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Highs, Lows, and Health Hazards of Herbology: A Review of Herbal Medications with Psychotropic Effects.
Smith-Stephens, SL
The Nursing clinics of North America. 2021;(1):137-152
Abstract
Mental health disorders, including depression, anxiety, and insomnia, are leading causes of hospitalization and disability for young and middle-aged adults. Approximately one-half of Americans will be diagnosed with a mental illness during their lifetime. Plants and roots have been used as medicinal agents since the beginning of recorded time. Complementary and alternative medicine or complementary integrative medicine use has been increasing throughout most socioeconomic classes, cultures, and age categories. This article reviews herbal and alternative therapies used to treat anxiety, depression, and insomnia. Indications for use, patient education, and possible interactions with conventional prescribed psychotropic medications are analyzed.
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Efficacy and safety of Chinese herbal medicine Long Dan Xie Gan Tang in insomnia: A systematic review and meta-analysis.
Fan, X, Su, Z, Nie, S, Yang, J, Zhang, X, Tan, D, Xie, S, Xu, Y, Zhao, Y, Feng, L, et al
Medicine. 2020;(11):e19410
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BACKGROUND Insomnia is a global public problem, which has a significant negative impact on both physical and mental health, while increasing the economic burden placed on both sufferers and society. Western medicine has a fast treatment on sleep, but it leads to side effects and strong dependence. Long Dan Xie Gan Tang(LDXGT) is a representative Chinese herbal medicine for the treatment of insomnia especially which has a bad-tempered symptom, and its effectiveness and safety has been validated clinically. However, there is yet to be any evidence-based medicine. Therefore, the effectiveness and safety of LDXGT in the treatment of insomnia are studied and systematically evaluated in this study. It will provide a theoretical support for the treatment of insomnia compared to western medicine. OBJECTIVE The study is purposed to evaluate the effectiveness and safety of LDXGT for the treatment of insomnia. METHODS Search was conducted for various databases including Pubmed, Chinese Biomedicine Database(CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wan-fang. Randomized-controlled trials (RCTs) were identified for insomnia treatment involving LDXGT and LDXGT combined with ordinary Western medicine. The quality of literature was evaluated by Cochrane assessing tool to reduce the risk of bias. RevMan 5.3 software and STATA 12.0 software were applied to perform the meta-analysis. RESULTS Thirteen studies involving 1181 participants were identified in this systematic review. Few studies described the details of random principle. No placebo was involved in treatment. LDXGT was compared with ordinary Western medicine in 11 trials and with LDXGT combined with conventional Western medicine in 2 trials. The results of our meta-analysis showed the relative benefits in effective rates compared with conventional western medicine. (Odds Ratio [OR]= 4.32, I = 0%,95% confidence interval CI [3.05 to 6.13], P < .00001) and recovery rate was (Odds Ratio [OR] = 2.67, I = 0%,95% confidence interval CI [2.04 to 3.48], P < .00001). In two trials, adverse events were reported, but no serious adverse effects were reported. CONCLUSION Our systematic evaluation will provide evidence for the clinical effectiveness and safety of LDXGT in the treatment of insomnia, and the side effects of western medicine are addressed. Further trials are necessary to collect the evidence for the use of LDXGT.
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Dynamic features of placebo effects addressing persistent insomnia disorder: A meta-analysis of placebo-controlled randomized clinical trials.
Jiang, B, He, D, Guo, Z, Gao, Z
Journal of sleep research. 2020;(4):e12997
Abstract
It has been accepted knowledge that placebo effects have been significant in insomnia clinical trials. However, the dynamic features of placebo effects have not been clarified. Our aim was therefore to conduct a meta-analysis of placebo-controlled randomized clinical trials to characterize the dynamic features of placebo effects addressing persistent insomnia disorder. We performed a comprehensive literature search for randomized, placebo-controlled, double-blind clinical trials evaluating the efficacy of therapeutic regimens addressing persistent insomnia disorder. We pooled separate effect size estimates (Hedge's g) of placebo and regimen conditions across trials for outcome measures, and multilevel mixed-effects models were used to explore potential sources of heterogeneity. The placebo effects were significant and robust to improve the symptoms of insomnia, and subjective measures were significantly smaller than objective measures (p < .001), but placebo response rates were nearly identical between subjective and objective measures. The overall placebo effects were influenced by publication year (p = .015), treatment duration (p = .010), sample size (p < .001) and therapeutic regimen (p < .001). Placebo effects showed a diphasic feature within treatment duration: initially a decrease and subsequently being stable; a sustained decline trend after withdrawals; and a steady-to-upward trend for a mixed therapeutic regimens in a large-scale period over decades. The dynamic features of placebo effects addressing persistent insomnia disorder may lead to the development and validation of dosing strategies that require less medication exposure to maintain clinical effects.
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Contributions of the Women's Health Initiative to understanding associations between sleep duration, insomnia symptoms, and sleep-disordered breathing across a range of health outcomes in postmenopausal women.
Beverly Hery, CM, Hale, L, Naughton, MJ
Sleep health. 2020;(1):48-59
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The Women's Health Initiative (WHI), a longitudinal study of more than 161,000 postmenopausal women across the United States, provides an opportunity to investigate the link between sleep health and healthy aging. The purpose of this paper was to systematically review all published WHI articles examining sleep as a predictor of health outcomes and health behaviors/quality of life outcomes. A strength of the WHI is that for most participants, sleep measures were completed before a major health diagnosis, with a significant portion of participants also providing sleep measures after diagnosis. Twenty-three WHI articles were identified and examined for this review. The combination of sleep duration and insomnia symptoms was the most commonly investigated sleep measure. The results indicated that both short (≤6 hours) and long (≥9 hours) sleep duration were associated with a higher risk of cardiovascular disease, colorectal cancer, mortality, cognitive decline, and poor diet. Insomnia symptoms, frequent snoring, and risk of sleep-disordered breathing (SDB) were also associated with increased risk for ischemic stroke and cardiovascular disease. However, many significant results were attenuated after multivariable adjustment. Limitations of these WHI examinations include the use of different categories for sleep measures across studies and a lack of examination by race/ethnicity. Owing to the longitudinal study design, large sample size, and long-term follow-up for health outcomes, the WHI serves as a rich resource for examining associations between sleep characteristics, demographics, and health in postmenopausal women.
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Sleep-Wake Disorders in Childhood.
Licis, A
Continuum (Minneapolis, Minn.). 2020;(4):1034-1069
Abstract
PURPOSE OF REVIEW The presentation of sleep issues in childhood differs from the presentation in adulthood and may be more subtle. Sleep issues may affect children differently than adults, and distinct treatment approaches are often used in children. RECENT FINDINGS Sodium oxybate was approved by the US Food and Drug Administration (FDA) in October 2018 for an expanded indication of treatment of sleepiness or cataplexy in patients with narcolepsy type 1 or narcolepsy type 2 aged 7 years or older, with side effect and safety profiles similar to those seen in adults. Restless sleep disorder is a recently proposed entity in which restless sleep, daytime sleepiness, and often iron deficiency are observed, but children do not meet the criteria for restless legs syndrome or periodic limb movement disorder. SUMMARY Children's sleep is discussed in this article, including normal sleep patterns and effects of insufficient sleep. Sleep disorders of childhood are reviewed, including insomnia, obstructive sleep apnea, restless legs syndrome, parasomnias, narcolepsy, and Kleine-Levin syndrome. Children with neurologic issues or neurodevelopmental disorders frequently have sleep disorders arising from an interaction of heterogeneous factors. Further attention to sleep may often be warranted through a polysomnogram or referral to a pediatric sleep specialist. Sleep disorders may cause indelible effects on children's cognitive functioning, general health, and well-being, and awareness of sleep disorders is imperative for neurologists who treat children.
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The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US army soldiers from 1997 to 2011: a retrospective cohort investigation.
Caldwell, JA, Knapik, JJ, Shing, TL, Kardouni, JR, Lieberman, HR
Sleep. 2019;(8)
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Since 2001, the United States has been engaged in the longest and most expensive overseas conflict in its history. Sleep disorders, especially insomnia and obstructive sleep apnea (OSA), are common in service members and appear related to deployment and combat exposure, but this has not been systematically examined. Therefore, the incidence of clinically diagnosed insomnia and OSA from 1997 to 2011 in the entire population of US Army soldiers was determined and associations of these disorders with deployment and combat exposure examined. This observational retrospective cohort study linked medical, demographic, deployment, and combat casualty data from all active duty US Army soldiers serving from 1997 to 2011 (n = 1 357 150). The mediating effects of multiple known comorbid conditions were considered. From 2003 to 2011, there were extraordinary increases in incidence of insomnia (652%) and OSA (600%). Factors increasing insomnia risk were deployment (risk ratio [RR] [deployed/not deployed] = 2.06; 95% confidence interval [CI], 2.04-2.08) and combat exposure (RR [exposed/not exposed] = 1.20; 95% CI, 1.19-1.22). Risk of OSA was increased by deployment (RR [deployed/not deployed] = 2.14; 95% CI, 2.11-2.17), but not combat exposure (RR [exposed/not exposed] = 1.00; 95% CI, 0.98-1.02). These relationships remained after accounting for other factors in multivariable analyses. A number of comorbid medical conditions such as posttraumatic stress disorder and traumatic brain injury mediated a portion of the association between the sleep disorders and deployment. It is essential to determine underlying mechanisms responsible for these very large increases in insomnia and OSA and introduce effective preventive measures.
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Physical Activity and Sleep Quality and Duration During Pregnancy Among Hispanic Women: Estudio PARTO.
Hawkins, M, Marcus, B, Pekow, P, Rosal, MC, Tucker, KL, Spencer, RMC, Chasan-Taber, L
Behavioral sleep medicine. 2019;(6):804-817
Abstract
Objective/Background: Poor sleep during pregnancy is common and is associated with pregnancy complications. Physical activity (PA) is associated with better sleep in nonpregnant populations. However, studies among pregnant women are sparse, conflicting, and none have been conducted among Hispanic women, who face a disproportionate burden of poor sleep and pregnancy complications. Therefore, our objective was to examine the relationship between intensity- and domain-specific PA, respectively, on sleep quality and duration among Hispanic pregnant women. Participants: We evaluated these associations among participants (n = 251) in Estudio PARTO, an ongoing randomized controlled trial aimed at reducing type 2 diabetes among women at high risk. Methods: We assessed the cross-sectional relationship between PA (via Pregnancy PA Questionnaire) and sleep quality and duration (via Pittsburgh Sleep Quality Index) using baseline data (26.5 ± 6.9 weeks gestation). Results: In multivariable logistic models, household and caregiving activities were associated with higher odds of very poor sleep quality (OR = 2.69; 95% CI = 1.04 to 7.04) and with short (vs. medium) sleep duration (OR = 2.85; 95% CI = 1.07 to 7.56). In contrast, occupational PA was associated with lower odds of very poor sleep quality (OR = 0.39; 95% CI = 0.17 to 0.89). Light-intensity PA was associated with lower odds of long (vs. medium) sleep duration (OR = 0.13; 95% CI = 0.03 to 0.52). There were no statistically significant relationships between PA in any other domain and sleep. Conclusions: Prospective studies will be critical in evaluating the potential adverse impact of household and caregiving activities on poor sleep quality.
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Neuropsychological Function Response to Nocturnal Blue Light Blockage in Individuals With Symptoms of Insomnia: A Pilot Randomized Controlled Study.
Zimmerman, ME, Kim, MB, Hale, C, Westwood, AJ, Brickman, AM, Shechter, A
Journal of the International Neuropsychological Society : JINS. 2019;(7):668-677
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OBJECTIVES Insomnia is associated with neuropsychological dysfunction. Evidence points to the role of nocturnal light exposure in disrupted sleep patterns, particularly blue light emitted through smartphones and computers used before bedtime. This study aimed to test whether blocking nocturnal blue light improves neuropsychological function in individuals with insomnia symptoms. METHODS This study used a randomized, placebo-controlled crossover design. Participants were randomly assigned to a 1-week intervention with amber lenses worn in wrap-around frames (to block blue light) or a 1-week intervention with clear lenses (control) and switched conditions after a 4-week washout period. Neuropsychological function was evaluated with tests from the NIH Toolbox Cognition Battery at three time points: (1) baseline (BL), (2) following the amber lenses intervention, and (3) following the clear lenses intervention. Within-subjects general linear models contrasted neuropsychological test performance following the amber lenses and clear lenses conditions with BL performance. RESULTS Fourteen participants (mean(standard deviation, SD): age = 46.5(11.4)) with symptoms of insomnia completed the protocol. Compared with BL, individuals performed better on the List Sorting Working Memory task after the amber lenses intervention, but similarly after the clear lenses intervention (F = 5.16; p = .014; η2 = 0.301). A similar pattern emerged on the Pattern Comparison Processing Speed test (F = 7.65; p = 0.002; η2 = 0.370). Consideration of intellectual ability indicated that treatment with amber lenses "normalized" performance on each test from approximately 1 SD below expected performance to expected performance. CONCLUSIONS Using a randomized, placebo-controlled crossover design, we demonstrated improvement in processing speed and working memory with a nocturnal blue light blocking intervention among individuals with insomnia symptoms. (JINS, 2019, 25, 668-677).
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Efficacy and safety of herbal medicine (Bailemian capsule) for treating insomnia: Protocol for a systematic review and meta-analysis.
Tian, T, Hua, L, Wang, J, Guan, J
Medicine. 2019;(4):e14275
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BACKGROUND Insomnia has become a universal subhealth disease, affecting more and more modern people's health and quality of life. At present, western medicine is only symptomatic treatment for insomnia. Bailemian Capsule (BLMC) is a proprietary Chinese medicine for treating insomnia. It has been widely used in China, but lacks evidence for evidence-based medicine. At the same time, the clinical efficacy and safety of BLMC are controversial. Therefore, the effectiveness and safety of BLMC in the treatment of insomnia are studied and systematically evaluated in this study. It provides reliable theoretical support for the treatment of insomnia with Traditional Chinese Medicine and the combination of traditional Chinese and Western medicine. METHODS The information was retrieved from electronic databases, Cochrane, PubMed, EMBASE, SinoMed, China National Knowledge Infrastructure, VIP Data, and WangFang Data. Randomized controlled trials on the BLMC in the treatment of insomnia were conducted. There was no limitation on the literature language. RevMan 5.3 software and STATA 12.0 software were used to perform the meta-analysis. RESULTS This review will be to assess the efficacy and safety of BLMC for insomnia. CONCLUSION Our systematic evaluation will provide evidence for the clinical efficacy and safety of BLMC in the treatment of insomnia, and will be published in the form of academic papers in the future to provide new ideas for clinicians in the treatment of insomnia.
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Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: the differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia.
Ji, X, Bastien, CH, Ellis, JG, Hale, L, Grandner, MA
Sleep health. 2019;(4):376-381
Abstract
OBJECTIVE Insomnia and depression are closely related. However, few studies have investigated whether certain insomnia symptoms differentially relate to certain depressive symptoms. The present study aimed to examine relationship between specific types of insomnia symptoms (sleep symptoms, daytime symptoms, and perception symptoms) and specific symptoms of depression. DESIGN Cross-sectional, observational study data from the Sleep, Health, Activity, Diet and Environment and Social Factors (SHADES) Survey. SETTING Community-level population. PARTICIPANTS A total of 1003 community-based adults aged 22-60 from the Philadelphia area. MEASUREMENTS Insomnia symptoms were represented by scores of sleep symptoms, daytime symptoms and perception symptoms, derived from the Insomnia Severity Index (ISI). Depression symptoms were assessed with the items of the Patient Health Questionnaire 9 (PHQ-9). RESULTS A Confirmatory Factor Analysis (CFA) supported the three-factor model based on ISI data. Binary logistic regressions examined independent associations between the three insomnia symptom types and individual depression symptoms. Sleep symptoms were more strongly associated with physiological aspects of depressive symptoms (appetite symptoms, psychomotor symptoms, and suicidal ideation). The daytime symptoms, on the other hand, were significantly associated with almost all depressive symptoms, except for appetite. Moreover, daytime symptoms were exclusively related to cognitive symptoms of depression (eg, trouble concentrating). The perception symptoms were independently associated with mood symptoms, tiredness, appetite, and judgment of oneself as a failure, but not with psychomotor, cognitive and suicidal ideation symptoms. CONCLUSION Daytime symptoms and perception symptoms of insomnia were more strongly associated with a full range of depressive symptoms than sleep symptoms. The sleep symptoms were mainly associated with more physiological symptoms of depression, implicating more biological mechanisms. Further research is needed regarding how these types of insomnia symptoms differentially related to multiple health consequences.