas, Anna M. Nguyen, A Muench, Célyne H. Bastien, Jason Ellis, Michael L. PerlisAbstract:Nearly one-third of the population reports new onset or acute Insomnia in a given year. Similarly, it is estimated that approximately 10% of the population endorses sleep initiation and maintenance problems consistent with diagnostic criteria for Chronic Insomnia. For decades, acute and Chronic Insomnia have been considered variations of the same condition or disorder, only really differentiated in terms of Chronicity of symptoms (days/weeks versus months). Whether or not acute and Chronic Insomnia are part of the same phenomena is an important question, one that has yet to be empirically evaluated. The goal of the present theoretical review was to summarize the definitions of acute and Chronic Insomnia and discuss the role that hyperarousal may have in explaining how the pathophysiology of acute and Chronic Insomnia is likely different (i.e., what biopsychological factors precipitate and/or perpetuate acute Insomnia, Chronic Insomnia, or both?).
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acute and Chronic Insomnia what has time and or hyperarousal got to do with it
Brain Sciences, 2020Co-Authors: Ivan Vargas, Anna M. Nguyen, A Muench, Célyne H. Bastien, Jason Ellis, Michael L. PerlisAbstract:Nearly one-third of the population reports new onset or acute Insomnia in a given year. Similarly, it is estimated that approximately 10% of the population endorses sleep initiation and maintenance problems consistent with diagnostic criteria for Chronic Insomnia. For decades, acute and Chronic Insomnia have been considered variations of the same condition or disorder, only really differentiated in terms of Chronicity of symptoms (days/weeks versus months). Whether or not acute and Chronic Insomnia are part of the same phenomena is an important question, one that has yet to be empirically evaluated. The goal of the present theoretical review was to summarize the definitions of acute and Chronic Insomnia and discuss the role that hyperarousal may have in explaining how the pathophysiology of acute and Chronic Insomnia is likely different (i.e., what biopsychological factors precipitate and/or perpetuate acute Insomnia, Chronic Insomnia, or both?).
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altered ultradian cortisol rhythmicity as a potential neurobiologic substrate for Chronic Insomnia
Sleep Medicine Reviews, 2018Co-Authors: Ivan Vargas, Knashawn H Morales, James L Abelson, Rose T. Faghih, Alexandros N Vgontzas, Michael L. PerlisAbstract:Summary Chronic Insomnia is highly prevalent and associated with significant morbidity (i.e., confers risk for multiple psychiatric and medical disorders, such as depression and hypertension). Therefore, it is essential to identify factors that perpetuate this disorder. One candidate factor in the neurobiology of Chronic Insomnia is hypothalamic-pituitary-adrenal-axis dysregulation, and in particular, alterations in circadian cortisol rhythmicity. Cortisol secretory patterns, however, fluctuate with both a circadian and an ultradian rhythm (i.e., pulses every 60–120 min). Ultradian cortisol pulses are thought to be involved in the maintenance of wakefulness during the day and their relative absence at night may allow for the consolidation of sleep and/or shorter nocturnal awakenings. It is possible that the wakefulness that occurs in Chronic Insomnia may be associated with the aberrant occurrence of cortisol pulses at night. While cortisol pulses naturally occur with transient awakenings, it may also be the case that cortisol pulsatility becomes a conditioned phenomenon that predisposes one to awaken and/or experience prolonged nocturnal awakenings. The current review summarizes the literature on cortisol rhythmicity in subjects with Chronic Insomnia, and proffers the suggestion that it may be abnormalities in the ultradian rather than circadian cortisol that is associated with the pathophysiology of Insomnia.
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The neurobiology, investigation, and treatment of Chronic Insomnia
The Lancet Neurology, 2015Co-Authors: Dieter Riemann, Michael L. Perlis, Christoph Nissen, Laura Palagini, Andreas Otte, Kai SpiegelhalderAbstract:Summary Chronic Insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic Insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that Chronic Insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep–wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.
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Cognitive Behavioral Treatment of Chronic Insomnia
Primary Care Sleep Medicine, 2014Co-Authors: James C. Findley, Michael L. PerlisAbstract:Cognitive behavior therapy for Insomnia (CBT-I) is an evidence-based treatment that has been shown to be an effective treatment for Chronic Insomnia. Chronic Insomnia occurs frequently and affects about 10 % of the general population, or 30 million individuals in the USA alone. Furthermore, Insomnia is unlikely to spontaneously remit and its impact on the daytime functioning is significant. Insomnia is a risk factor for medical and psychiatric comorbidity as well as impaired work and social performance. Short-term efficacy of CBT-I has been shown to be comparable to sedative-hypnotic medication and CBT-I treatment effects have been shown to be more durable than sedative-hypnotic medication at follow-ups of up to 2 years. The basic components of CBT-I include sleep restriction, stimulus control, and sleepy hygiene interventions. Adjunctive treatments may include relaxation therapy, phototherapy, and cognitive therapy. A step-by-step description of how treatment is delivered is provided as well as behavioral recommendations for primary care patients.