INSOMNIA WATCH

How Negative Emotions Affect Sleep Quality

If individuals have ever been under stress and had difficulty sleeping, they understand firsthand how anxiety and negative emotions might interfere with healthy sleep patterns. Recently, Swedish scientists assessed the interplay between emotional state, views on sleep, and insomnia, and they discovered a connection between these factors.

As reported in Behaviour Research and Therapy (June 2006), persistent insomnia was significantly related to patients' anxiety, depression, and arousal, as well as their beliefs in the long-term negative consequences of insomnia. Of the almost 2000 patients evaluated through surveys, 91% of those who complained of lasting insomnia also had high scores on measures of dysfunctional sleep beliefs, anxiety, depression, and anxiety-associated arousal. Using statistical analyses, the researchers ranked "beliefs in the long-term negative consequences of insomnia" as the most prominent factor behind the continued insomnia. Anxiety-associated arousal, depression, and anxiety, in that order, were the next most important factors.

The authors believe that the results of this study support the findings of other research indicating that insomnia is a complex condition. Several psychological and behavioral mechanisms appear to play important, interacting roles in the development and persistence of poor sleep.

Temazepam Is Effective Sleep Aid

Temazepam is an effective benzodiazepine sleep aid, even when given at low, once-daily doses such as 7.5 and 15 mg. Recent studies, however, have not specifically addressed the beneficial effects of these doses on sleep maintenance toward the end of the sleep period.

In Current Medical Research and Opinion (February 2005), the researchers compared the effect of temazepam 7.5 mg and 15 mg on sleep maintenance and architecture in patients with transient insomnia. In this post hoc analysis of data from a double-blind, randomized, parallel-group, multicenter study, both doses were well-tolerated: no (0/65) patients on temazepam 7.5 mg and only 3 of 66 on temazepam 15 mg reported adverse events.

No significant difference was noted in the 8-hour sleep architecture in patients treated with the 2 doses. Sleep efficiency and the number of sleep interruptions were similar at the 2 doses. The results confirmed the efficacy and tolerability of temazepam therapy for insomnia reported in previous studies and highlighted this medication's value as a sleep aid throughout the entire sleep period.

Newer Is Not Necessarily Better

Patients with insomnia often are treated with newer, frequently more costly medications that may be prescribed off label. Some pharmacists, however, use evidence-based protocols and approved algorithms to prescribe older medications under a collaborative practice model. The authors of a study reported in the American Journal of Hospice & Palliative Medicine (March/April 2006) determined that the newer drugs were not superior to the older ones for treating insomnia in the hospice setting.

The retrospective analysis of patients in end-of-life care investigated the outcomes of those whose insomnia was treated with a newer drug, zolpidem, compared with those treated with an older drug, temazepam. A complete response to therapy (no insomnia symptoms) occurred in 52% of the temazepam patients, versus only 22% of the zolpidem patients. The data also suggested that patients who were prescribed temazepam achieved or maintained better control of insomnia symptoms, compared with participants using zolpidem.

Anxiety and Depression Are Connected with Insomnia

Behavioral problems and insomnia have long been viewed as linked, yet confounding factors often have made it hard for researchers to definitively connect the 2 conditions. A study in Sleep (November 2005) quantified the association of insomnia with depression and anxiety and also assessed whether demographic variables play a role in this association.

In a study of >770 participants aged 20 to >89 years of age, self-reported measures of sleep and health were analyzed. Patients with insomnia had greater depression and anxiety levels than those without sleep problems. These patients were approximately 10 times more likely than those without insomnia to have clinically significant depression and 17 times more likely to have anxiety. As the frequency of insomnia increased, so did patients' scores on scales measuring depression and anxiety. As unwanted awakenings increased, only depression scores increased. Patients with both onset and maintenance insomnia experienced greater levels of depression, compared with patients experiencing either of these insomnia types alone.

Importantly, these results proved valid in spite of potentially confounding factors such as race, sex, and existing medical disorders. The study data suggested a reciprocal relationship between insomnia, anxiety, and depression. The authors believe that this possible relationship, as well as specific interventions, warrant additional research.