Beyond One-Size-Fits-All: Testing Insomnia Treatments in Special Populations

Editorials16 January 2024Beyond One-Size-Fits-All: Testing Insomnia Treatments in Special PopulationsRonald B. Postuma, MD, MScRonald B. Postuma, MD, MScMontreal Neurological Institute and Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, CanadaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-3448 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Insomnia is commonly conceived of as a single entity, but in fact it is markedly heterogeneous. The most common cause of chronic insomnia in the general population is psychophysiological insomnia; a temporary event disrupts sleep, which then sets off a chronic maladaptive sleep pattern. However, many other medical conditions can be implicated. The most prominent causes include neurologic conditions that directly affect sleep control centers, such as Parkinson or Alzheimer disease; cardiovascular conditions linked to orthopnea or apnea; mental health conditions; restless legs syndrome (RLS); or any condition causing nocturnal pain. With such diverse causes, one should never assume that ...References1. Mehrotra R, Cukor D, McCurry SM, et al. Effectiveness of existing insomnia therapies for patients undergoing hemodialysis. A randomized clinical trial. Ann Intern Med. 16 January 2024. [Epub ahead of print]. doi:10.7326/M23-1794 LinkGoogle Scholar2. van der Zweerde T, Bisdounis L, Kyle SD, et al. Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Med Rev. 2019;48:101208. [PMID: 31491656] doi:10.1016/j.smrv.2019.08.002 CrossrefMedlineGoogle Scholar3. Sharafkhaneh A, Salari N, Khazaie S, et al. Telemedicine and insomnia: a comprehensive systematic review and meta-analysis. Sleep Med. 2022;90:117-130. [PMID: 35151065] doi:10.1016/j.sleep.2022.01.016 CrossrefMedlineGoogle Scholar4. Scharf M, Rogowski R, Hull S, et al. Efficacy and safety of doxepin 1 mg, 3 mg, and 6 mg in elderly patients with primary insomnia: a randomized, double-blind, placebo-controlled crossover study. J Clin Psychiatry. 2008;69:1557-1564. [PMID: 19192438] doi:10.4088/jcp.v69n1005 CrossrefMedlineGoogle Scholar5. Everitt H, Baldwin DS, Stuart B, et al. Antidepressants for insomnia in adults. Cochrane Database Syst Rev. 2018;5:CD010753. MedlineGoogle Scholar6. Camargos EF, Louzada LL, Quintas JL, et al. Trazodone improves sleep parameters in Alzheimer disease patients: a randomized, double-blind, and placebo-controlled study. Am J Geriatr Psychiatry. 2014;22:1565-1574. [PMID: 24495406] doi:10.1016/j.jagp.2013.12.174 CrossrefMedlineGoogle Scholar7. Shareh H, Hasheminik M, Jamalinik M. Cognitive behavioural group therapy for insomnia (CBGT-I) in patients undergoing haemodialysis: a randomized clinical trial. Behav Cogn Psychother. 2022;50:559-574. [PMID: 36111518] doi:10.1017/S1352465822000364 CrossrefMedlineGoogle Scholar8. Chen HY, Chiang CK, Wang HH, et al. Cognitive-behavioral therapy for sleep disturbance in patients undergoing peritoneal dialysis: a pilot randomized controlled trial. Am J Kidney Dis. 2008;52:314-323. [PMID: 18511165] doi:10.1053/j.ajkd.2008.03.012 CrossrefMedlineGoogle Scholar9. Kolla BP, Mansukhani MP, Bostwick JM. The influence of antidepressants on restless legs syndrome and periodic limb movements: a systematic review. Sleep Med Rev. 2018;38:131-140. [PMID: 28822709] doi:10.1016/j.smrv.2017.06.002 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Ronald B. Postuma, MD, MScAffiliations: Montreal Neurological Institute and Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, CanadaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3448.Corresponding Author: Ronald B. Postuma, MD, MSc, Montreal Neurological Institute, 3801 University Avenue, Room NW107, Montreal, QC H3A 2B4, Canada; e-mail, ron.postuma@mcgill.ca.This article was published at Annals.org on 16 January 2024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis Rajnish Mehrotra , Daniel Cukor , Susan M. McCurry , Tessa Rue , Maria-Eleni Roumelioti , Patrick J. Heagerty , and Mark Unruh Metrics Latest Keywords Hemodialysis Insomnia Sleep ePublished: 16 January 2024 Copyright & PermissionsCopyright © 2024 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...