Sömnlöshet, insomni
Senast uppdaterad: Senast reviderad:
Sakkunnig:Athena Adeli
Definition:
En subjektiv känsla av dålig sömn trots tillrättalagda förhållanden, och som ger nedsatt funktion dagtid.
Förekomst:
Vanlig problemställning i primärvården. 10 % av den vuxna befolkningen beräknas ha besvär med sömnen.
Symtom:
Insomni kan uppträda sekundärt till både psykiska och medicinska tillstånd. Cirka hälften av de med insomni har en samtida psykisk sjukdom – vanligast är ångest eller depression.
Kliniska fynd:
Vissa patienter kan ha synliga tecken på sömnbrist, men oftast finns det en avsaknad av kliniska fynd.
Diagnostik:
Blodprover kan i vissa fall vara relevant för differentialdiagnostik. Sömndagbok bör användas för att rikta behandlingen mot långvariga sömnproblem.
Behandling:
Vid primär insomni är sömnrestriktion, sömnhygieniska råd och KBT förstahandsval. Läkemedel kan ges i andra hand som korttidsbehandling.
- International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
- Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675-700. PMID:28875581. PubMed
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 2013: American Psychiatric Publishing, Arlington, VA.
- Patel D, Steinberg J, Patel P. Insomnia in the Elderly: A Review. J Clin Sleep Med. 2018 Jun 15;14(6):1017-1024. doi: 10.5664/jcsm.7172. PMID: 29852897; PMCID: PMC5991956.
- 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. PubMed
- Suh S, Cho N, Zhang J. Sex Differences in Insomnia: from Epidemiology and Etiology to Intervention. Curr Psychiatry Rep. 2018;20(9):69. Published 2018 Aug 9. doi:10.1007/s11920-018-0940-9 DOI
- de Zambotti M, Goldstone A, Colrain IM, Baker FC. Insomnia disorder in adolescence: Diagnosis, impact, and treatment. Sleep Med Rev. 2018 Jun;39:12-24. doi: 10.1016/j.smrv.2017.06.009. Epub 2017 Jul 1. PMID: 28974427; PMCID: PMC5931364.
- 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
- SBU. Arbetsmiljöns betydelse för sömnstörningar. En systematisk litteraturöversikt. Stockholm: Elanders, 2013.
- Owens JA, Moore M. Insomnia in Infants and Young Children. Pediatric Annals, 46(9), e321–e326. 2017. doi:10.3928/19382359-20170816-02 DOI
- Regestein QR, Monk TH. Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry 1995; 152: 602-08.
- Zammit G. Subjective ratings of the characteristics and sequelae of good and poor sleep in normals. J Clin Psychol 1988; 44: 123-30. PubMed
- Stepanski E, Koshorek G, Zorick F, Glinn M, Roehrs T, Roth T. Characteristics of individuals who do or do not seek treatment for chronic insomnia. Psychosomatics 1989; 30: 421-27. PubMed
- Bjorvatn B, Sivertsen B, Øyane N, Nordhus IH, Pallesen S. Insomni. Tidsskr Nor Legeforen 2009; 129: 1766-8. Tidsskrift for Den norske legeforening
- Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994; 151: 1172 - 80. American Journal of Psychiatry
- 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
- Jespersen KV, Koenig J, Jennum P, et al. . Music for insomnia in adults. Cochrane Database Syst Rev. 2015. pmid:26270746 PubMed
- 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
- Zammit GK, Weiner J, Damato N, Sillup GP, McMillan CA. Quality of life in people with insomnia. Sleep 1999; 22 (suppl 2): S379-85.
- Hajak G. Epidemiology of severe insomnia and its consequences in Germany. Eur Arch Psychiatry Clin Neurosci 2001; 251: 49-56. PubMed
- Hatoum HT, Kania CM, Kong SX, Wong JM, Mendelson WB. Prevalence of insomnia: a survey of the enrollees at five managed care organizations . Am J Manag Care 1998; 4: 79-86. PubMed
- 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
- 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
- Seyffert M, Lagisetty P, Landgraf J, et al. Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis. PLoS One. 2016 Feb 11;11(2):e0149139. pmid: 26867139. PubMed
- Kay-Stacey M, Attarian H. Advances in the management of chronic insomnia. BMJ. 2016 Jul 6;354:i2123.PMID: 27383400.
- Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults published correction appears in JAMA Intern Med. 2019 Jun 17;:. Arch Intern Med. 2011;171(10):887-895. doi:10.1001/archinternmed.2010.535 DOI
- 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
- 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. pmid: 27136278. PubMed
- Solomon DH, Ruppert K, Habel LA, Finkelstein JS, Lian P, Joffe H, Kravitz HM. Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study. BMJ Open. 2021 May 11;11(5):e045074. doi: 10.1136/bmjopen-2020-045074. PMID: 33975865; PMCID: PMC8127972.
- 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
- Janusinfo: Region Stockholms läkemedelskommittés expertgrupp för psykisk hälsa. Melatonin – förstahandsval vid behandling av sömnstörning hos barn. Publicerad 2018-04-09. Hämtad 2020-07-08.
- Sateia MJ, Nowell PD. Insomnia. Lancet 2004; 364: 1959-73. PubMed
- Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, et al. Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis. BMJ 2006; 332: 385-8. British Medical Journal
- Atkin T, Comai S, Gobbi G. Drugs for Insomnia beyond Benzodiazepines: Pharmacology, Clinical Applications, and Discovery. Pharmacol Rev. 2018;70(2):197-245. PMID:29487083. PubMed
- Thunander Sundbom L, Fornstedt Wallin B, Wändel Liminga U, Nordmark Grass J, K Jönsson A, Nurminen ML. Sedativa antihistaminer – risk för allvarlig intoxikation Sedating antihistamines - risk of severe intoxication. Lakartidningen. 2021;118:21037. PMID:34590703. PubMed
- Monahan K, Cuzens-Sutton J, Siskind D, Kisely S. Quetiapine withdrawal: A systematic review. Aust N Z J Psychiatry. 2021;55(8):772-783. PMID:33059460. PubMed
- Modesto-Lowe V, Harabasz AK, Walker SA. Quetiapine for primary insomnia: Consider the risks. Cleve Clin J Med. 2021;88(5):286-294. Published 2021 May 3. PMID:33941603. PubMed
- RELIS. Finns det risker med användning av kvetiapin som sömnpreparat? Finns det någon risk för tillvänjning? RELIS database 2021; spm.nr. 860, LUPP. 2021-11-05 (hämtad 2022-11-28). relis.no
- Herxheimer A, Petrie KJ. Melatonin for preventing and treating jetlag. Cochrane Database Syst Rev. 2002;(2):CD001520. Assessed as up-to-date: 11 FEB 2008. DOI: 10.1002/14651858.CD001520. DOI
- Rajaratnam SMW, Polymeropoulos MH, Fisher DM, et al. Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. Lancet 2009; 373: 482-91. PubMed
- Liira J, Verbeek JH, Costa G, et al. Pharmacological interventions for sleepiness and sleep disturbances caused by shift work. Cochrane Database Syst Rev. 2014 Aug 12;8:CD009776. DOI: 10.1002/14651858.CD009776.pub2. DOI
- 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
- 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
- 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
- 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
- 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
- Janusinfo. Expertgruppsutlåtande, äldres hälsa. Sömnstörningar. Senast ändrad 2020-06-18. Senast hämtad 2020-06-19.
- Region Stockholms läkemedelskommittés expertgrupp för psykisk hälsa. Ta reda på orsaken innan du behandlar en sömnstörning. Hämtad 2022-04-18. janusinfo.se
- 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
- Daghlas I, Dashti HS, Lane J et al. Sleep Duration and Myocardial Infarction. J Am Coll Cardiol. 2019 Sep 10;74(10):1304-1314. PMID: 31488267 PubMed
- Winkelman JW, et al. CLINICAL PRACTICE. Insomnia Disorder. N Engl J Med. 2015 Oct 8;373(15):1437-44. PubMed
- Athena Adeli, ST-läkare internmedicin, S:t Görans sjukhus
- Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas