AASM Membership Sections Newsletter Issue #2
9
degenerative disorders, heart disease, diabetes, obesity)
and psychiatric conditions (anxiety, depression, and
relapse from substance dependence). There is also little
debated over the effectiveness of cognitive, behavioral
and/or pharmacotherapy for management of insomnia.
There is less agreement, however, over the role
that polysomnography might serve as a tool to
increased our knowledge and understanding of the
mechanisms that underlie insomnia, to help identify
neurophysiological correlates of different subtypes of
insomnia, identify characteristics of vulnerable indi-
viduals and to guide treatment decisions.
In the American Academy of Sleep Medicine’s
2003
Practice Parameters for Using Polysomnogra-
phy to Evaluate Insomnia, PSG is endorsed if there
is suspicion of sleep disordered breathing or peri-
odic limb movements, if the diagnosis of insomnia
is uncertain after a detailed medical, psychiatry and
sleep history has been obtained, if behavioral and
pharmacological approaches have failed, or in the
context of precipitous arousals with violent or injuri-
ous behavior in sleep. Nevertheless, these Practice
Parameters also state significant weakness in the
published literature concerning the diagnostic utility
of polysomnography for clinically evaluating patients
with insomnia and encourage such research.
Some clinicians may be weary of or unfamiliar
with polysomnography for the evaluation of insom-
nia. Lack of reimbursement from insurance provid-
ers as well as patient resistance about spending a
night in the laboratory can also present as barriers to
evaluation. However, this may become more feasible
with the growth of home sleep studies. Given the
prevalence of insomnia, the host of evidence that
insomnia is associated with deterioration in many
areas of physical, emotional and psychological health,
and that many patients continue to struggle with
insomnia and its consequences despite persistent and
well-thought out treatment attempts, we at least need
to ask the question—are we missing potentially use-
ful information by not running a PSG? Just as certain
PSG measures (apnea-hypopnea index, respiratory
disturbance index, respiratory straining, blood oxy-
gen desaturation, etc) guide the treatment course for
the patient with disordered breathing, might mea-
sures of sleep efficiency, spontaneous arousal index,
disturbance in normal sleep architecture, presence/
absence of atypical EEG features help distinguish
between different subtypes, degrees and treatments of
insomnia? Future studies might help to clarify such
questions and to expand our current repertoire of
how we understand and manage insomnia.
Complementary Alternative Medicine for
Insomnia
by Zhaoming Cheng, MD
Complementary alternative medicine used to be
main stream medical system around the world for
hundreds and thousands of years. Nowadays, it
still plays a major role in delivering medical care at
some other countries. There are over 1.6 millions of
American people using some kinds of complemen-
tary alternative medicine to help them to achieve
high quality sleep as of 2002. The most commonly
used forms of complementary alternative rem-
edies are herbal or diet supplement, and relaxation
therapy. Currently there are several ongoing clinical
trials to investigate if the complementary alternative
remedies can improve sleep for people with specific
medical conditions such as: light therapy for Al-
zheimer disease, hypnosis for posttraumatic stress
disorder, melatonin for hypertension, Valerian for
Parkinson’s disease, and stress reduction techniques
for sleep quality improvement.
Continue the Discussion!
Log onto AASM member’s discussion forum and
click Insomnia Section.
Continued >>