Insomnia and Sleep Disturbance

                                       

Specialist Treatments-  (Herbal formula also may required)

Introduction

The incidence of insomnia is estimated to be 35% to 40% of the adult population. It currently affects more than 60 million Americans, and this figure is expected to grow to 100 million by the middle of the 21st century. The defining characteristic of insomnia in the context of anxiety is a pattern of multiple arousals from sleep. Anxious subjects have difficulty maintaining sleep, spend less time in deep sleep, and their sleep is more fragmented than that of normal subjects.Conversely, sleep deprivation may produce symptoms that fall within the total complex of anxiety. Although current opinion suggests that insomnia and anxiety are separate entities, their symptoms overlap considerably. Individuals with insomnia and individuals with anxiety have elevated psychosomatic profiles on psychological tests, maintain chronically high states of arousal, and rely on an "internalizing" style of conflict resolution (DSM-IV, 4th Edition).These commonalities have prompted speculation that a common thread underlies the conditions, although their exact relationship, namely whether insomnia is the product of or simply a correlate of anxiety, is still inconsistently viewed in current diagnostic systems (i.e., the ICD-10, DSM-IV and ICSD [International Classification of Sleep Disorders]). It is nevertheless true that the dual diagnostic pattern of anxious insomnia is the most commonly seen problem in sleep disorder clinics today.The high rate of comorbidity between anxiety and insomnia, coupled with the high population incidence of insomnia, undoubtedly account for this phenomenon. Although we are unaware of any epidemiological studies on the incidence of anxiety which does not fulfill the criteria for a defined anxiety disorder, it is reasonable to infer that a large segment of the population may have "subsyndromal" anxiety, symptoms that are not associated with debilitating psychopathology, but which nevertheless produce a significant degree of mental discomfort.

Traditional treatment strategies for anxious insomnia have emphasized benzodiazepines. The useful anxiolytic effects of these agents have made them the most widely prescribed of all pharmaceuticals.The risks of benzodiazepines, however, are well documented and involve physical as well as psychological effects. These include their potential to promote dependence or acute toxicity in overdose. Other adverse effects include sedation, psychomotor and cognitive impairment, memory loss, potentiation of other CNS depressants, and treatment-emergent depression. Acupuncture, which relies on the release of neurally active agents from endogenous stores, has been shown to have a superior side effect profile compared to some psychoactive drugs and may thus represent a means for addressing the concerns about benzodiazepine therapy.

Evidence supporting acupuncture's utility as a treatment for insomnia has come from a variety of sources, including the non-western scientific literature. Among these, investigations by Nan and Qingming, Jiarong, and Cangliang showed positive results. The shortcoming of these studies, however, is that their dependent measures have usually been inexact, relying mainly on subjective accounts of sleep experience or duration, and consequently, despite the consistency of their support for acupuncture, they are difficult to evaluate. Several European studies used polysomnography to measure acupuncture effects on sleep disorders, but all failed to monitor nocturnal neurochemical changes which would have strengthened their experimental design.

Acupuncture and Insomnia

Acupuncture, which is considered in the category of alternative medical systems, also acts on meridian points to influence health [1]. The majority of studies utilizing acupuncture have relied on subjective measures or have not had a placebo control, thus making interpretation of study findings difficult ^[1]. Few studies have examined the effects of acupuncture in insomnia using polysomnography ^[2,3]. While both demonstrated evidence of improved sleep, one was a pilot study that was not placebo-controlled ^[2]. This study also demonstrated increases in nocturnal melatonin secretion and reductions in stress/anxiety scores compared to pre-treatment levels.

Acupuncture has also been examined as a treatment modality for sleep disruption due to other conditions, including insomnia post stroke ^[4] and post menopausal symptoms ^[5,6]. Other sleep disorders that have been treated with acupuncture include fibromyalgia ^[7,8] and sleep apnea ^[9,10].

Taiji and it effect on Insomnia

 Taiji is a low- to moderate-intensity Chinese exercise that includes a meditational component. A study of the effects of Tai Chi (consisting of three 60 minutes sessions for 24 weeks) in 118 older adults in comparison to low-impact exercise noted that Tai Chi improved self-reported sleep duration by 48 min [11]. General health-related quality of life and daytime sleepiness levels also improved. No injuries were reported in either group. Of note, 33% of subjects withdrew from the study (no significant difference between the Tai Chi and exercise groups). These findings are very interesting and if replicated by additional research using objective measures, could add to the CAM treatment options for insomnia.

References

1. Sok, SR; Erlen, JA; Kim, KB. Effects of acupuncture therapy on insomnia. J Adv Nurs. 2003 Nov;44(4):375–384. [PubMed]

11. Li, F; Fisher, KJ; Harmer, P; Irbe, D; Tearse, RG; Weimer, C. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. 2004 Jun;52(6):892–900. [PubMed]