X

Download Treatment of Chronic Insomnia PowerPoint Presentation

SlidesFinder-Advertising-Design.jpg

Login   OR  Register
X


Iframe embed code :



Presentation url :

Home / Health & Wellness / Health & Wellness Presentations / Treatment of Chronic Insomnia PowerPoint Presentation

Treatment of Chronic Insomnia PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

PowerPoint is the world's most popular presentation software which can let you create professional Treatment of Chronic Insomnia powerpoint presentation easily and in no time. This helps you give your presentation on Treatment of Chronic Insomnia in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this Treatment of Chronic Insomnia powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by slidesfinder in Health & Wellness ppt presentation category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

About This Presentation

Treatment of Chronic Insomnia Presentation Transcript

Slide 1 - Treatment of Chronic Insomnia:A Literature Search of Practice Guidelines, Meta-Analyses, and Review Articles Praveen Kambam, PGY-2 EBM Seminar 10/27/2005
Slide 2 - What would you recommend for treatment? 45 year-old man with primary insomnia and difficulty initiating sleep 83 year-old woman with depression treated with fluoxetine and complaints of repeated awakenings throughout the night 25 year-old man with anxiety and difficulty initiating sleep 12 year-old girl with early morning awakening
Slide 3 - Searching the Literature Online resources able to be accessed from UM Clinical Home Page or internet only Searches on PubMed, Medline, Up To Date, MD Consult Keywords: “Insomnia” and “treatment” “Soporific” “Trazodone” and “quetiapine”
Slide 4 - Pharmacological Treatments Trials for continuous use do not exceed 6 months for eszopiclone, 12 weeks for temazepam, 6 weeks for trazodone, 5 weeks for zolpidem (12 weeks for intermittent use2), and 4 weeks for zapelon1,6
Slide 5 - Diphenhydramine RCT’s suggest improved sleep subjectively but limited by small numbers, short duration, lack of objective measurements2 No recent data of efficacy over 3 weeks; tolerance within a few days1 Considerations: next day neurocognitive effects, anticholinergic effect, orthostasis, increased liver enzymes
Slide 6 - Melatonin Conflicting results Studies limited by small numbers, short periods, various dosages and formulations2 Considerations: not regulated by FDA so unknown formulation and dosage
Slide 7 - Trazodone Limited data, and especially limited on primary insomnia (only 2 studies) Lack of objective efficacy measures Short duration of trials (longest is 6 weeks) Consideration for side effects (sedation, dizziness, orthostasis, psychomotor impairment, priapism, etc.) Some evidence of tolerance (after 1-2 weeks) especially for primary insomnia _________________________________________________________________________________________________________ 6. Mendelson WB. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry. 2005 Apr;66(4):469-76.
Slide 8 - Trazodone vs. zolpidem 14 day, placebo controlled, primary insomnia Subjective sleep latency and duration showed significant improvement with both trazodone and zolpidem vs. placebo Effect was greater with zolpidem __________________________________________________________________________________________________________ 2. Silber MH. Clinical practice. Chronic insomnia. N Engl J Med. 2005 Aug 25;353(8):803-10.
Slide 9 - Benzodiazepines Subjective and objective improvements in sleep maintenance measures (WTSO, number of awakenings) greater for longer-acting agents (flurazepam, quazepam, estazolam) vs. triazolam However next-day sedation as well as cognitive and psychomotor function impairment worse. Objective sleep lab data on temazepam to improve number of awakenings is equivocal _________________________________________________________________________________________________________ 1. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005 Mar;56(3):332-43.
Slide 10 - Benzodiazepines and non-benzodiazepine agonists Reduction in sleep onset latency greater than that for antidepressants and melatonin by indirect comparisons Risk for harm greater for benzodiazepines vs. non-benzodiazepines based on indirect comparisons Strong evidence of publication bias __________________________________________________________________________________________________________ 3. Buscemi N et al. Manifestations and Management of Chronic Insomnia in Adults. Evidence Report/Technology Assessment. Agency for Healthcare Research and Quality. 2005 Jun;125:1-11.
Slide 11 - Benzodiazepines and non-benzodiazepine agonists Less evidence of subjective and objective next-day residual effects associated with zolpidem vs. benzos Less evidence of subjective next-day impairment with zaleplon, even if given in the middle of the night Efficacy for sleep-onset, not for maintenance Less drug-drug interactions _________________________________________________________________________________________________________ 1. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005 Mar;56(3):332-43.
Slide 12 - Non-benzodiazepine agonists Next day benefits of zolpidem not clearly defined (only improvement in somatic complaints over placebo) _________________________________________________________________________________________________________ 1. Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005 Mar;56(3):332-43.
Slide 13 - Quetiapine ??? Emerging case reports for PTSD and anxiety Consideration of cost, metabolic side effects, tardive dyskinesia
Slide 14 - Behavioral Treatments Well-established treatments: Stimulus Control Paradoxical Intention Progressive Muscle Relaxation Probably efficacious treatments: Sleep Restriction Sleep Hygiene education Cognitive Therapy Biofeedback _________________________________________________________________________________________________________ 4. Chesson AL et al. Practice Parameters for the Nonpharmacologic Treatment of Chronic Insomnia. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 1999;22(8):1128-1133.
Slide 15 - Considerations - Behavioral Cost Lack of availability Potential problems with patient motivation and adherence Training Limited if any side effects Differences in insomnia and outcome measures make comparison of study results difficult3
Slide 16 - Pharmacologic vs. Behavioral Treatments Evidence favoring pharmacologic therapy over behavioral therapy or vice versa was inconclusive1 Hypnotic drugs may result in more rapid improvements in the first 1-4 weeks Clinical benefit not as well maintained over time (6-24 months) after discontinuation of treatment Combined treatments did worse than behavioral therapy alone
Slide 17 - Pharmacological Treatment vs. CBT vs. Combo CBT>combo after treatment termination (10-24 month follow-up)1,2 Pharmacological therapy tended to be superior in the first 2 weeks
Slide 18 - Conclusions No prospective studies demonstrating treatment of insomnia improves outcomes of its associated comorbid conditions1 Limited duration of studies No conclusive evidence to favor pharmacological vs. behavioral therapy but limited evidence to guide specific treatment goals and settings In the absence of evidence, need to match nature of sleep problem with treatment, availability, cost tolerance, side effect tolerance, and co-morbid conditions
Slide 19 - Selected Articles Benca RM. Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv. 2005 Mar;56(3):332-43. Silber MH. Clinical practice. Chronic insomnia. N Engl J Med. 2005 Aug 25;353(8):803-10. Buscemi N et al. Manifestations and Management of Chronic Insomnia in Adults. Evidence Report/Technology Assessment. Agency for Healthcare Research and Quality. 2005 Jun;125:1-11. Chesson AL et al. Practice Parameters for the Nonpharmacologic Treatment of Chronic Insomnia. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 1999;22(8):1128-1133. Nowell PD et al. Benzodiazepines and Zolpidem for Chronic Insomnia: A Meta-analysis of Treatment Efficacy. JAMA. 1997 Dec;278(24):2170-2177. Mendelson WB. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry. 2005 Apr;66(4):469-76.
 

Frequently Asked Questions

> About SlidesFinder?

Slidesfinder is a website that allows users to upload and share their PowerPoint presentations online. It provides a platform for individuals and businesses to share their ideas and knowledge through presentations, and for others to view and download these presentations for educational or professional purposes.
Slidesfinder offers a wide range of presentation topics and categories, including business, education, science, technology, health, and more. Users can also search for presentations using keywords, tags, or by category. The website provides tools to create professional presentations with rich media, animations, and graphics.



One of the key features of Slidesfinder is its user-friendly interface, which allows users to easily upload, view, and share presentations. Users can also embed their presentations in their websites or blogs using the website's embed code feature.
Slidesfinder also offers premium services, such as the ability to create private presentations and to download presentations in high-quality formats. However, the basic features of Slidesfinder are free to use, making it accessible to anyone who wants to share their ideas and knowledge through presentations.

> How do I register with SlidesFinder?

Go to registration page (you can see signup link on top of website page) https://www.slidesfinder.com/signup . If you have facebook/gmail account them just click on SIGN IN WITH FACEBOOK OR SIGN IN WITH GOOGLE button, by this you will be a registered member of slidesfinder without filling any form, required detail automatically will be fatch from your account. If you do not a Facebook account, then click on "Signup". Fill all required fields and you will be a registered member of slidesfinder.

> Is slidesfinder account confirmation is mandatory?

Yes it is mandetory to active your account to login.

> Do I need to signup/login on SlidesFinder before uploading a PowerPoint presentation?

Yes, you need to login with your account before uploading presentation. Your username will be displayed on your uploaded presentation. Your registered email id is needed for sending your stats of uploaded presentation.

Slidesfinder is a sharing website for PowerPoint presentations search and share. Find your interest in the form of powerpoint presentations on slidesfinder and save your valuable time . On Slidesfinder you get presentations from our huge library of professional ppt presentations. We believe in making your search INFORMATIVE and FUN. Find your best ppt presentation from a pool of PowerPoint presentations stacked under important industry categories like business & management, heath & Wellness,eduction & training etc. We provide unique informative PowerPoint presentation for marketers, presenters and educationists. These professional PowerPoint presentations are uploaded by professionals from across numerous industry segments.These ppt presentations are available for FREE download.

Not just finding your interest, but facilitate you broadcast your interest. We have created this platform for easy sharing of PowerPoint presentations, ensuring that these presentations get maximum exposure. Create your slidesfinder account and upload PowerPoint presentations for free, share on social media platforms and BUILD YOUR CROWD WITH PRESENTATION !!

The Great Buddha says, "Share your knowledge.It’s a way to achieve immortality"! So, start sharing knowledge and we are here to make that immortal !!

© 2013-2024 SlidesFinder. All rights reserved.

Re-productivity of content are not allowed. Without prior written permission from author, commercial use of any content is illegal.