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Insomni

Sist revidert:
Sist revidert av:

Definisjon:
Subjektiv opplevelse av dårlig søvn til tross for tilrettelagte forhold, og som gir nedsatt funksjon på dagtid
Forekomst:
Vanlig problemstilling. Minst 10% av den voksne befolkning har kronisk insomni
Symptomer:
Insomni opptrer ofte komorbid til andre sykdommer, både fysiske og psykiske. Omtrent halvparten av de med insomni har komorbid psykisk sykdom – oftest depresjon eller angst
Funn:
Noen pasienter kan ha synlige tegn på søvnmangel, men dette mangler vanligvis
Diagnostikk:
Blodprøver kan i noen tilfeller være relevant. Søvndagbok bør fylles ut før behandling mot vedvarende søvnvansker
Behandling:
Anbefalt behandling ved kronisk insomni er kognitiv atferdsterapi. Medikamentell tilnærming kommer i andre rekke
  • Nasjonal kompetansetjeneste for søvnsykdommer (SOVno) - nettsted 
  1. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
  2. Sateia MJ, Nowell PD. Insomnia. Lancet 2004; 364: 1959-73. PubMed  
  3. Pallesen S, Sivertsen B, Nordhus IH, Bjorvatn B. A 10-year trend of insomnia prevalence in the adult Norwegian population. Sleep Med 2013. doi:10.1016/j.sleep.2013.10.009 DOI  
  4. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia: an American Academy of Sleep Medicine review . Sleep 2000; 23: 243-308. PubMed  
  5. Ohayon M. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002; 6: 97-111. PubMed  
  6. Wolkove N, Elkholy O, Baltzan M et al. Sleep and aging: 1. Sleep disorders commonly found in older people. CMAJ 2007; 24: 1299–304. DOI: 10.1503/cmaj.060792 DOI  
  7. MMWR-report. Perceived insufficient rest or sleep among adults - United States, 2008. JAMA 2009; 302: 2532-39. Journal of the American Medical Association  
  8. Perlis ML, Vargas I, Ellis JG, et al. The Natural History of Insomnia: the incidence of acute insomnia and subsequent progression to chronic insomnia or recovery in good sleeper subjects. Sleep. 2020 Jun 15;43(6):zsz299. PMID: 31848629.
  9. Fetveit A, Bjorvatn B. Søvnforstyrrelser hos eldre. Tidsskrift Nor Legeforening 2009; 129: 2004-6. doi:10.4045/tidsskr.08.0403 DOI  
  10. SLK, terapianbefaling. Behandling av søvnvansker. Oslo 2000.
  11. Wolkove N, Elkholy O, Baltzan M et al. Sleep and aging: 2. Management of sleep disorders in older people. CMAJ 2007; 8: 1449–54. doi: 10.1503/cmaj.070335 DOI  
  12. Bjorvatn B. Søvnregistrering og søvnstadier. Nasjonal kompetansetjeneste for søvnsykdommer (SOVno). Sist oppdatert 26.01.2018. helse-bergen.no  
  13. Hirshkowitz M, et al, National Sleep Foundation’s sleep time duration recommendations: methodology and results summary, Sleep Health (2015), doi: 10.1016/j.sleh.2014.12.010 DOI  
  14. Espie CA. Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults . Annu Rev Psychol 2002; 53: 215-43. PubMed  
  15. SBU. Arbetsmiljöns betydelse för sömnstörningar. En systematisk litteraturöversikt. Stockholm: Elanders, 2013.
  16. Bjorvatn B. Alternativer til sovemidler hos eldre. Tidsskr Nor Lægeforen 2003; 123: 1048. PubMed  
  17. Riemann D, Baglioni C, Bassetti C, Bjorvatn B, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017 Dec;26(6):675-700. Epub 2017 Sep 5. PMID: 28875581. PubMed  
  18. Bjorvatn B, Sivertsen B, Øyane N, Nordhus IH, Pallesen S. Insomni. Tidsskr Nor Legeforen 2009; 129: 1766-8. Tidsskrift for Den norske legeforening  
  19. Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 2004; 164: 1888-96. PubMed  
  20. Davidson JR, Dickson C, Han H. Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes. Br J Gen Pract 2019; 69: e657-e664. pmid:31358494 PubMed  
  21. Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2021 Jun 21. Epub ahead of print. PMID: 34170250. PubMed  
  22. Stepanski EJ, Rybarczyk B. Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Med Rev 2006; 10: 7–18. PMID: 16376125 PubMed  
  23. Ritterband LM, Thorndike FP, Gonder-Frederik LA, et al. Efficacy of an internet-based behavioral intevention for adults with insomnia. Arch Gen Psychiatry 2009; 66: 692-8. PubMed  
  24. Bjorvatn B, Fiske E, Pallesen S. A self-help book is better than sleep hygiene advice for insomnia. A randomized controlled comparative study. Scand J Psychology 2011; 52: 580-5. PubMed  
  25. Stepanski EJ, Wyatt JK. se of sleep hygiene in the treatment of insomnia. Sleep Med Rev 2003; 7: 215. pmid:12927121 PubMed  
  26. Morin CM, Culbert JP, Schwartz SM. Non-pharmacological interventions for insomnia: a meta-analysis og treatment efficacy. Am J Psychiatry 1994; 151: 1172-80 American Journal of Psychiatry  
  27. Bjorvatn B. Langvarige søvnvansker - kan de behandles? Tidsskr Nor Lægeforen 2000; 120:579-82. Tidsskrift for Den norske legeforening  
  28. Black DS, O'Reilly GA, Olmstead R, et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med 2015. doi:10.1001/jamainternmed.2014.8081 DOI  
  29. Pallesen S, Nordhus IH, Kvale G, Nielsen GH, et al. Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions. Behav Res Ther 2003; 41: 31. pmid:12488118 PubMed  
  30. Trauer JM, Qian MY, Doyle JS, et al. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Ann Intern Med 2015. doi:10.7326/M14-2841 DOI  
  31. Brasure M, Fuchs E, MacDonald R, et al. Psychological and Behavioral Interventions for Managing Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med 2016. doi:10.7326/M15-1782 DOI  
  32. van Straten A, van der Zweerde T, Kleiboer A et al. Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Med Rev 2018; 38: 3-16. pmid:28392168 PubMed  
  33. Espie CA, Inglis SJ, Tessier S, Harvey L. The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice. Behav Res Ther 2001; 39: 45-60. PubMed  
  34. Wu JQ, Appleman ER, Salazar RD, Ong JC. Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis. JAMA Intern Med 2015. doi:10.1001/jamainternmed.2015.3006 DOI  
  35. Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults. JAMA 2006; 295: 2851-8. PubMed  
  36. Morin CM, Vallieres A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia. A randomized controlled trial. JAMA 2009; 301: 2005-15. Journal of the American Medical Association  
  37. Morgan K, Gregory P, Tomeny M, et al. Self-help treatment for insomnia symptoms associated with chronic conditions in older adults: a randomized controlled trial. J Am Geriatr Soc 2012; 60: 1803-10. PubMed  
  38. Espie CA, Kyle SD, Williams C, et al. A randomized, placebo-controlled trial of online cognitive behavioural therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep 2012; 35: 769-81. PubMed  
  39. Bootzin RR, Nicassion PM. Behavioral treatments for insomnia. In: Hersen M, Eissler R, Miller P, eds. Progress in Behavior Modification. New York, NY: Academic Press, 1978: 1-45.
  40. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia: an American Academy of Sleep Medicine review. Sleep 1999; 22: 1134-56. PubMed  
  41. Morgenthaler T, Kramer M, Alessi C et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. SLEEP 2006; 29: 1415-19. pmid:17162987 PubMed  
  42. Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 2011; 171: 887-95. PubMed  
  43. Baillargeon L, Demers M, Ladoceur R. Stimulus control: nonpharmacological treatment for insomnia. Can Fam Physician 1998; 44: 73-9. PubMed  
  44. Hogan DB, Maxwell CJ, Fung TS, Ebly EM. Prevalence and potential consequences of benzodiazepine use in senior citizens: results from the Canadian study of health and aging. Can J Clin Pharmacol 2003; 10: 72-7. PubMed  
  45. Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF, Kupfer DJ. Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. JAMA 1997; 278: 2170-77. Journal of the American Medical Association  
  46. Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ 2000; 162: 225-33. Canadian Medical Association Journal  
  47. Wilt TJ, MacDonald R, Brasure M, et al. Pharmacologic Treatment of Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med 2016. doi:10.7326/M15-1781 DOI  
  48. Wilson SJ, Nutt DJ, Alford C, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010 Nov; 24(11): 1577-601. pmid:20813762 PubMed  
  49. Ray WA, Thapa PB, Gideon P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc 2000; 48: 682-85. PubMed  
  50. Roehrs T, Merlotti L, Zorick F, Roth T. Rebound insomnia in normals and patients with insomnia after abrupt and tapered discontinuation. Psychopharmacology 1992; 108: 67-71. PubMed  
  51. Roth T, Roehrs TA. A review of the safety profiles of benzodiazepine hypnotics. J Clin Psychiatry 1991; 52 (suppl): 38-41.
  52. Hajak G, Muller WE, Wittchen HU, Pittrow D, Kirch W. Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data . Addiction 2003; 98: 1371-78. PubMed  
  53. National Institute for Clinical Excellence. Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia. London: NICE, 2004. (Technology Appraisal 77.) www.nice.org.uk/TA077guidance (accessed 20 Sep 04).
  54. Mellingsæter TC, Bramness JG, Slørdal L. Er z-hypnotika bedre og tryggere sovemedisiner enn benzodiazepiner?. Tidsskr Nor Lægeforen 2006; 126: 2954-6. PubMed  
  55. Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and Pharmacological Therapies for Late-Life Insomnia. A Randomized Controlled Trial. JAMA 1999;281:991-9. Journal of the American Medical Association  
  56. Liira J, Verbeek JH, Costa G, et al. Pharmacological interventions for sleepiness and sleep disturbances caused by shift work. Cochrane Database of Syst Rev 2014; (8): CD009776. doi:10.1002/14651858.CD009776.pub2 DOI  
  57. Fetveit A, Bjorvatn B. Søvnforstyrrelser hos sykehjemspasienter - praktiske behandlingsråd Søvnforstyrrelser hos sykehjemspasienter - praktiske behandlingsråd. Tidsskr Nor Lægeforen 2005; 125: 1676-8. PubMed  
  58. Relis: Diazepam versus oksazepam og risiko for avhengighet. RELIS database 2019; spm.nr. 13187, RELIS Vest. relis.no  
  59. Culpepper L, Wingertzahn MA. Over-the-Counter Agents for the Treatment of Occasional Disturbed Sleep or Transient Insomnia: A Systematic Review of Efficacy and Safety. Prim Care Companion CNS Disord 2015 Dec 31. pmid:27057416 PubMed  
  60. BMJ Best Practice: Insomnia. Sist oppdatert 25.01.2016. bestpractice.bmj.com  
  61. Debernard KAB, Frost J, Roland PH. Kvetiapin er ikke en sovemedisin. Tidsskr Nor Legeforen 2019; 139. doi: 10.4045/tidsskr.19.0205. DOI  
  62. Wilhelmsen-Langeland A, Vågenes VA, Magerøy N, Bredeli E. Utviklingen i bruken av hypnotika er trolig gledelig, men vi er bekymret for økningen i bruken av kvetiapin på indikasjon for søvnvansker. SovNo 2022. en.calameo.com  
  63. Waal H, Vold JH, Skurtveit SO. Kvetiapinmisbruk – myte eller realitet?. Tidsskr Nor Legeforen 2020. doi:10.4045/tidsskr.20.0059 DOI  
  64. Alessi CA, Martin JL, Webber AP, Cynthia Kim E, Harker JO, Josephson KR. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc 2005; 53: 803-10. PubMed  
  65. Rosenberg R, Murphy P, Zammit G, et al. Comparison of Lemborexant With Placebo and Zolpidem Tartrate Extended Release for the Treatment of Older Adults With Insomnia Disorder: A Phase 3 Randomized Clinical Trial. JAMA Netw Open 2019; 2: e1918254. pmid:31880796 PubMed  
  66. Mignot E, Mayleben D, Fietze I, et al. Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Lancet Neurol 2022. doi:10.1016/S1474-4422(21)00436-1 DOI  
  67. Holbrook AM, Crowther R, Lotter A, Cheng C, King D. The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. CMAJ 2000; 162: 216-20. Canadian Medical Association Journal  
  68. King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA 1997; 277: 32-7. Journal of the American Medical Association  
  69. Montgomery P, Dennis J. Physical exercise for sleep problems in adults aged 60+ (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software. The Cochrane Library  
  70. Montgomery P, Dennis J. Bright light therapy for sleep problems in adults aged 60+ (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software. The Cochrane Library  
  71. Fetveit A, Bjorvatn B. Lysbehandling mot søvnvansker i sykehjem - et ikke-farmakologisk alternativ. Tidsskr Nor Lægeforen 2005; 125: 1679-81. PubMed  
  72. King CR, Knutson KL, Rathouz PJ, et al. Short sleep duration and incident coronary artery calcification. JAMA 2008; 300: 2859-66. Journal of the American Medical Association  
  73. Riemann D, Voderholzer U. Primary insomnia: a risk factor to develop depression? J Affect Disord 2003; 76: 255–9. PMID: 12943956 PubMed  
  74. Hajak G. Epidemiology of severe insomnia and its consequences in Germany. Eur Arch Psychiatry Clin Neurosci 2001; 251: 49-56. PubMed  
  75. Edinger JD, Means MK, Carney CE et al. Psychomotor performance deficits and their relation to prior nights" sleep among individuals with primary insomnia. Sleep 2008; 31: 599–607.
  76. Backhaus J, Junghanns K, Born J et al. Impaired declarative memory consolidation during sleep in patients with primary insomnia: Influence of sleep architecture and nocturnal cortisol release. Biol Psychiatry 2006; 60: 1324–30. DOI: 10.1016/j.biopsych.2006.03.051 DOI  
  77. Morin CM, Rodrigue S, Ivers H. Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med 2003; 65: 259–67. PMID: 12651993 PubMed  
  78. Sivertsen B, Øverland S, Bjorvatn B et al. Does insomnia predict sick leave? The Hordaland Health Study. J Psychosom Res 2009; 66: 67–74. doi: 10.1016/j.jpsychores.2008.06.011 DOI  
  79. Sivertsen B, Øverland S, Neckelmann D et al. The long-term effect of insomnia on work disability: the HUNT-2 historical cohort study. Am J Epidemiol 2006; 163: 1018–24. PMID: 16611665 PubMed  
  80. Sørensen E. Søvn og utvikling hos barn og unge. Tidsskr Nor Lægeforen 2003; 123: 26-9. Tidsskrift for Den norske legeforening  
  • Bjørn Bjorvatn, professor dr.med., Institutt for global helse og samfunnsmedisin, Universitetet i Bergen, og leder for Nasjonal kompetansetjeneste for søvnsykdommer, Haukeland Universitetssykehus