New guidelines for diagnosis and treatment of insomnia

Brazilian Sleep Association, São Paulo, SP, Brazil.
Arquivos de neuro-psiquiatria (Impact Factor: 0.84). 08/2010; 68(4):666-75. DOI: 10.1590/S0004-282X2010000400038
Source: PubMed


The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.

Download full-text


Available from: John Araujo,
1 Follower
52 Reads
  • Source
    • "The interventions were limited to primarily sleep hygiene and sleep scheduling interventions, which are two components in the concept of cognitive behavioural therapy (CBT) for primary insomnia (Pinto et al. 2010). A broader approach, that is, a full CBT intervention might have been more beneficial. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to evaluate effects of a non-pharmacological intervention on sleep, activity and fatigue in patients receiving peritoneal dialysis by the use of both actigraphy registration and self-assessed questionnaires. Insomnia is estimated to affect up to 60% of haemo- and peritoneal dialysis patients. It is associated with two common uremic symptoms, pruritus and restless legs syndrome. To our knowledge, no interventions have been evaluated by actigraphy. A prospective multiple baseline single-case experimental design. Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study from January 2009 to February 2011. Two interventions were separately implemented. First, a pressure-relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires. A total of 315 sleep-wake cycles from nine individuals were evaluated. Three patients improved clinically significantly in five or more of the nine outcomes, i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index, number of steps, metabolic equivalent unit, sleep efficiency and fatigue. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements. This study illuminates the need for regular assessment of sleep and tiredness. It also demonstrates how a non-pharmacological treatment and self-management can be applied with renal supportive care to improve sleep quality. This study is a clinical example of a non-pharmacological intervention with supportive care and self-management. This model can improve health and reduce the pharmacological burden because hypnotics can be replaced by sleep hygiene self-care activities.
    Journal of Clinical Nursing 12/2012; 21(23-24):3402-17. DOI:10.1111/j.1365-2702.2012.04282.x · 1.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The rate coefficient of the reaction H + O2 → OH + O was determined using tunable diode laser absorption of H2O near 2.5 μm behind reflected shock waves over the temperature range 1100–1530 K, at approximately 2 atm. Detailed kinetic analysis of the recorded H2O temporal profiles yielded the rate coefficient expression: k = (1.12 ± 0.08) × 1014 exp [(−7805 ± 90)/T] cm3 mol−1 s−1, with estimated uncertainties of ±4.6% at 1500 K and ±8.8% at 1100 K. Excellent agreement between this study and that of Masten et al. (1990) was found in the overlapping temperature range. By combining the results of these two studies, the reaction rate coefficient over the range 1100–3370 K was found to be described well by:
    Proceedings of the Combustion Institute 01/2011; 33(1):309-316. DOI:10.1016/j.proci.2010.05.101 · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether the outcome of treatment with trazodone CR in primary insomnia differs between patients with and without subthreshold depression. 14 patients (9 females, mean age 57.3 ± 13.3) with primary insomnia and increased Beck Depression Inventory (BDI) scores (>10) and 15 sex- and age-matched patients with primary insomnia and low BDI scores (≤ 10) were treated with trazodone CR 25-150 mg/d for 3 months and followed for 1 month after discontinuation of the medication. The Athens Insomnia Scale (AIS), Sheehan Disability Scale (SDS), and Clinical Global Impression scale (CGI) were completed at baseline, after each month of treatment and after the first week of run-out phase. Additional assessment tools comprised sleep diaries, the Leeds Sleep Evaluation Questionnaire (LSEQ) and actigraphic recordings. Subjective sleep time increased by 61.5 ± 72.3 min in the group with low BDI and 60.0 ± 59.4 min in the group with increased BDI at the end of the treatment phase. The significant improvements were also observed in the AIS, CGI, LSEQ and SDS. During the run-out phase the improvement was sustained in patients with low BDI, while AIS scores, sleep latency and total sleep time deteriorated in patients with increased BDI. Patients with subthreshold depression, even if the depressive symptoms do not fulfill the time criteria for depressive episode, show marked worsening of insomnia after discontinuation of sleep promoting medication.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 06/2011; 35(7):1671-6. DOI:10.1016/j.pnpbp.2011.06.010 · 3.69 Impact Factor
Show more