![]() ![]() To date, four main systems interacting to regulate sleep are known. ![]() The NREM sleep is divided into three stages: N1, N2, and N3 (N3 also defined as “slow waves sleep”, SWS). Thanks to the application of recent discoveries and techniques and the development of sleep medicine, during the last decade, much knowledge has been acquired about the inner mechanisms that promote, induce, maintain, and interrupt the sleep itself, how its processes take place, and how anatomical sites and their neuronal systems work.ĭifferent modes of sleep exist, based on the presence or absence of rapid eye movements, respectively, rapid eye movements-REM sleep, and non-rapid eye movements-NREM sleep. The sleep is one of the most complex and dynamic cerebral phenomena, resulting from the combination or alternation of multiple neurophysiological and neuro-biochemical active processes. Keywords: Sleep Insomnia Pharmacological Treatment Non-pharmacological treatment Cognitive-behavioral therapy for insomnia (CBT-I) A combined (non-pharmacological and pharmacological) approach could be considered in poor responders to manage drug dependence and to increase compliance to treatment and patients’ quality of life. In clinical practice, the usual therapeutic approach is pharmacological (benzodiazepines, z drugs, slow wave sleep enhancers), even if the American Academy of Sleep Medicine (AASM), the American College of Physicians (ACP), and the European Sleep Research Society (ESRS) guidelines suggest that the first clinical choice should be non-pharmacological (cognitive behavioral therapy). According to the International Classification of Sleep Disorders 3 rd edition, ICSD-3, it has been defined as chronic (lasting more than three months) or short-term insomnia (less than three months). Among the typical symptoms, there are fatigue, decreased mood or irritability, general malaise, and cognitive impairment. It is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep and that results in some form of daytime impairment. Insomnia is the most prevalent sleep disorder (10-40%). Cognitive-Behavioral and Pharmacological Treatments for Insomnia: A Combined ApproachĪlessandro Cicolin 1, Alessandra Giordano 1ġ Sleep Medicine Center, Department of Neuroscience, University of Torino, Torino, Italy ![]()
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