Department of Psychosocial Science, University of Bergen, P.O. Box 7807, N-5020 Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Jonas Lies vei 65, 5021 Bergen, Norway. Electronic address: firstname.lastname@example.org.
We aimed to investigate the 10-year trend in the prevalence of insomnia symptoms, insomnia cases, and use of hypnotic agents in the adult Norwegian population.
Data from two representative surveys assessing identical insomnia symptoms in the adult population of Norway, one conducted in 1999-2000 (N=2001) and one conducted in 2009-2010 (N=2000), were compared.
Controlling for basic demographic variables, significant increases were found over the 10-year study period in the prevalence of sleep-onset insomnia from 13.1% to 15.2%, dissatisfaction with sleep from 8.2% to 13.6%, daytime impairment from 14.8% to 18.8%, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) insomnia cases from 11.9% to 15.5%, and hypnotic agent use from 6.9% to 11.1%. No secular trend was found for maintenance insomnia or for early morning awakening insomnia. Across the two surveys, women reported a higher prevalence of insomnia than men. Age was positively associated with the prevalence of nocturnal sleep problems and use of hypnotic agents but was inversely associated with daytime impairment. Individuals with low socioeconomic status (SES) reported a higher prevalence of several insomnia symptoms.
Insomnia seems to be on the rise in the general adult population, which gives reason for concern. Prevention of insomnia and cost-effective interventions should receive higher priority in the future.
The adrenal response in critically ill patients, including trauma victims, has been debated over the last decade. The aim of this study was to assess the early adrenal response after trauma.
Prospective, observational study of 50 trauma patients admitted to a level-1-trauma centre. Serum and saliva cortisol were followed from the accident site up to five days after trauma. Corticosteroid binding globulin (CBG), dehydroepiandrosterone (DHEA) and sulphated dehydroepiandrosterone (DHEAS) were obtained twice during the first five days after trauma. The effect of time and associations between cortisol levels and; severity of trauma, infusion of sedative/analgesic drugs, cardiovascular dysfunction and other adrenocorticotropic hormone (ACTH) dependent hormones (DHEA/DHEAS) were studied.
There was a significant decrease over time in serum cortisol both during the initial 24 h, and from the 2nd to the 5th morning after trauma. A significant decrease over time was also observed in calculated free cortisol, DHEA, and DHEAS. No significant association was found between an injury severity score = 16 (severe injury) and a low (
Advertisements for psychotropic drugs which appeared in the leading medical journals in Finland, Sweden and Denmark were analyzed to identify the picture content and trends in advertising between 1975 and 1985. The most common picture was a metaphor, the frequency of which increased in the 1980s. The second largest picture category was a patient, the rate of which remained constant during the study period. Both the use of a metaphor and a patient was related to the low sales of the drug in respective country whereas picture of a drug package was related to a stable market position of a drug in the country. The patients were increasingly depicted as men in the Danish and Swedish journal whereas the pictures of females were most common in the Finnish one. The portrayal of working persons, especially office workers and teachers, was a new feature in the advertisements in the 1980s. It is argued that the drug industry still uses gender as a device to expand their market of psychotropic drugs in a new way.
The present study used analyses of data from five surveys of the same population over a 6-year period to examine the relationship of use of tranquilizers/sleeping pills with gender, age and use of other psychoactive substances. Part of the study involved identifying methodological issues in using surveys to study tranquilizer/sleeping pill use. Across surveys and within all age groups, females were more likely to use tranquilizers and/or sleeping pills than males, with an average ratio overall of a little higher than three to two (varying across surveys from 1.4 to 2.1; mode of 1.6). Prevalence rates for both females and males were strongly affected by timeframe over which use was measured. Use of tranquilizers/sleeping pills increased with age; however, the relationship with age was different for tranquilizers than for sleeping pills. For tranquilizers, the high correlation between age and use was largely attributable to the low rate of use by those aged 34 and younger. For sleeping pills, on the other hand, the relationship is based more on the high rate of use by those aged 65 and older. In addition, age was a major factor in nonmedical use of tranquilizers/sleeping pills, with nonmedical use decreasing dramatically with age. Use of other types of psychoactive medications was significantly higher among tranquilizer/sleeping pill users than among non-users. The results pertaining to concurrent use of tranquilizers/sleeping pills and alcohol, marijuana, and tobacco, however, showed some trends, but findings were not consistent across all surveys. Further analyses suggested that this lack of consistent findings might be attributable to survey design issues, in particular, the extent that the format of the survey question tended to exclude nonmedical users. The implications of these results for future research on tranquilizer/sleeping pill use are discussed.
Hospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its determinants including the use of drugs with sedating properties.
This single-centre prospective study involved an assessment of sleep quality for consenting patients admitted to the general medicine and family practice units of an acute care Canadian hospital. A validated Verran and Snyder-Halpern (VSH) Sleep Scale measuring sleep disturbance, sleep effectiveness, and sleep supplementation was completed daily by patients and scores were compared to population statistics. Patients were also asked to identify factors influencing sleep while in hospital, and sedating drug use prior to and during hospitalization was also assessed.
During the 70-day study period, 100 patients completed at least one sleep questionnaire. There was a relatively even distribution of males versus females, most patients were in their 8th decade of life, retired, and suffered from multiple chronic diseases. The median self-reported pre-admission sleep duration for participants was 8 hours and our review of PharmaNet profiles revealed that 35 (35%) patients had received a dispensed prescription for a hypnotic or antidepressant drug in the 3-month period prior to admission. Benzodiazepines were the most common sedating drugs prescribed. Over 300 sleep disturbance, effective and supplementation scores were completed. Sleep disturbance scores across all study days ranged 16-681, sleep effectiveness scores ranged 54-402, while sleep supplementation scores ranged between 0-358. Patients tended to have worse sleep scores as compared to healthy non-hospitalized US adults in all three scales. When compared to US non-hospitalized adults with insomnia, our patients demonstrated sleep disturbance and supplementation scores that were similar on Day 1, but lower (i.e. improved) on Day 3, while sleep effectiveness were higher (i.e. better) on both days. There was an association between sleep disturbance scores and the number of chronic diseases, the presence of pain, the use of bedtime tricyclic antidepressants, and the number of chronic diseases without pain. There was also an association between sleep effectiveness scores and the length of hospitalization, the in hospital use of bedtime sedatives and the presence of pain. Finally, an association was identified between sleep supplementation scores and the in hospital use of bedtime sedatives (tricyclic antidepressants and loxapine), and age. Twenty-nine (29%) patients received a prescription for a hypnotic drug while in hospital, with no evidence of pre-admission hypnotic use. The majority of these patients were prescribed zopiclone, lorazepam or another benzodiazepine.
The results of this study reveal that quality of sleep is a problem that affects hospitalized adult medical service patients and a relatively high percentage of these patients are being prescribed a hypnotic prior to and during hospitalization.
Cites: Med Lett Drugs Ther. 2000 Aug 7;42(1084):71-210932303
Answering comments on the letter of J.O. Hörnquist. An expression of concern on the paper 'Sleep and hypnotic use in relation to perceived somatic and mental health among the elderly' by Dr Ragnar Asplund (Arch. Gerontol. Geriatr. 31, 199-205 (2000)), which appeared in Arch. Gerontol. Geriatr. 35, 189-192 (2002).
The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368. In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p
To investigate the associations of social support at work and in private life with sleeping problems and use of sleep medication.
In the nationwide Health 2000 Study, with a cohort of 3430 employees, social support at work and in private life, and sleep-related issues were assessed with self-assessment scales. Purchases of sleep medication over a 3-year period were collected from the nationwide pharmaceutical register of the Social Insurance Institution.
Low social support from supervisor was associated with tiredness (odds ratio [OR] 1.68, 95% confidence interval [CI] = 1.26 to 2.23) and sleeping difficulties within the previous month (OR 1.74, 95% CI = 1.41 to 1.92). Low support from coworkers was associated with tiredness (OR 1.55, 95% CI = 1.41 to 1.92), sleeping difficulties within the previous month (OR 1.77, 95% CI = 1.32 to 2.36), and only among women, with short sleep duration (OR 2.06, 95% CI = 1.22 to 3.47). Low private life support was associated with short sleep duration (OR 1.49, 95% CI = 1.13 to 1.98) and among women, with sleeping difficulties (OR 1.46, 95% CI = 1.08 to 1.33).
Low social support, especially at work, is associated with sleeping-related problems.