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Chapter 60. Treatment of Insomnia

Martin Reite, M.D.
DOI: 10.1176/appi.books.9781585623860.442061

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Excerpt

Our conceptualization of insomnia has undergone a dramatic shift during the past few years, from an annoying but not particularly serious symptom to the recognition that 1) sleep loss from any cause has serious consequences, 2) chronic insomnia and the impaired sleep it represents are highly comorbid with (or indeed may cause) many other medical and psychiatric disorders, and 3) chronic insomnia in some cases may represent a separate medical disorder in itself, with an independent neurobiological basis. It has been suggested that certain chronic insomnias be considered on a par with depression as a serious disorder with a tendency toward chronicity whose treatment needs independent assessment and possibly long-term management (Jindal et al. 2004). This increase in complexity is in part offset by improved treatment options, both pharmacological and nonpharmacological. This chapter will review these areas in what we hope is a clinically useful manner.

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FIGURE 60–1. Differential diagnosis decision tree for chronic insomnia.Note. SMSS = sleep state misperception syndrome.
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TABLE 60–1. Characteristics of non-REM and REM sleep
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TABLE 60–2. Medical conditions commonly associated with impaired sleep
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TABLE 60–3. Commonly used drugs with insomnia as a side effect
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TABLE 60–4. Overview of the effects of antidepressants on sleep
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TABLE 60–5. DSM-IV-TR diagnostic criteria for primary insomnia
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TABLE 60–6. Sleep hygiene
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TABLE 60–7. Benzodiazepine agents for treatment of insomnia
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TABLE 60–8. Nonbenzodiazepine agents for treatment of insomnia

References

American Academy of Sleep Medicine: The International Classification of Sleep Disorders, 2nd Edition. Rochester, MN, Johnson Printing, 2005
 
American Academy of Sleep Medicine: The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specification. Westchester, IL, American Academy of Sleep Medicine, March 2007
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Ancoli-Israel S, Poceta JS, Stepnowsky C, et al: Identification and treatment of sleep problems in the elderly. Sleep Med Rev 1:3–17, 1997
[PubMed]
 
Ancoli-Israel S, Roth T: Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey, I. Sleep 22 (suppl 2):S347–S353, 1999
 
Ancoli-Israel S, Ayalon L: Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry 14:95–103, 2006
[PubMed]
 
Anttila SA, Leinonen EV: A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev 7:249–264, 2001
[PubMed]
 
Armitage R, Landis C, Hoffmann R, et al: The impact of a 4-hour sleep delay on slow wave activity in twins discordant for chronic fatigue syndrome. Sleep 30:657–662, 2007
[PubMed]
 
Attarian HP, Duntley S, Brown KM: Reverse sleep state misperception. Sleep Med 5:269–272, 2004
[PubMed]
 
Avidan AY, Fries BE, James ML: Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes. J Am Geriatr Soc 53:955–962, 2005
[PubMed]
 
Backhaus J, Junghanns K, Born J, et al: Impaired declarative memory consolidation during sleep in patients with primary insomnia: influence of sleep architecture and nocturnal cortisol release. Biol Psychiatry 60:1324–1330, 2006
[PubMed]
 
Bain KT: Management of chronic insomnia in elderly persons. Am J Geriatr Pharmacother 4:168–192, 2006
[PubMed]
 
Basheer R, Strecker RE, Thakkar MM, et al: Adenosine and sleep-wake regulation. Prog Neurobiol 73:379–396, 2004
[PubMed]
 
Beaumont M, Batejat D, Pierard C, et al: Zaleplon and zolpidem objectively alleviate sleep disturbances in mountaineers at a 3,613 meter altitude. Sleep 30:1527–1533, 2007
[PubMed]
 
Boeve BF, Silber MH, Ferman TJ, et al: REM sleep behavior disorder and degenerative dementia: an association likely reflecting Lewy body disease. Neurology 51:363–370, 1998
[PubMed]
 
Bonnet MH, Arand DL: Physiological activation in patients with sleep state misperception. Psychosom Med 59:533–540, 1997
[PubMed]
 
Brisbare-Roch C, Dingemanse J, Koberstein R, et al: Promotion of sleep by targeting the orexin system in rats, dogs and humans. Nat Med 13:150–155, 2007
[PubMed]
 
Brzezinski A: Melatonin in humans. N Engl J Med 336:186–195, 1997
[PubMed]
 
Campbell SS, Terman M, Lewy AJ, et al: Light treatment for sleep disorders: consensus report, V: age-related disturbances. J Biol Rhythms 10:151–154, 1995
[PubMed]
 
Cardinali DP, Furio AM, Reyes MP, et al: The use of chronobiotics in the resynchronization of the sleep-wake cycle. Cancer Causes Control 17:601–609, 2006
[PubMed]
 
Chaput JP, Despres JP, Bouchard C, et al: The association between sleep duration and weight gain in adults: a 6-year prospective study from the Quebec Family Study. Sleep 31:517–523, 2008
[PubMed]
 
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 22:1128–1133, 1999
[PubMed]
 
Clemens Z, Fabo D, Halasz P: Overnight verbal memory retention correlates with the number of sleep spindles. Neuroscience 132:529–535, 2005
[PubMed]
 
Connor JR, Boyer PJ, Menzies SL, et al: Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology 61:304–309, 2003
[PubMed]
 
Cortoos A, Verstraeten E, Cluydts R: Neurophysiological aspects of primary insomnia: implications for its treatment. Sleep Med Rev 10:255–266, 2006
[PubMed]
 
Czeisler CA, Allan JS, Strogatz SH, et al: Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle. Science 233:667, 1986
[PubMed]
 
Czeisler CA, Duffy JF, Shanahan TL, et al: Stability, precision, and near-24-hour period of the human circadian pacemaker. Science 284:2177–2181, 1999
[PubMed]
 
Dahlitz M, Alvarez B, Vignau J, et al: Delayed sleep phase syndrome response to melatonin. Lancet 337:1121–1124, 1991
[PubMed]
 
Davis JL, Wright DC: Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults. J Trauma Stress 20:123–133, 2007
[PubMed]
 
Dawson D, Reid K: Fatigue, alcohol and performance impairment. Nature 388:235, 1997
[PubMed]
 
Deacon S, Staner L, Staner C, et al: Effect of short-term treatment with gaboxadol on sleep maintenance and initiation in patients with primary insomnia. Sleep 30:281–287, 2007
[PubMed]
 
Deviva JC, Zayfert C, Pigeon WR, et al: Treatment of residual insomnia after CBT for PTSD: case studies. J Trauma Stress 18:155–159, 2005
[PubMed]
 
Driver HS, Taylor SR: Exercise and sleep. Sleep Med Rev 4:387–402, 2000
[PubMed]
 
Duffy JF, Zeitzer JM, Czeisler CA: Decreased sensitivity to phase-delaying effects of moderate intensity light in older subjects. Neurobiol Aging 28:799–807, 2007
[PubMed]
 
Edinger JD, Krystal AD: Subtyping primary insomnia: is sleep state misperception a distinct clinical entity? Sleep Med Rev 7:203–214, 2003
[PubMed]
 
Edinger JD, Sampson WS: A primary care "friendly" cognitive behavioral insomnia therapy. Sleep 26:177–182, 2003
[PubMed]
 
Edinger JD, Wohlgemuth WK, Krystal AD, et al: Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med 165:2527–2535, 2005
[PubMed]
 
Erman MK: Therapeutic options in the treatment of insomnia. J Clin Psychiatry 66:18–23, 2005
[PubMed]
 
Erman M, Guiraud A, Joish VN, et al: Zolpidem extended-release 12.5 mg associated with improvements in work performance in a 6-month randomized, placebo-controlled trial. Sleep 31:1371–1378, 2008
[PubMed]
 
Ferman TJ, Boeve BF, Smith GE, et al: REM sleep behavior disorder and dementia: cognitive differences when compared with AD. Neurology 52:951–957, 1999
[PubMed]
 
Foley DJ, Monjan AA, Brown SL, et al: Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 18:425–432, 1995
[PubMed]
 
Franklin KA, Eriksson P, Sahlin C, et al: Reversal of central sleep apnea with oxygen. Chest 111:163–169, 1997
[PubMed]
 
Gangwisch JE, Heymsfield SB, Boden-Albala B, et al: Sleep duration as a risk factor for diabetes incidence in a large US sample. Sleep 30:1667–1673, 2007
[PubMed]
 
Gooneratne NS, Gehrman PR, Nkwuo JE, et al: Consequences of comorbid insomnia symptoms and sleep-related breathing disorder in elderly subjects. Arch Intern Med 166:1732–1738, 2006
[PubMed]
 
Granton JT, Naughton MT, Benard DC, et al: CPAP improves inspiratory muscle strength in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 153:277–282, 1996
[PubMed]
 
Guilleminault C, Poyares D, Rosa A, et al: Chronic fatigue, unrefreshing sleep and nocturnal polysomnography. Sleep Med 7:513–520, 2006
[PubMed]
 
Haimov I, Lavie P, Laudon M, et al: Melatonin replacement therapy of elderly insomniacs. Sleep 18:598–603, 1995
[PubMed]
 
Hamet P, Tremblay J: Genetics of the sleep-wake cycle and its disorders. Metabolism 55:S7–S12, 2006
 
Happe S, Sauter C, Klosch G, et al: Gabapentin versus ropinirole in the treatment of idiopathic restless legs syndrome. Neuropsychobiology 48:82–86, 2003
[PubMed]
 
Hauri PJ, Percy L, Hellekson C, et al: The treatment of psychophysiologic insomnia with biofeedback: a replication study. Biofeedback Self Regul 7:223–235, 1982
[PubMed]
 
Heath AC, Kendler KS, Eaves LJ, et al: Evidence for genetic influences on sleep disturbance and sleep pattern in twins. Sleep 13:318–335, 1990
[PubMed]
 
Hening WA: Current guidelines and standards of practice for restless legs syndrome. Am J Med 120:S22–S27, 2007
 
Hofman MA, Swaab DF: The sexually dimorphic nucleus of the preoptic area in the human brain: a comparative morphometric study. J Anat 164:55–72, 1989
[PubMed]
 
Hogl B: Periodic limb movements are associated with disturbed sleep. J Clin Sleep Med 3:12–14, 2007
[PubMed]
 
Huber R, Ghilardi MF, Massimini M, et al: Local sleep and learning. Nature 430:78–81, 2004
[PubMed]
 
Israel AG, Kramer JA: Safety of zaleplon in the treatment of insomnia. Ann Pharmacother 36:852–859, 2002
[PubMed]
 
Jindal RD, Buysse DJ, Thase ME: Maintenance treatment of insomnia: what can we learn from the depression literature? Am J Psychiatry 161:19–24, 2004
[PubMed]
 
Krystal A: Treating the health, quality of life, and functional impairments in insomnia. J Clin Sleep Med 3:63–72, 2007
[PubMed]
 
Krystal AD, Erman M, Zammit GK, et al: Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep 31:79–90, 2008
[PubMed]
 
Kubitz KA, Landers DM, Petruzzello SJ, et al: The effects of acute and chronic exercise on sleep: a meta-analytic review. Sports Med 21:277–291, 1996
[PubMed]
 
Kuzniar TJ, Silber MH: Multiple skeletal injuries resulting from uncontrolled restless legs syndrome. J Clin Sleep Med 3:60–61, 2007
[PubMed]
 
Lamberg L: Melatonin potentially useful but safety, efficacy remain uncertain. JAMA 276:1011–1014, 1996
[PubMed]
 
Lange T, Perras B, Fehm HL, et al: Sleep enhances the human antibody response to hepatitis A vaccination. Psychosom Med 65:831–835, 2003
[PubMed]
 
Lankford DA, Corser BC, Zheng YP, et al: Effect of gaboxadol on sleep in adult and elderly patients with primary insomnia: results from two randomized, placebo-controlled, 30-night polysomnography studies. Sleep 31:1359–1370, 2008
[PubMed]
 
Lapierre O, Dumont M: Melatonin treatment of a non-24-hour sleep-wake cycle in a blind retarded child. Biol Psychiatry 38:119–122, 1995
[PubMed]
 
Lewy AJ, Emens J, Jackman A, et al: Circadian uses of melatonin in humans. Chronobiol Int 23:403–412, 2006
[PubMed]
 
Littner M, Kushida CA, Anderson WM, et al: Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Sleep 26:337–341, 2003
[PubMed]
 
Liu RY, Zhou JN, vanHeerikhuize J, et al: Decreased melatonin levels in postmortem cerebral spinal fluid in relation to aging, Alzheimer's disease, and apolipoprotein E-episilon4/4 genotype. J Clin Endocrinol Metab 84:323–327, 1999
[PubMed]
 
Lockley SW, Evans EE, Scheer FA, et al: Short-wavelength sensitivity for the direct effects of light on alertness, vigilance, and the waking electroencephalogram in humans. Sleep 29:161–168, 2006
[PubMed]
 
Lu J, Sherman D, Devor M, et al: A putative flip-flop switch for control of REM sleep. Nature 441:589–594, 2006
[PubMed]
 
Lydiard RB, Lankford DA, Seiden DJ, et al: Efficacy and tolerability of modified-release indiplon in elderly patients with chronic insomnia: results of a 2-week double-blind, placebo-controlled trial. J Clin Sleep Med 2:309–315, 2006
[PubMed]
 
Mahowald MW: Periodic limb movements are NOT associated with disturbed sleep: con. J Clin Sleep Med 3:15–17, 2007
[PubMed]
 
McCurry SM, Logsdon RG, Vitiello MV, et al: Treatment of sleep and nighttime disturbances in Alzheimer's disease: a behavior management approach. Sleep Med 5:373–377, 2004
[PubMed]
 
McKeith IG: Clinical Lewy body syndromes. Ann N Y Acad Sci 920:1–8, 2000
[PubMed]
 
Meier-Ewert HK, Ridker PM, Rifai N, et al: Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 43:678–683, 2004
[PubMed]
 
Mellman TA, Nolan B, Hebding J, et al: A polysomnographic comparison of veterans with combat-related PTSD, depressed men, and non-ill controls. Sleep 20:46–51, 1997
[PubMed]
 
Mendelson WB, Jain B: An assessment of short-acting hypnotics. Drug Saf 13:257–270, 1995
[PubMed]
 
Merica H, Blois R, Gaillard JM: Spectral characteristics of sleep EEG in chronic insomnia. Eur J Neurosci 10:1826–1834, 1998
[PubMed]
 
Monti JM, Attali P, Monti D, et al: Zolpidem and rebound insomnia—a double-blind, controlled polysomnographic study in chronic insomniac patients. Pharmacopsychiatry 27:166–175, 1994
[PubMed]
 
Morin CM: Cognitive-behavioral approaches to the treatment of insomnia. J Clin Psychiatry 65:33–40, 2004
[PubMed]
 
Najib J: Eszopiclone, a nonbenzodiazepine sedative-hypnotic agent for the treatment of transient and chronic insomnia. Clin Ther 28:491–516, 2006
[PubMed]
 
Nardone R, Ausserer H, Bratti A, et al: Cabergoline reverses cortical hyperexcitability in patients with restless legs syndrome. Acta Neurol Scand 114:244–249, 2006
[PubMed]
 
Neckelmann D, Mykletun A, Dahl AA: Chronic insomnia as a risk factor for developing anxiety and depression. Sleep 30:873–880, 2007
[PubMed]
 
Nofzinger EA, Buysse DJ, Germain A, et al: Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161:2126–2128, 2004
[PubMed]
 
Novak M, Mucsi I, Shapiro CM, et al: Increased utilization of health services by insomniacs—an epidemiological perspective. J Psychosom Res 56:527–536, 2004
[PubMed]
 
O'Keeffe ST: Iron deficiency with normal ferritin levels in restless legs syndrome. Sleep Med 6:281–282, 2005
[PubMed]
 
Owen RT: Extended-release zolpidem: efficacy and tolerability profile. Drugs Today (Barc) 42:721–727, 2006a
 
Owen RT: Ramelteon: profile of a new sleep-promoting medication. Drugs Today (Barc) 42:255–263, 2006b
 
Ozaki N, Iwata T, Itoh A, et al: Body temperature monitoring in subjects with delayed sleep phase syndrome. Neuropsychobiology 20:174–177, 1988
[PubMed]
 
Pallier PN, Maywood ES, Zheng Z, et al: Pharmacological imposition of sleep slows cognitive decline and reverses dysregulation of circadian gene expression in a transgenic mouse model of Huntington's disease. J Neurosci 27:7869–7878, 2007
[PubMed]
 
Pandi-Perumal SR, Srinivasan V, Poeggeler B, et al: Drug Insight: the use of melatonergic agonists for the treatment of insomnia-focus on ramelteon. Nat Clin Pract Neurol 3:221–228, 2007
[PubMed]
 
Pasternak RE, Reynolds CF III, Schlernitzauer M, et al: Acute open-trial nortriptyline therapy of bereavement-related depression in late life. J Clin Psychiatry 52:307–310, 1991
[PubMed]
 
Perlis ML, Kehr EL, Smith MT, et al: Temporal and stagewise distribution of high frequency EEG activity in patients with primary and secondary insomnia and in good sleeper controls. J Sleep Res 10:93–104, 2001a
 
Perlis ML, Smith MT, Andrews PJ, et al: Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep 24:110–117, 2001b
 
Perlis ML, Jungquist C, Smith MT, et al: Cognitive Behavioral Treatment o Insomnia: A Session by Session Guide. New York, Springer, 2005
 
Rechtschaffen A, Kales A: A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects (NIH publication no. 204). Washington, DC. U.S. Government Printing Office, 1968
 
Regestein QR, Pavlova M: Treatment of delayed sleep phase syndrome. Gen Hosp Psychiatry 17:335–345, 1995
[PubMed]
 
Richardson GS: Managing insomnia in the primary care setting: raising the issues. Sleep 23 (suppl 1):S9–S12, 2000
 
Richardson GS, Malin HV: Circadian rhythm sleep disorders: pathophysiology and treatment. J Clin Neurophysiol 13:17–31, 1996
[PubMed]
 
Riemann D, Voderholzer U, Spiegelhalder K, et al: Chronic insomnia and MRI-measured hippocampal volumes: a pilot study. Sleep 30:955–958, 2007
[PubMed]
 
Roane BM, Taylor DJ: Adolescent insomnia as a risk factor for early adult depression and substance abuse. Sleep 31:1351–1356, 2008
[PubMed]
 
Rosenfeld DS, Furman Y: Pure sleep panic: two case reports and a review of the literature. Sleep 17:462–465, 1994
[PubMed]
 
Rosenthal NE, Joseph-Vanderpool JR, Levendosky AA, et al: Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome. Sleep 13:354–361, 1990
[PubMed]
 
Ross RJ, Ball WA, Dinges DF, et al: Motor dysfunction during sleep in posttraumatic stress disorder. Sleep 17:723–732, 1994
[PubMed]
 
Roth T, Rogowski R, Hull S, et al: Efficacy and safety of doxepin 1 mg, 3 mg, and 6 mg in adults with primary insomnia. Sleep 30:1555–1561, 2007a
 
Roth T, Seiden D, Wang-Weigand S, et al: A 2-night, 3-period, crossover study of ramelteon's efficacy and safety in older adults with chronic insomnia. Curr Med Res Opin 23:1005–1014, 2007b
 
Rybarczyk B, Stepanski E, Fogg L, et al: A placebo-controlled test of cognitive-behavioral therapy for comorbid insomnia in older adults. J Consult Clin Psychol 73:1164–1174, 2005
[PubMed]
 
Saiz-Ruiz J, Cebollada A, Ibanez A: Sleep disorders in bipolar depression: hypnotics vs sedative antidepressants. J Psychosom Res 38:55–60, 1994
[PubMed]
 
Saper CB, Scammell TE, Lu J: Hypothalamic regulation of sleep and circadian rhythms. Nature 437:1257–1263, 2005
[PubMed]
 
Savard J, Laroche L, Simard S, et al: Chronic insomnia and immune functioning. Psychosom Med 65:211–221, 2003
[PubMed]
 
Schabus M, Gruber G, Parapatics S, et al: Sleep spindles and their significance for declarative memory consolidation. Sleep 27:1479–1485, 2004
[PubMed]
 
Schaller JL, Behar D: Modafinil in fibromyalgia treatment. J Neuropsychiatry Clin Neurosci 13:530–531, 2001
[PubMed]
 
Scharf MB, Roth T, Vogel GW, et al: A multicenter, placebo-controlled study evaluating zolpidem in the treatment of chronic insomnia. J Clin Psychiatry 55:192–199, 1994
[PubMed]
 
Scharf MB, Baumann M, Berkowitz DV: The effects of sodium oxybate on clinical symptoms and sleep patterns in patients with fibromyalgia. J Rheumatol 30:1070–1074, 2003
[PubMed]
 
Schenck CH, Mahowald MW: Rapid eye movement sleep parasomnias. Neurol Clin 23:1107–1126, 2005
[PubMed]
 
Schwartz JR, Roth T: Shift work sleep disorder: burden of illness and approaches to management. Drugs 66:2357–2370, 2006
[PubMed]
 
Shibui K, Uchiyama M, Okawa M: Melatonin rhythms in delayed sleep phase syndrome. J Biol Rhythms 14:72–76, 1999
[PubMed]
 
Sivertsen B, Nordhus IH: Management of insomnia in older adults. Br J Psychiatry 190:285–286, 2007
[PubMed]
 
Smith MT, Perlis ML, Park A, et al: Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 159:5–11, 2002
[PubMed]
 
Smith MT, Perlis ML: Who is a candidate for cognitive-behavioral therapy for insomnia? Health Psychol 25:15–19, 2006
[PubMed]
 
Spiegel K, Tasali E, Penev P, et al: Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 141:846–850, 2004
[PubMed]
 
Spiegel K, Knutson K, Leproult R, et al: Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol 99:2008–2019, 2005
[PubMed]
 
Spielman AJ, Saskin P, Thorpy MJ: Treatment of chronic insomnia by restriction of time in bed. Sleep 10:45–56, 1987
[PubMed]
 
Sugerman JL, Stern JA, Walsh JK: Daytime alertness in subjective and objective insomnia: some preliminary findings. Biol Psychiatry 20:741–750, 1985
[PubMed]
 
Szeinberg A, Borodkin K, Dagan Y: Melatonin treatment in adolescents with delayed sleep phase syndrome. Clin Pediatr 45:809–818, 2006
[PubMed]
 
Thalhofer S, Dorow P: Central sleep apnea. Respiration 64:2–9, 1997
[PubMed]
 
VanHoof E, DeBecker P, Lapp C, et al: Defining the occurrence of alpha-delta sleep in chronic fatigue syndrome. Am J Med Sci 333:78–84, 2007
 
van Liempt S, Vermetten E, Geuze E, et al: Pharmacotherapy for disordered sleep in post-traumatic stress disorder: a systematic review. Int Clin Psychopharmacol 21:193–202, 2006
 
Wafford KA, Ebert B: Gaboxadol—a new awakening in sleep. Curr Opin Pharmacol 6:30–36, 2006
[PubMed]
 
Walker MP, Stickgold R: Sleep, memory, and plasticity. Annu Rev Psychol 57:139–166, 2006
[PubMed]
 
Walsh JK, Perlis M, Rosenthal M, et al: Tiagabine increases slow-wave sleep in a dose-dependent fashion without affecting traditional efficacy measures in adults with primary insomnia. J Clin Sleep Med 2:35–41, 2006
[PubMed]
 
Walsh JK, Deacon S, Dijk DJ, et al: The selective extrasynaptic GABAA agonist, gaboxadol, improves traditional hypnotic efficacy measures and enhances slow wave activity in a model of transient insomnia. Sleep 30:593–602, 2007a
 
Walsh JK, Krystal AD, Amato DA, et al: Nightly treatment of primary insomnia with eszopiclone for six months: effect on sleep, quality of life, and work limitations. Sleep 30:959–968, 2007b
 
Ware JC, Walsh JK, Scharf MB, et al: Minimal rebound insomnia after treatment with 10-mg zolpidem. Clin Neuropharmacol 20:116–125, 2007
 
Winkelmann J, Polo O, Provini F, et al: Genetics of restless legs syndrome (RLS): state-of-the-art and future directions. Mov Disord 22 (suppl 18):S449–S458, 2007
 
Wolk R, Somers VK: Sleep and the metabolic syndrome. Exp Physiol 92:67–78, 2007
[PubMed]
 
Yaggi HK, Araujo AB, McKinlay JB: Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care 29:657–661, 2006
[PubMed]
 
Yaron M, Lindgren K, Halbower AC, et al: Sleep disturbance after rapid ascent to moderate altitude among infants and preverbal young children. High Alt Med Biol 5:314–320, 2004
[PubMed]
 
Zammit GK, Corser B, Doghramji K, et al: Sleep and residual sedation after administration of zaleplon, zolpidem, and placebo during experimental middle-of-the-night awakening. J Clin Sleep Med 2:417–423, 2006
[PubMed]
 
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