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Current research provides evidence for a comorbid and bidirectional relationship between OSA and depression. Conversely, undiagnosed OSA may be exacerbated by adjunct pharmaceutical drugs that are used to treat depression and insomnia. Benzodiazepines, which are commonly used for treating depression and insomnia, can worsen OSA; they can exacerbate airway obstruction via the lowering of muscle tone , cause respiratory suppression and result in a higher hypercapnic threshold for arousal-ventilatory response during apnoeic episodes.
The present study was not without limitations. Referral bias is significant in the present study, as the patients identified were highly self-selected and agreed to PSG evaluation. Most of the clinical data in the present study was obtained retrospectively from patient medical records. Data obtained via this method is neither comprehensive nor intentional, as compared to data obtained in a prospective study. Future studies reviewing the sleep studies of patients at the SDU should be prospective in design and include a control group.
Chronic insomnia patients who did not undergo PSG could be used as controls, which was not done in the present study. In addition, standardised symptom rating scales and screening questionnaires could have been used to better characterise the patients. In the present study, information on psychological symptoms and assessments of their severity and impact on insomnia symptoms were heterogeneous and lacked standardisation. Unlike physiological and categorical parameters, which are clear-cut, descriptions of psychological and mental states leave room for interpretation, resulting in poorer reliability and the possibility of confounding the clinical picture.
Records for comorbid medical conditions and medications used were of heterogeneous integrity, further confounding the clinical picture. The strategy with which psychiatrists approach patients who present with insomnia may also have differed from that of non-psychiatrist sleep specialists due to different emphases and concerns. This may have influenced clinical management and stage of illness at which patients entered PSG evaluation.
However, in spite of these limitations, the present study provides important lessons that are applicable in clinical practice because it was based on the observations of a real-world practice. To conclude, the management of insomnia remains an interesting challenge for physicians.
Insomnia is often treated symptomatically at the primary care level even though it is a complex medical condition that may have various underlying aetiologies, resulting in its chronicity. A high proportion of chronic insomnia sufferers have underlying psychiatric illnesses that pose as red herrings, leading to delayed or underdiagnosis of primary sleep disorders, which require different treatments from psychiatric illnesses.
In the present study, targeted use of PSG revealed the presence of common sleep disorders, especially OSA, in a significant proportion up to one third of chronic insomnia sufferers. Similar findings were also noted of the insomnia patients with underlying psychiatric conditions.
This finding is a cause for concern, as it suggests that the referring physicians had inadequate knowledge and training in sleep medicine to effectively manage chronic insomnia. Physicians should have a comprehensive understanding of the aetiologies of insomnia and be able to make timely referrals for further investigations or goal-directed specialist interventions. This gap in sleep medicine education should be addressed by the medical education system. To mitigate this, physicians should consider using available CPGs to facilitate the diagnosis and management of sleep disorders.
TOP includes the Insomnia Screening Questionnaire, a item tool that outlines six diagnostic domains, including SDB and other primary sleep disorders. Future local studies examining issues related to insomnia management at the primary care level, as well as the broader perspective of insomnia evaluation at sleep medicine clinics, may help identify gaps in services and education needs.
Nonetheless, these may be viable primary care tools when used in conjunction with good sleep history-taking and examination, and a healthy index of suspicion. National Center for Biotechnology Information , U. Journal List Singapore Med J v. Author information Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Open in a separate window. Good and poor sleepers: Guilleminault C, Lugaresi E, editors. Natural history, epidemiology, and long term evolution.
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Prevalence and persistence of sleep complaints in rural, older community sample: J Am Geriatr Soc. Gislason T, Almqvist M. Somatic diseases and sleep complaints. An epidemiological study of 3, Swedish men. Sleep complaints in community dwelling older persons: An international survey of sleeping problems in the general population. Curr Med Res Opin. Insomnia in the community. Insomnia and its treatment. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Sleep disturbance and psychiatric disorders: American Academy of Sleep Medicine; American Academy of Sleep Medicine.
How do I best manage insomnia and other sleep disorders in older adults with cancer?
International Classification of Sleep Disorders: Diagnostic and Coding Manual. Obstructive sleep apnea in adults: J Clin Sleep Med. Prevalence of insomnia symptoms in patients with sleep-disordered breathing. The Whole Truth About Alcohol. Natural Sleep and its Regulation. Normal at Any Cost. Impaired Health - Its cause and cure.
Insomnia; and Other Disorders of Sleep by Henry M. Lyman - Free Ebook
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