Penderita insomnia kronis dapat menemukan bantuan dengan setengah dari dosis pil standar --T-REC-komunitas reptil-semarang--KSE-komunitas satwa eksotik

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Penderita insomnia kronis dapat menemukan bantuan dengan setengah dari dosis pil standar 

Date:

August 3, 2015

Source:

University of Pennsylvania School of Medicine

Summary:

Kira-kira sembilan juta orang Amerika yang mengandalkan pil tidur resep untuk mengobati insomnia kronis yang  mungkin bisa mendapatkan bantuan dari sesedikitnya setengah dari obat , dan bahkan dapat dibantu dengan mengambil plasebo dalam rencana pengobatan , menurut penelitian baru . 

............... Temuan , yang menganjurkan untuk strategi dosis dari dosis yang lebih kecil dan lebih sedikit obat tidur dan penggunaan plasebo , akan mengurangi jumlah obat yang diperlukan untuk mempertahankan efek obat dari waktu ke waktu . Pendekatan baru ini memungkinkan individu untuk memaksimalkan keuntungan klinis mereka sehubungan dengan proses  tidur sekaligus mengurangi efek samping dan memotong biaya obat resep ....more

Chronic insomnia
sufferers may find relief with half of standard pill dose

Findings point to use of placebos to help sufferers sleep

Date:

August 3, 2015

Source:

University of Pennsylvania School of Medicine

Summary:

The roughly nine million Americans who rely on prescription sleeping pills
to treat chronic insomnia may be able to get relief from as little as half of
the drugs, and may even be helped by taking placebos in the treatment plan,
according to new research. These findings starkly contrast with the standard
prescribing practices for chronic insomnia treatment.

.......................

The roughly nine million Americans who rely on prescription sleeping pills
to treat chronic insomnia may be able to get relief from as little as half of
the drugs, and may even be helped by taking placebos in the treatment plan,
according to new research published today in the journal Sleep Medicine by researchers from the Perelman School of Medicine at the University
of Pennsylvania. Their findings starkly contrast with the standard prescribing
practices for chronic insomnia treatment.

The findings, which advocate for a dosing strategy of smaller and fewer
doses of sleep drugs and use of placebos, would decrease the amount of
medication needed to maintain medication effects over time. The new approach
allows the individual to maximize their clinical gains with respect to falling
and staying asleep while reducing side effects and cutting prescription drug
costs.

Chronic insomnia is characterized by difficulty falling asleep or staying
asleep at least three nights a week for at least one month.

"The clinical effects of sleeping pills cannot be relied on to last
forever, and long-term use increases risk of psychological dependence and side
effects including daytime drowsiness, nausea, and muscle pain," said the
study's senior author Michael Perlis, PhD, an associate professor in Penn's
department of Psychiatry and director of the Penn Behavioral Sleep Medicine
Program. "Our research found that changing the industry standard for
maintenance therapy can maintain treatment responses and lower the incidence of
side effects."

The study treated 74 adults experiencing chronic insomnia with 10 mg of the
sleeping pill zolpidem (Ambien) for four weeks. Those responding to the
treatment were randomized into three dosing groups for 12 weeks: nightly dosing
with 10 mg or 5 mg, "intermittent dosing" of 10 mg 3 to 5 days a
week, or "partial reinforcement" through nightly pills in which half
were 10 mg capsules and half were placebo capsules.

All three strategies the team tested were effective in maintain peoples'
ability to fall and stay asleep, but those in the intermittent dosing group
slept worse and reported more medical symptoms and greater symptom severity
than those in the other dosing groups.

"When it comes to day-to-day quality of therapeutic outcomes, the
strategy we use most frequently, the intermittent doing strategy performed
worst," Perlis said. "Our findings also go against the standard
practice of 'start low and go slow,' in favor of a 'start high and go low'
dosing strategy in which a patient starts with 10 mg nightly and then when the
desired result is reached, switch to either a lower nightly dose or
intermittent dosing with placebos on non-medication nights."

The authors see the findings as a path diverting from the tendency to
increase dose over time, thus making use of these medications potentially safer
in the long run with the added benefit (in the case of nightly dosing with 5mg
or 10mg doses interspersed with placebos) of being up to 50 percent less
expensive. These savings could cut costs drastically for both consumers and
pharmaceutical companies (as consumers take a higher percentage of placebos,
the profit margin would be higher on placebos than it is on the drug).

"The full dose may or may not be required to get the initial
effect," said Perlis, "but certainly maintaining the effect can be
done with less medication."

The Penn study also offers the first data confirming that 5 mg can be
effective as a maintenance strategy. This supports the 2013 decision of the FDA
which required lowering the recommended dose of the sleep medication zolpidem
in non-elderly women, citing a risk of next-morning impairment, including
problems with alertness while driving.

"What is particularly novel about the present study is the use of
placebos on non-medication nights and that such a practice appears to extend a
level of therapeutic benefit that is not seen with intermittent dosing,"
Perlis said. "This effect is thought to occur owing not only to the
enhancement of patient expectancy but to the conditioning of medication
effects, i.e., the medication induced effects may be elicited, with
conditioning, by the medication capsule itself and that this can be sustained
over time with occasional use of full dose medication (partial
reinforcement)."

Perlis notes that if sufficient data can be gathered to show that such
conditioning is possible, in the future, this may influence how medications are
prescribed for maintenance therapy. That is, in the future, the prescriber may
not only indicate what drug, and what dose and/or what time of day to use the
medication, but also what starting dose and what schedule of medication and
placebo use is needed for maintenance therapy.







Story Source:

The above post is reprinted from materials provided byUniversity of Pennsylvania School of Medicine. Note:
Materials may be edited for content and length.







Journal Reference:

1.   
Michael Perlis, Michael Grandner, Jarcy Zee, Erin Bremer, Julia Whinnery,
Holly Barilla, Priscilla Andalia, Phil Gehrman, Knashawn Morales, Michael
Thase, Richard Bootzin, Robert Ader. Durability of treatment response
to zolpidem with three different maintenance regimens: a preliminary study. Sleep
Medicine, 2015; 16 (9): 1160 DOI: 10.1016/j.sleep.2015.06.015

http://www.sciencedaily.com/releases/2015/08/150803212516.htm

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