REVIEW – July – August 2008

Possibilities for treatment of insomnia


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Insomina is a symptom of sleeping disorder characterized by persistent difficulty with falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake.
The total duration of sleep and the duration of deep NREM sleep are normally shortened after the age 55 years. These changes that are a part of normal ageing are not associated with day-time tiredness.
Insomnia requires treatment when poor quality or short-term sleep is associated with tiredness, irritability and impaired day-time function. Incorrect living and sleeping habits, difficulties in life, physical diseases and their symptoms, states of depression, undesirable effects of medicines, restless legs, periodic limb movement disorder as well as sleep apnoea are common causes of insomnia. Light, social functions, exercise and sufficient intake of food in the daytime,  peaceful action for a couple of hours before going to bed, noise-free bedroom as well as a bed that suits the body promote a good night’s sleep.
In cases when correction of life-style is not effective, short-time medication is recommended. Benzodiazepine derivatives or drugs acting like these are the most commonly used class of hypnotics prescribed for insomnia. These medications can develop tolerance and dependence especially after consistent usage over a long period of time and may be recommended for short-term treatment of severe functional insomnia. Prolonged action melatonin has recently been approved for treatment of primary insomnia in patients over the age of 55. The adverse effects of melatonin are practically nonexistent and this medication improves the quality of sleep in a relatively large number of persons suffering from primary insomnia.