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Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches.

Revue neurologique
October 1, 2023
R de Bergeyck et al. (2 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the potential of morning bright light therapy as a treatment option for insomnia in neurological disorders.

Results Summary

The abstract suggests that morning bright light therapy may be an effective treatment for insomnia in neurological disorders, though it is listed as a secondary option after cognitive behavioral therapy for insomnia (CBT-I). No specific efficacy data or adverse effects are detailed.

Population

Patients with neurological disorders (e.g., neurodegenerative disorders, vascular diseases, inflammatory diseases, epilepsy, migraines) experiencing insomnia.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (12)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Cognitive behavioral therapy for insomnia (CBT-I)
neutral
insomnia management
neurological disorders
-
is the first-line recommendation for insomnia management
#1
Melatonin
decrease
insomnia
-
-
may demonstrate effectiveness in addressing insomnia
#2
Melatonin
decrease
"sundowning" and behavioral disturbances
-
-
has the potential to alleviate
#3
Melatonin
neutral
tolerability
-
-
generally being well-tolerated
#4
morning bright light therapy
neutral
-
-
-
may be of interest
#5
sedative antidepressants
neutral
-
-
-
may be of interest
#6
new orexin dual antagonists
neutral
-
-
-
may be of interest
#7
levodopa
neutral
Parkinson's disease
Parkinson's disease
-
specifically indicated for
#8
Benzodiazepines and z-drugs
decrease
pharmacotolerance and side effects
-
-
can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects
#9
Benzodiazepines and z-drugs
neutral
-
patients with neurological disorders
-
should be avoided
#10
Benzodiazepines and z-drugs
neutral
-
patients over 75 years old
-
not used
#11
Effective treatment
increase
outcomes
-
-
can result in improved outcomes
#12
Abstract

Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.

Medical Subject Headings (MeSH)
HumansAgedSleep Initiation and Maintenance DisordersPrevalenceQuality of LifeSleepHypnotics and Sedatives
Study Links
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality60/10
Citation Metrics
Total Citations14
Citations/Year7.0
Relative Citation Ratio4.10
NIH Percentile90.5%
Research Impact Scores
APT Score0.75
Weight Score2.45
Normalized Score0.60
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