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C.01.01 Importance of a good night's sleep
S705
Satellite symposia
C.OI Sleep well - live well - a fresh look at insomnia IC.01.011Importance of a good night's sleep A. Williams 1 ". 1 Sf Thomas' Hospital, Sleep Disorders Centre Lane Fox Unit, London, United Kingdom
Insomnia symptoms are reported by approximately 30% of the general population, and around lO% suffer from chronic insomnia with daytime consequences, such as fatigue, negative mood and poor concentration. Insomnia is often underdiagnosed and undertreated for various reasons. Long-term insomnia is associated with increased adverse effects on mental and physical health. Since the NIH state-of-thescience conference statement on manifestations and management of chronic insomnia in 2005, the consequences of chronic insomnia have been recognised as a significant public health problem, affecting millions of individuals, along with their families and communities. The high degree of absenteeism, poor productivity, and risk oflong-term sick leave associated with insomnia, makes this disorder a costly one to ignore [1]. Standard treatment protocols focus on insomnia as either primary or secondary to another disorder. Treatment guidelines often recommend that if insomnia is secondary, the course of action should be to treat the primary disorder. However, insomnia is increasingly recognised as being co-morbid with, as opposed to secondary to, many - especially psychiatric - diseases. Accumulating evidence suggests that insomnia may be an independent risk factor for onset or relapse of psychiatric disorders, such as depression and schizophrenia, rather than a symptom. If left untreated, insomnia may also predict response to treatment for the associated condition [2,3]. Increased awareness of the importance of treating insomnia, and therefore better treatment of the disorder, is likely to improve well-being of the individuals, as well as reduce the costly burden to society. References [1] Daley, M., Morin, C.M., LeBlanc, M., et al., 2009 The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep 32, 55-64. [2] Manber, R., Edinger, J.D., Gress, J.L., et al., 2008 Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 31, 489--495. [3] Benson, K.L., 2006 Sleep in schizophrenia: impairments, correlates, and treatment. Psychiatr C1in North Am 29, 1033-1045, abstract ix-x.
IC.01.021 Treating insomnia C. Espie 1 ", 1Southern General Hospital, Sleep Research Laboratory, Glasgow Scotland, United Kingdom Much of the impact of insomnia relates to the degree to which the individual is affected during the daytime. Despite this, treatments have generally been approved based on the extent to which they
improve quantitative sleep parameters, such as total sleep time, night-time awakenings, and sleep-onset latency. Paradoxically, they often adversely affect how the patient feels the next day, by increasing the incidence of drowsiness and inducing a general feeling of hang-over. The serious potential safety concerns associated with traditional hypnotic use are well known, and include addictive potential, cognitive impairment/confusion, and anterograde anmesia. The prevalence of insomnia is highest in the elderly population. Furthermore, the use of sleep medication is also high in this population, making this group particularly vulnerable to the adverse effects associated with traditional insomnia treatments [1]. Traditional hypnotics are also often prescribed for patients with psychiatric disorders, such as depression, schizophrenia and alcoholism, who have comorbid sleep disturbances. Their use in this patient population leads to concerns about safety, especially the potential for abuse. An intriguing question is that given the riskbenefit profile in various subgroups would traditional hypnotics be approved today? Alternative treatments for insomnia include cognitivebehavioural therapy, effective but not readily available to many patients; antihistamines, which have not been studied for insomnia; and alcohol, with its obvious drawbacks. Sleep hygiene is recommended complementary to other therapies, but is rarely effective as a stand-alone treatment. There is no doubt that there is a clear need for new treatments in insomnia. References [1] Glass, J., Lanctot, K.L., Herrman, N., et al., 2005 Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 331,1169-1175. [2] Sivertsen, R, Omvik, S., Pallesen, S., et al., 2006 Cognitive behavioral therapy vs zopic1one for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 295, 2851-2858. [3] Morin, C.M., Bootzin, R.R., Buysse, D.J., et al., 2006 Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep 29, 1398-1414.
IC.01.031 Melatonin agonism in the treatment of sleep-wake disturbances
L. Leissner 1 ", Sweden
1 University
of Orebro, Neurology Clinic, Orebro,
Circadian rhythms are the predictable 24-hour, monthly, or seasonal variations that occur in many aspects of the human body, such as hormone expression and behaviour. Melatonin, an endogenous hormone secreted nocturnally from the pineal gland, plays a key role in the proper functioning of the circadian timing system. This timing system appears to be malfunctioning in many people with insomnia, and also in people with psychiatric disorders such as Alzheimer's disease ('sundowning'), seasonal affective disorder, Parkinson's disease and schizophrenia, where it manifests as comorbid insomnia. The strategy underlying the development of a melatonin receptor agonist for the treatment of insomnia was to produce an agent
Satellite symposia
C.OI Sleep well - live well - a fresh look at insomnia IC.01.011Importance of a good night's sleep A. Williams 1 ". 1 Sf Thomas' Hospital, Sleep Disorders Centre Lane Fox Unit, London, United Kingdom
Insomnia symptoms are reported by approximately 30% of the general population, and around lO% suffer from chronic insomnia with daytime consequences, such as fatigue, negative mood and poor concentration. Insomnia is often underdiagnosed and undertreated for various reasons. Long-term insomnia is associated with increased adverse effects on mental and physical health. Since the NIH state-of-thescience conference statement on manifestations and management of chronic insomnia in 2005, the consequences of chronic insomnia have been recognised as a significant public health problem, affecting millions of individuals, along with their families and communities. The high degree of absenteeism, poor productivity, and risk oflong-term sick leave associated with insomnia, makes this disorder a costly one to ignore [1]. Standard treatment protocols focus on insomnia as either primary or secondary to another disorder. Treatment guidelines often recommend that if insomnia is secondary, the course of action should be to treat the primary disorder. However, insomnia is increasingly recognised as being co-morbid with, as opposed to secondary to, many - especially psychiatric - diseases. Accumulating evidence suggests that insomnia may be an independent risk factor for onset or relapse of psychiatric disorders, such as depression and schizophrenia, rather than a symptom. If left untreated, insomnia may also predict response to treatment for the associated condition [2,3]. Increased awareness of the importance of treating insomnia, and therefore better treatment of the disorder, is likely to improve well-being of the individuals, as well as reduce the costly burden to society. References [1] Daley, M., Morin, C.M., LeBlanc, M., et al., 2009 The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep 32, 55-64. [2] Manber, R., Edinger, J.D., Gress, J.L., et al., 2008 Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 31, 489--495. [3] Benson, K.L., 2006 Sleep in schizophrenia: impairments, correlates, and treatment. Psychiatr C1in North Am 29, 1033-1045, abstract ix-x.
IC.01.021 Treating insomnia C. Espie 1 ", 1Southern General Hospital, Sleep Research Laboratory, Glasgow Scotland, United Kingdom Much of the impact of insomnia relates to the degree to which the individual is affected during the daytime. Despite this, treatments have generally been approved based on the extent to which they
improve quantitative sleep parameters, such as total sleep time, night-time awakenings, and sleep-onset latency. Paradoxically, they often adversely affect how the patient feels the next day, by increasing the incidence of drowsiness and inducing a general feeling of hang-over. The serious potential safety concerns associated with traditional hypnotic use are well known, and include addictive potential, cognitive impairment/confusion, and anterograde anmesia. The prevalence of insomnia is highest in the elderly population. Furthermore, the use of sleep medication is also high in this population, making this group particularly vulnerable to the adverse effects associated with traditional insomnia treatments [1]. Traditional hypnotics are also often prescribed for patients with psychiatric disorders, such as depression, schizophrenia and alcoholism, who have comorbid sleep disturbances. Their use in this patient population leads to concerns about safety, especially the potential for abuse. An intriguing question is that given the riskbenefit profile in various subgroups would traditional hypnotics be approved today? Alternative treatments for insomnia include cognitivebehavioural therapy, effective but not readily available to many patients; antihistamines, which have not been studied for insomnia; and alcohol, with its obvious drawbacks. Sleep hygiene is recommended complementary to other therapies, but is rarely effective as a stand-alone treatment. There is no doubt that there is a clear need for new treatments in insomnia. References [1] Glass, J., Lanctot, K.L., Herrman, N., et al., 2005 Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 331,1169-1175. [2] Sivertsen, R, Omvik, S., Pallesen, S., et al., 2006 Cognitive behavioral therapy vs zopic1one for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 295, 2851-2858. [3] Morin, C.M., Bootzin, R.R., Buysse, D.J., et al., 2006 Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep 29, 1398-1414.
IC.01.031 Melatonin agonism in the treatment of sleep-wake disturbances
L. Leissner 1 ", Sweden
1 University
of Orebro, Neurology Clinic, Orebro,
Circadian rhythms are the predictable 24-hour, monthly, or seasonal variations that occur in many aspects of the human body, such as hormone expression and behaviour. Melatonin, an endogenous hormone secreted nocturnally from the pineal gland, plays a key role in the proper functioning of the circadian timing system. This timing system appears to be malfunctioning in many people with insomnia, and also in people with psychiatric disorders such as Alzheimer's disease ('sundowning'), seasonal affective disorder, Parkinson's disease and schizophrenia, where it manifests as comorbid insomnia. The strategy underlying the development of a melatonin receptor agonist for the treatment of insomnia was to produce an agent