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Objective To explore the effect of two different exercise modes on sleep quality of patients with primary insomnia (PI), and to provide a new perspective and approach for the treatment of insomnia. Methods By convenient sampling, a total of 16 male and 24 female insomniacs were randomly selected from No. 169 PLA Hospitals from 2017 to 2018. A single blind trial was conducted and aerobic training (AT) group and aerobic combined resistance training (AR) group were divided. Twenty people in each group were given exercise prescription for 4 months.Results (J) Compared with pre-experiment, there were significant differences in total sleep time, sleep efficiency, wake-up times, rapid eye movement (REM) sleep latency, non-REM sleep stage I, II, III - IV and REM sleep between AT group and AR group after the experiment, showing the prolonged total sleep time, improved sleep efficiency, reduced number of awakenings and shortened latency of REM sleep. (2) No significant difference between AT group and AR group was found in sleep latency, wake-up times after sleep, stage I and II of non-REM sleep and lowest oxygen saturation; while there were significant differences in the non-REM sleep stage III - IV and REM sleep stages with an increased total sleep time and the longer deep sleep time. (D The serum levels of IL-1β, IL-6 and TNF-α in the patients after the experiment were significantly lower than that before the experiment. (4)After the experiment, there was no significant difference in serum IL-1β and TNF-α between the AT group and the AR group, while significant difference was found in IL-6. Conclusions (1)Most of PI patients have normal sleep structure, which belongs to subjective insomnia. Exercise can improve the sleep quality of patients by regulating the bad emotions such as tension and anxiety and inhibiting the over-awakening state. (2) During resistance training, IL-6 released by skeletal muscle is involved in the immune regulation of the body and reduces the inflammatory response, thus improving the sleep quality of patients to a certain extent. (3) Both aerobic training and aerobic combined resistance training have a good effect on the improvement of sleep quality of PI patients; the latter is more prominent, mainly manifested in the further extension of the total sleep time. [ABSTRACT FROM AUTHOR]

Suvorexant is a dual orexin receptor agonist and is currently approved for the treatment of insomnia in the United States and Japan. We conducted a systematic review and meta-analysis to assess the efficacy and safety of suvorexant for the treatment of primary insomnia. We searched PubMed, EMBASE, and the Cochrane central register of controlled trials, contacted a relevant pharmaceutical company, and accessed websites of the U.S. Food and Drug Administration (FDA) and Pharmaceuticals and Medical Devices Agency (PMDA) for published and unpublished data. A total of four randomized trials involving 3076 patients with primary insomnia were included in our analysis. Our analysis suggested that suvorexant was associated with significant improvements in subjective time to sleep onset, subjective total sleep time, and subjective quality of sleep at 1 mo and 3 mo. Somnolence, fatigue, and abnormal dreams were the most common adverse effects. We concluded that suvorexant was associated with improvement in some sleep parameters and some adverse effects. To determine the place of suvorexant in the treatment of insomnia, comparative effectiveness trials are needed. [ABSTRACT FROM AUTHOR]

Introduction Primary insomnia is defined as sleeplessness that cannot be attributed to a medical, psychiatric, or environmental cause. This systematic review of randomised controlled trials (RCTs) evaluated the efficacy and safety of acupuncture and/or moxibustion for primary insomnia compared with western or Chinese medicine. Methods Seven databases were searched for RCTs where acupuncture and/or moxibustion was the main intervention for primary insomnia. Effectiveness rate and the Pittsburgh Sleep Quality Index (PSQI) were primary outcomes. The protocol was registered in PROSPERO (CRD42016051984). Results Fifty-seven studies involving 4140 participants were included. The risk of bias was generally high. There were significant differences in effectiveness rate (acupuncture vs. western medicine, acupuncture plus western medicine vs. western medicine, acupuncture plus oral Chinese medicine vs. oral Chinese medicine, acupuncture plus moxibustion vs. western medicine, acupuncture plus moxibustion vs. acupuncture, and moxibustion vs. western medicine) and PSQI (acupuncture vs. western medicine, acupuncture plus western medicine vs. western medicine, and acupuncture plus moxibustion vs. western medicine). No significant difference was found in effectiveness rate (moxibustion plus oral Chinese medicine vs. oral Chinese medicine) and PSQI (acupuncture vs. sham acupuncture). Acupuncture and/or moxibustion might be associated with few adverse effects and potential long-term positive effects. Conclusions These findings indicated that acupuncture and/or moxibustion may be effective for primary insomnia although no significant difference in effectiveness rate (moxibustion plus oral Chinese medicine vs. oral Chinese medicine) and PSQI (acupuncture vs. sham acupuncture). Current evidence is insufficient. The safety and long-term effects are still uncertain. Higher quality RCTs are warranted. [ABSTRACT FROM AUTHOR]

Animal and human studies have shown that disorders of the autonomic nervous system may influence sleep physiology. Conversely, sleep disorders may be associated with autonomic dysfunctions. The current review describes the clinical presentation, supposed pathogenetic mechanisms and the diagnostic and prognostic implications of impaired cardiovascular autonomic control in sleep disorders. This dysfunction may result from a common pathogenetic mechanism affecting both autonomic cardiovascular control and sleep, as in fatal familial insomnia, or it may be mainly caused by the sleep disorder, as observed in obstructive sleep apnoea. For other sleep disorders, like primary insomnia, restless legs syndrome, narcolepsy type 1 and rapid eye movement sleep behaviour disorder, the causal link with the autonomic dysfunction and its possible impact on health remains unsettled. Given its clinical implications, most of the data available suggest that a systematic assessment of the association between sleep disorders and impaired autonomic control of the cardiovascular system is warranted. Understanding the mechanism of this association may also yield insights into the interaction between the autonomic nervous system and sleep. [ABSTRACT FROM AUTHOR]

Abstract: Background: To determine the relative efficacy of acupuncture and zolpidem in the treatment of primary insomnia, we administered a sleep quality scale to thirty-three patients with primary insomnia randomly chosen to receive one of the two therapies at a psychosomatic clinic. Methods: A study in the psychosomatic clinic at a teaching hospital in southern Taiwan from November 2007 to November 2008. The 19 patients in acupuncture group underwent one acupuncture session a week. The 14 patients in the control group took zolpidem 1# (10mg) every night. Members of both groups returned to our clinic once a week for four weeks. The main outcome measure was the Pittsburgh Sleep Quality Index (PSQI). Results: Both groups were found to have improved significantly. Using generalized estimating equation analysis to test the variance with group and time as factors, we found both groups improved over time at a similar rate (p =0.79). In regression analysis, setting the fourth total PSQI score to zero, the baseline PSQI score was 4.13 (p <0.001), the second score 1.32 (p =0.005), and the third 1.49 (p =0.03); men had a higher PSQI score 1.56 than women (p =0.02); the increasing age of one year would have lower PSQI score 0.08 (p <0.001) and increasing educational level of one year which would decrease PSQI score 0.25 (p =0.007). Conclusions: Acupuncture might be used as an alternative strategy compared to zolpidem for the treatment of primary insomnia. [Copyright &y& Elsevier]

Summary: In the past few years it has become increasingly clear that insomnia is a chronic disease that interacts with many other medical conditions. As our ability to examine complex physiological activity during sleep has increased, additional evidence continues to suggest that insomnia is associated with inappropriate physiological arousal. It is now known that patients with primary insomnia have increased high-frequency EEG activation, abnormal hormone secretion, increased whole body and brain metabolic activation, and elevated heart rate and sympathetic nervous system activation during sleep. This activation can be measured throughout the day and night and is chronic. Other research suggests that insomnia, probably based upon the associated chronic physiologic arousal, is associated with increased risk for medical disorders such as depression, hypertension, or cardiac disease. An animal model that has used odor stress to produce poor sleep in rats has identified specific activated brain sites similar to those found in human brain metabolic studies to suggest that insomnia is a state in which sleep and arousal systems are both simultaneously active. The animal studies have also shown that the inappropriate arousal can be blocked by lesions in the limbic and arousal systems. It is hoped that these findings can be extended to identify new compounds that improve insomnia by acting at these sites of abnormal brain activation. [Copyright &y& Elsevier]

Objectives: To evaluate the clinical efficacy and safety of zolpidem extended release for the treatment of primary insomnia in elderly patients. Methods: A randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted. A total of 205 (117 women, 88 men; mean age 70.2 ± 4.5 years) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined primary insomnia patients were randomized to 3 weeks of nightly treatment with either zolpidem extended release 625 mg or placebo; 198 patients completed the study. Results: Relative to placebo, zolpidem extended release 625 mg significantly decreased wake time after sleep onset during the first six hours of the night, as measured by polysomnogram (PSG). PSG latency to persistent sleep was reduced and PSG total sleep time was increased, both at nights 1/2 and 15/16 Patient self-report measures were significantly better with zolpidem extended-release 625 mg than with placebo throughout treatment. Some PSG measures indicated a worsening of sleep for a single night after abrupt discontinuation of zolpidem extended release. No next-morning residual effects were observed. The overall incidence and nature of adverse events was comparable between the two groups. Conclusions: Zolpidem extended release 625 mg improved both sleep maintenance and sleep induction in elderly primary insomnia patients during three weeks of administration. [ABSTRACT FROM AUTHOR]

Summary: Insomnia has usually been studied from a behavioral perspective. Somatic and/or cognitive conditioned arousal was shown to play a central role in sleep complaints becoming chronic, and was used as a starting point for the development of treatment modalities. The introduction of the neurocognitive perspective, with its focus on cortical or CNS arousal, has given rise to a renewed interest in the neurophysiological characteristics of insomnia. Recent research, using quantitative EEG, neuroimaging techniques and the study of the microstructure of sleep, suggests a state of hyperarousal with a biological basis. Furthermore, insomnia might not be restricted to sleep complaints alone because it appears to be a 24-h disorder, affecting several aspects of daytime functioning as well. These new findings have implications for the treatments used and indicate that a focus on cortical or CNS arousal should be pursued. As such, the use of EEG neurofeedback, a self-regulation method based on the paradigm of operant conditioning, might be a promising treatment modality. Preliminary results for insomnia and successful applications for other disorders suggest that this treatment can have the necessary stabilizing effects on the EEG activity, possibly resulting in a normalizing effect on daytime as well as nighttime functioning. [Copyright &y& Elsevier]

The efficacy and safety of dual orexin receptor antagonists (DORAs) for primary insomnia have been well verified in several large randomized controlled trials (RCTs) over the past several decades. However, there have been few systematic comparisons of different DORAs, and the best DORA for insomniacs has remained unclear. Here, Medline, Embase, Cochrane library, and clinicaltrials.gov were searched for RCTs (through December 31, 2020) to evaluate different DORAs versus a placebo. We pooled data from 13 RCTs. DORAs were superior to the placebo in all efficacy outcomes except the subjective number of awakenings (P = 0.90), but also showed higher risks of somnolence, abnormal dreams, fatigue, and dry mouth (somnolence: P < 0.00001; abnormal dreams: P = 0.03; fatigue: P = 0.001; dry mouth: P = 0.007). No statistical differences were found between any two of the DORAs in terms of primary efficacy outcomes. However, lemborexant yielded the three-highest surfaces under the curve ranking area (SUCRA) values (78.25%, 96.25% and 89.13%). Taken together, we conclude that DORAs are superior to the placebo in terms of efficacy and safety measures. [ABSTRACT FROM AUTHOR]

Zusammenfassung Bei auffallend vielen Patienten mit Schlafstörungen kam es durch Nadelung einer bisher unbekannten Zone, die jeweils auch als tastbare Verquellung lateral der von Yamamoto beschriebenen Gehirnpunkte zu lokalisieren ist, zu schneller Ermüdung. Die meisten Patienten fielen schon während der Akupunktur in einen leichten Schlaf. Die Verbesserung des Nachtschlafs trat nach drei bis fünf Sitzungen ein und hielt über einen Beobachtungszeitraum von zwölf Monaten an. Anhand von kurzen Fallberichten über die Erfahrungen von zehn Patienten soll diese neue Zone vorgestellt werden. Remarkably often, patients suffering from sleep disorders tired rapidly after needling of a hitherto not recognized zone, which will be localized as a palpable maceration laterally situated from the brain points described by Yamamoto. The majority of patients dozed off even during acupuncture. Onset of improvement of night's sleep occurred after three to five sessions and was sustained through an observation period of twelve months. Based on brief case reports of ten patients, this newly detected zone will be depicted. [ABSTRACT FROM AUTHOR]