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CBT-I versus pharmacotherapy for primary Insomnia

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varkam Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 03:17 PM
Original message
CBT-I versus pharmacotherapy for primary Insomnia
I recall some discussion on this topic here a while back - an interesting study I found:

Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.
Archives of Internal Medicine
2004
Jacobs et. al.


Abstract:
BACKGROUND: Chronic sleep-onset insomnia is a prevalent health complaint in adults. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy, singly and in combination, for chronic sleep-onset insomnia. METHODS: This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. The main outcome measures were sleep-onset latency as measured by sleep diaries; secondary measures included sleep diary measures of sleep efficiency and total sleep time, objective measures of sleep variables (Nightcap sleep monitor recorder), and measures of daytime functioning. RESULTS: In most measures, CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation. CONCLUSIONS: These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia.
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HysteryDiagnosis Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 03:36 PM
Response to Original message
1. Quite often, there may be little real need for the new drug of the day
and here is something that may go with the CBT paper, thanks for posting this btw.

http://www.healthy.net/scr/article.asp?ID=2060

Problems that May be Helped by Magnesium

Atherosclerosis Kidney stones
Arrhythmias Menstrual pain
Angina pectori Alcoholism
Hypertension Fatigue
Bronchial asthma Fatigue
Epilepsy Osteoporosis
Autism Anxiety
Hyperactivity Insomnia
Premenstrual syndrome Muscle cramps
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varkam Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 04:03 PM
Response to Reply #1
2. One on that list caught my eye...
namely, Hypertension Fatigue. Obstructive Sleep Apnea Syndrome is a condition wherein the airway becomes obstructed during sleep, thereby preventing respiration. OSAS has several effects - the most widely recognized and supported are: hypertension (which in turn leads to an increased risk of heart attack and stroke), inreased cortisol levels, increased CNS activity, and excessive daytime sleepiness (which is a result of fragmented sleep from forcing the airway open).

In short, hypertension and fatigue often go together - so I think that, in many cases, both hypertension and fatigue are secondary to OSAS.
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HysteryDiagnosis Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 04:39 PM
Response to Reply #2
3. Papers.....
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books <---- Enter magnesium insomnia in the search window


1: Eby GA, Eby KL. Related Articles, Links
Abstract Rapid recovery from major depression using magnesium treatment.
Med Hypotheses. 2006 Mar 14;
PMID: 16542786

2: Naderi-Heiden A, Frey R, Presslich O, Frottier P, Willinger U, Blasbichler T, Smetana R, Schmid D, Kasper S. Related Articles, Links
Abstract Effect of intravenous magnesium sulphate in reducing irritability and restlessness in pure and polysubstance opiate detoxification.
Psychiatry Res. 2005 May 15;135(1):53-63.
PMID: 15893381

3: Hornyak M, Haas P, Veit J, Gann H, Riemann D. Related Articles, Links
Abstract Magnesium treatment of primary alcohol-dependent patients during subacute withdrawal: an open pilot study with polysomnography.
Alcohol Clin Exp Res. 2004 Nov;28(11):1702-9.
PMID: 15547457

4: Bhatia A, Kashyap L, Pawar DK, Trikha A. Related Articles, Links
Abstract Effect of intraoperative magnesium infusion on perioperative analgesia in open cholecystectomy.
J Clin Anesth. 2004 Jun;16(4):262-5.
PMID: 15261316

5: Kurup RK, Kurup PA. Related Articles, Links
Abstract Familial hypothalamic digoxin deficiency syndrome.
J Neuropsychiatry Clin Neurosci. 2004 Winter;16(1):93-101.
PMID: 14990764

6: Kurup RK, Kurup PA. Related Articles, Links
Abstract Hypothalamic digoxin, hemispheric chemical dominance, and sleep.
Int J Neurosci. 2003 Apr;113(4):537-46.
PMID: 12856481

7: Durlach J, Pages N, Bac P, Bara M, Guiet-Bara A, Agrapart C. Related Articles, Links
Abstract Chronopathological forms of magnesium depletion with hypofunction or with hyperfunction of the biological clock.
Magnes Res. 2002 Dec;15(3-4):263-8. Review.
PMID: 12635882

8: Kumar AR, Kurup PA. Related Articles, Links
Free Full Text Familial hypodigoxinemic membrane Na(+)-K(+) ATPase upregulatory syndrome - relation between digoxin status and cerebral dominance.
Neurol India. 2002 Sep;50(3):340-7.
PMID: 12391467

9: Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann D. Related Articles, Links
Abstract Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.
Sleep. 1998 Aug 1;21(5):501-5.
PMID: 9703590

10: Tramer MR, Schneider J, Marti RA, Rifat K. Related Articles, Links
Abstract Role of magnesium sulfate in postoperative analgesia.
Anesthesiology. 1996 Feb;84(2):340-7.
PMID: 8602664

11: Taylor M. Related Articles, Links
No abstract Insomnia and nutrition.
Aust Fam Physician. 1994 Mar;23(3):498. No abstract available.
PMID: 8048886

12: Kondou N, Hiasa Y, Kishi K, Fujinaga H, Ohishi Y, Ohtani R, Wada T, Aihara T. Related Articles, Links
Abstract
Kokyu To Junkan. 1993 Nov;41(11):1117-20. Japanese.
PMID: 8256055

13: Depoortere H, Francon D, Granger P, Terzano MG. Related Articles, Links
Abstract Evaluation of the stability and quality of sleep using Hjorth's descriptors.
Physiol Behav. 1993 Oct;54(4):785-93.
PMID: 8248358

14: Takahashi H, Imai K, Katanuma A, Sugaya T, Hisano K, Motoya S, Aoki S, Sugiyama T, Yachi A. Related Articles, Links
Abstract

Arerugi. 1992 Nov;41(11):1605-10. Japanese.
PMID: 1492795

15: Voci P, Bilotta F, Sandoz W, De Vito A, Caprettini S, Wagner SL, Viola R. Related Articles, Links
Abstract
Cardiologia. 1990 Jan;35(1):79-81. Italian.
PMID: 2376057

16: Popoviciu L, Corfariu O, Fagaraseanu M, Kollo K, Bagathai I. Related Articles, Links
No abstract Polysomnographic research in sleep disorders associated with magnesium deficiency.
Neurol Psychiatr (Bucur). 1987 Apr-Jun;25(2):83-90. No abstract available.
PMID: 3602904

17: Abraham GE. Related Articles, Links
Abstract Nutritional factors in the etiology of the premenstrual tension syndromes.
J Reprod Med. 1983 Jul;28(7):446-64.
PMID: 6684167

18: Bech P, Hey H. Related Articles, Links
Abstract Depression or asthenia related to metabolic disturbances in obese patients after intestinal bypass surgery.
Acta Psychiatr Scand. 1979 May;59(5):462-70.
PMID: 463585

19: Frankel BL, Patten BM, Gillin JC. Related Articles, Links
No abstract Restless legs syndrome. Sleep-electroencephalographic and neurologic findings.
JAMA. 1974 Dec 2;230(9):1302-3. No abstract available.
PMID: 4371194

20: Conners CK, Taylor E, Meo G, Kurtz MA, Fournier M. Related Articles, Links
No abstract Magnesium pemoline and dextroamphetamine: a controlled study in children with minimal brain dysfunction.
Psychopharmacologia. 1972;26(4):321-36. No abstract available.
PMID: 4508756
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HysteryDiagnosis Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 04:43 PM
Response to Reply #2
4. Metabolic syndrome in young adults.... and hypertension/fatigue
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16567569&query_hl=2&itool=pubmed_docsum

1: Circulation. 2006 Apr 4;113(13):1675-82. Epub 2006 Mar 27. Related Articles, Links
Click here to read
Magnesium intake and incidence of metabolic syndrome among young adults.

He K, Liu K, Daviglus ML, Morris SJ, Loria CM, Van Horn L, Jacobs DR Jr, Savage PJ.

Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. kahe@northwestern.edu

BACKGROUND: Studies suggest that magnesium intake may be inversely related to risk of hypertension and type 2 diabetes mellitus and that higher intake of magnesium may decrease blood triglycerides and increase high-density lipoprotein (HDL) cholesterol levels. However, the longitudinal association of magnesium intake and incidence of metabolic syndrome has not been investigated. METHODS AND RESULTS: We prospectively examined the relations between magnesium intake and incident metabolic syndrome and its components among 4637 Americans, aged 18 to 30 years, who were free from metabolic syndrome and diabetes at baseline. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III definition. Diet was assessed by an interviewer-administered quantitative food frequency questionnaire, and magnesium intake was derived from the nutrient database developed by the Minnesota Nutrition Coordinating Center. During the 15 years of follow-up, 608 incident cases of the metabolic syndrome were identified. Magnesium intake was inversely associated with incidence of metabolic syndrome after adjustment for major lifestyle and dietary variables and baseline status of each component of the metabolic syndrome. Compared with those in the lowest quartile of magnesium intake, multivariable-adjusted hazard ratio of metabolic syndrome for participants in the highest quartile was 0.69 (95% confidence interval , 0.52 to 0.91; P for trend <0.01). The inverse associations were not materially modified by gender and race. Magnesium intake was also inversely related to individual component of the metabolic syndrome and fasting insulin levels. CONCLUSIONS: Our findings suggest that young adults with higher magnesium intake have lower risk of development of metabolic syndrome.

PMID: 16567569


1: Magnes Res. 2005 Dec;18(4):275-84. Related Articles, Links
Click here to read
Magnesium and ischemic heart disease: a review of epidemiological, experimental, and clinical evidences.

Ueshima K.

The Second Division of Internal Medicine, Iwate Medical University, Morioka, Japan. k_ueshima@imu.ncvc.go.jp

Magnesium (Mg) plays an essential role in a wide range of fundamental cellular reactions in patients with ischemic heart disease. It has been well known that Mg plays a pivotal role in control of cardiac excitability, neuromuscular transmission, vasomotor tone, and blood pressure, among other functions. Especially, many epidemiological, experimental, and clinical studies support a pathological role for Mg in the etiology and development of major coronary risk factors as diabetes mellitus, hypertension, and hyperlipidemia as well as ischemic heart disease. Furthermore, the therapeutic value of Mg in the management of coronary risk factors and ischemic heart disease has been clarified. Dietary Mg supplementation should be considered as a preventive element in atherosclerosis and ischemic heart disease.

Publication Types:

* Review


PMID: 16548143
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varkam Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 04:57 PM
Response to Reply #4
5. There's probably
more than one road to rome, so to speak.
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HysteryDiagnosis Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 05:02 PM
Response to Reply #5
6. Yes there is.... have you ever considered the effect of the
rabidly irresponsible use of medications in this drugged out nation??

http://www.findarticles.com/p/articles/mi_m0FDN/is_2_7/ai_85522989

Many of the top 100 drugs prescribed in the United States have been shown to deplete a variety of nutrients. For instance, did you know that the HMG-Co A reductase inhibitors Lipitor, Mevacor, Pravachol, and Zocor, as well as the beta blockers, Toprol, and Lopressor, all deplete coenzyme Q10, a nutrient essential to ATP production in cellular mitochondria? It has also been demonstrated that both oral and inhaled corticosteroids, such as hydrocortisone, Prednisone, Azmacort, Flonase, and Serevent, deplete several important minerals, folic acid, and vitamins C and D. The popularly prescribed histamine agonists Pepcid, Tagamet, and Zantac can deplete folic acid, B vitamins, calcium, iron, zinc, and vitamin D. The second edition of Drug-Induced Nutrient Depletion Handbook includes detailed information on these drugs and nearly 1,000 more, and is a valuable reference guide addressing drug-induced nutrient depletion in humans. It expands on the information found in the first edition and the authors' intent is to provide health professionals and the lay public access to the large body of credible scientific research pertaining to drug-induced nutrient deficiencies.

The book is divided into four main sections, in addition to the introduction, appendix, and alphabetical index. The first section is an alphabetical listing of drug monographs by brand and generic name, providing synonyms, pharmacological class, nutrients depleted by the drug, the scientific basis for this information, and a reference to the corresponding nutrient monograph. The second section is a cross reference to the first, alphabetically listing nutrients and the drugs that deplete them, along with a reference number for the abstracts/studies section of the book. The nutrient monograph section is perhaps the most informative, as it provides an alphabetically arranged overview of the nutrients, their biological functions and effects, as well as side effects and toxicity. The monographs also describe the physiological effects of depletion, suggested daily dosage, and dietary sources of the nutrient. The "Studies and Abstracts" section provides brief summaries of the citations and abstracts of over 500 scientific studies corresponding to the drug monographs.
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varkam Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 09:32 PM
Response to Reply #6
7. While we do use meds to an excess..
I think many of the disorders have been around long before we started our "pill culture"
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HysteryDiagnosis Donating Member (1000+ posts) Send PM | Profile | Ignore Mon May-22-06 05:17 AM
Response to Reply #7
9. Many of them were birthed by the advent of the processed food
industry.


http://www.diagnose-me.com/treat/T208804.html
Processed Foods Avoidance can help with the following:

More at link:


Meniere's Disease
Among individuals with Meniere’s disease who replaced refined carbohydrates in their diet with high-fiber, complex carbohydrates, tinnitus frequently improved or disappeared.

Organ Health
Diabetes Type II
Many doctors and researchers agree that the regular consumption of tasty, mostly modern, commercially processed foods is the primary cause of adult-onset diabetes. Consuming anything sweet, regardless of its calorific content, may be sending a signal from the mouth to the brain that more insulin is needed.

Poor Bone Health
Eat organic whenever possible and eat whole grains instead of refined flour.

Hepatitis

Skin-Hair-Nails
Adult Acne
Dandruff
Refined carbohydrates in white flour or sugar can cause dandruff and should be avoided because they deplete the body of B-vitamins.

Uro-Genital
Female Infertility


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HuckleB Donating Member (1000+ posts) Send PM | Profile | Ignore Sun May-21-06 09:51 PM
Response to Original message
8. For sleep-onset insomnia, this has been my experience.
Anecdotally, of course, but in clinical practice with adolescents and young adults.

Thanks for sharing.
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