Intervenciones no farmacológicas en el insomnio primario: la evidencia de los ensayos clínicos controlados en los últimos diez años (1998–2008)

Article information

Resumen

Introducción

El insomnio es un trastorno del sueño que afecta al 10% de la población general e impacta a quien lo padece emocional, física y socialmente, por lo que es importante su adecuado diagnóstico y tratamiento.

Objetivo

Describir los principales hallazgos de las intervenciones no farmacológicas sobre insomnio primario según la metodología de ensayos clínicos controlados.

Método

Revisión sistemática durante febrero del 2009 en la base de datos de Ensayos Clínicos Controlados de Cochrane. Se seleccionaron artículos escritos en inglés, portugués o español publicados entre 1998 y 2008. Las palabras clave utilizadas fueron: primary insomnia, management, treatment y nonpharmacological. Se descartaron artículos sobre insomnio secundario, con sólo resultados preliminares y aquellos escritos en idioma diferente a los establecidos. Al final se analizaron 37 artículos.

Resultados

La modalidad de intervención más usada fue la combinación de técnicas cognitivo-conductuales (TCC). De manera general, todas las intervenciones tuvieron resultados positivos en la calidad del sueño. Las mejorías fueron de moderadas a altas y se mantuvieron a través del seguimiento. Según lo obtenido, el mejor tratamiento para el insomnio es la TCC, aunque otras opciones, como la máscara de luz, presentan resultados alentadores.

Conclusiones

Hay hallazgos ciertos sobre los beneficios de las intervenciones no farmacológicas en el insomnio primario, con más estudios referentes a la TCC. Se plantea la necesidad de realizar estudios que evalúen dosis respuesta y la costo-efectividad de estas intervenciones.

Palabras clave:

Insomnio

revisión

intervención no farmacológica

Abstract

Introduction

Insomnia is the most common sleep disorder and it affects approximately 10% of the world's population causing a negative impact on sufferers' emotional, physical, and social wellbeing. Several non–pharmacological treatments have been developed that appear to be effective.

Objective

To analyze the main findings on primary insomnia. Methodology: During February 2009, a systematic review was undertaken using the Cochrane Database of Controlled Clinical Trials. A selection was made of articles written in English, Portuguese, and Spanish published between 1998 and 2008. The key words used were: primary insomnia, management, treatment and non–pharmacological. An analysis was carried out on 37 articles.

Results

In general, all interventions had positive effects on the quality of sleep. With most of the combined techniques, the improvements were moderate–to–high and they were maintained through follow-up. According to the evidence gathered, the best non–pharmacological treatment was Cognitive Behavioral Therapy (CBT) although other intervention options such as Light Exposure produced encouraging results. The non–pharmacological approach gave better long–term results than pharmacological treatments.

Conclusions

There is evidence of the benefits of non–pharmacological interventions for primary insomnia. Further research is necessary to evaluate the dose–response ratio and the cost–effectiveness of treatments.

Key words:

Primary

review

non-pharmacological intervention

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Referencias

[1]

American Academy of Sleep Medicine (AASM).

International classification of sleep disorders: Diagnostic and coding manual, 2ed, AASM, (2005),

[2]

T Roth.

Insomnia: definition, prevalence, etiology and consequences.

J Clin Sleep Med, 5 (2007), pp. S710

[3]

GK Zammit.

The prevalence, morbidities, and treatments of insomnia.

CNS Neurol Disord Drug Targets, 6 (2007), pp. 316

[4]

NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults.

NIH Consens Sci Statements, 22 (2005), pp. 1-30

[5]

M Blanco, N Kriber, DP Cardinali.

Encuesta sobre dificultades del sueño en una población urbana lationamericana.

Rev Neurol, 39 (2004), pp. 115-119

Medline

[6]

R Alvarado.

Frecuencia del insomnio en México.

Arch Neurocien, 2 (1997), pp. 11421

[7]

JL Acosta Patiño, EA Jímenez Balderas.

Prevalencia de insomnio en pacientes adscritos a la Unidad de Medicina Familiar No. 43 del IMSS, delegación Tabasco.

Salud Tab, 4 (1998), pp. 2202

[8]

CE Carney, JD Edinger, B Meyer, et al.

Daily activities and sleep quality in college students.

Chronobiol Int, 23 (2006), pp. 623-637

http://dx.doi.org/10.1080/07420520600650695 | Medline

[9]

CL Drake, T Roehrs, T Roth.

Insomnia causes, consequences, and therapeutics: an overview.

Depress Anxiety, 18 (2003), pp. 163-176

http://dx.doi.org/10.1002/da.10151 | Medline

[10]

WM Glazer.

Importance of recognizing and treating insomnia.

J Clin Psychiatry, 67 (2006), pp. 34

Medline

[11]

T Roth.

Prevalence, associated risks, and treatment patterns of insomnia.

J Clin Psychiatry, 66 (2005), pp. 10-13

Medline

[12]

O Médina, N Sánchez, J Conejo, et al.

Alteraciones del sueño en los trastornos psiquiátricos.

Rev Colomb Psiquiat, 36 (2007), pp. 701-717

[13]

H Pallos, V Gergely, N Yamada, S Miyazaki, M Okawa.

The quality of sleep and factors associated with poor sleep in Japanese graduate students.

Sleep Biol Rhythms, 5 (2007), pp. 2348

[14]

BM Roane, DJ Taylor.

Adolescent insomnia as a risk factor for early adult depression and substance abuse.

Sleep, 31 (2008), pp. 13516

[15]

JK Walsh.

Pharmacologic management of insomnia.

J Clin Psychiatry, 65 (2004), pp. 415

[16]

R HaroValencia.

Roncan o padecen insomnio crónico alrededor del 10 por ciento de los mexicanos [internet] 2007. [citado: 09.03.2009].

Disponible en: http://www.universia.net.mx/index.php/news_user/content/view/full/51128

[17]

S Passarella, MT Duong.

Diagnosis and treatment of insomnia.

Am J Health Syst Pharm, 65 (2008), pp. 92734

[18]

FC Brown, WC Buboltz Jr, B Soper.

Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students.

Behav Med, 28 (2002), pp. 338

[19]

GS Passos, S Tufik, MG Santana, et al.

Nonpharmacologic treatment of chronic insomnia.

Rev Bras Psiquiatr, 29 (2007), pp. 27982

[20]

CM Morin, RR Bootzin, DJ Buysse, et al.

Psychological and behavioral treatment of insomnia: update of the recent evidence (19982004).

Sleep, 29 (2006), pp. 1398414

[21]

A Germain, DE Moul, PL Franzen, et al.

Effects of a brief behavioral treatment for latelife insomnia: preliminary findings.

J Clin Sleep Med, 2 (2006), pp. 4036

[22]

L Friedman, K Benson, A Noda, et al.

An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults.

J Geriatr Psychiatry Neurol, 13 (2000), pp. 1727

[23]

C Kirisoglu, C Guilleminault.

Twenty minutes versus fortyfive minutes morning bright light treatment on sleep onset insomnia in elderly subjects.

J Psychosom Res, 56 (2004), pp. 53742

[24]

KL Lichstein, BW Riedel, NM Wilson, et al.

Relaxation and sleep compression for latelife insomnia: a placebo-controlled trial.

J Consult Clin Psychol, 69 (2001), pp. 22739

[25]

K Morgan, S Dixon, N Mathers, et al.

Psychological treatment for insomnia in the management of longterm hypnotic drug use: a pragmatic randomised controlled trial.

Br J Gen Pract, 53 (2003), pp. 9238

[26]

CM Morin, F Blais, J Savard.

Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia?.

Behav Res Ther, 40 (2002), pp. 74152

[27]

CM Morin, C Bastien, B Guay, et al.

Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia.

Am J Psychiatry, 161 (2004), pp. 33242

[28]

CM Morin, C Colecchi, J Stone, et al.

Behavioral and pharmacological therapies for latelife insomnia: a randomized controlled trial.

JAMA, 281 (1999), pp. 9919

[29]

CN Semler, AG Harvey.

Daytime functioning in primary insomnia: does attentional focus contribute to real or perceived impairment?.

Behav Sleep Med, 4 (2006), pp. 85103

[30]

B Sivertsen, S Omvik, S Pallesen, et al.

Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial.

JAMA, 295 (2006), pp. 28518

[31]

JP Soeffing, KL Lichstein, SD Nau, et al.

Psychological treatment of insomnia in hypnoticdependant older adults.

Sleep Med, 9 (2008), pp. 16571

[32]

LK Suen, TK Wong, AW Leung, et al.

The longterm effects of auricular therapy using magnetic pearls on elderly with insomnia.

Complement Ther Med, 11 (2003), pp. 8592

[33]

A Usui, Y Ishizuka, Y Matsushita, et al.

Bright light treatment for nighttime insomnia and daytime sleepiness in elderly people: comparison with a shortacting hypnotic.

Psychiatry Clin Neurosci, 54 (2000), pp. 3746

[34]

KB Kim, SR Sok.

Auricular acupuncture for insomnia: duration and effects in Korean older adults.

J Gerontol Nurs, 33 (2007), pp. 238

[35]

CH Bastien, CM Morin, MC Ouellet, et al.

Cognitivebehavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations.

J Consult Clin Psychol, 72 (2004), pp. 6539

[36]

CA Espie, SJ Inglis, S Tessier, et al.

The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice.

Behav Res Ther, 39 (2001), pp. 4560

[37]

CA Espie, KM MacMahon, HL Kelly, et al.

Randomized clinical effectiveness trial of nurseadministered smallgroup cognitive behavior therapy for persistent insomnia in general practice.

Sleep, 30 (2007), pp. 57484

[38]

JD Edinger, WS Sampson.

A primary care “friendly” cognitive behavioral insomnia therapy.

Sleep, 26 (2003), pp. 17782

[39]

JD Edinger, WK Wohlgemuth, RA Radtke, et al.

Doseresponse effects of cognitivebehavioral insomnia therapy: a randomized clinical trial.

Sleep, 30 (2007), pp. 20312

[40]

V Mimeault, CM Morin.

Selfhelp treatment for insomnia: bibliotherapy with and without professional guidance.

J Consult Clin Psychol, 67 (1999), pp. 5119

[41]

L Ström, R Pettersson, G Andersson.

Internetbased treatment for insomnia: a controlled evaluation.

J Consult Clin Psychol, 72 (2004), pp. 11320

[42]

CE Carney, WF Waters.

Effects of a structured problemsolving procedure on presleep cognitive arousal in college students with insomnia.

Behav Sleep Med, 4 (2006), pp. 1328

[43]

JD Edinger, WK Wohlgemuth, RA Radtke, et al.

Does cognitivebehavioral insomnia therapy alter dysfunctional beliefs about sleep?.

Sleep, 24 (2001), pp. 5919

[44]

JD Edinger, WK Wohlgemuth, RA Radtke, et al.

Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial.

JAMA, 285 (2001), pp. 185664

[45]

M Jansson, SJ Linton.

Cognitivebehavioral group therapy as an early intervention for insomnia: a randomized controlled trial.

J Occup Rehabil, 15 (2005), pp. 17790

[46]

M Viens, J De Koninck, P Mercier, et al.

Trait anxiety and sleeponset insomnia: evaluation of treatment using anxiety management training.

J Psychosom Res, 54 (2003), pp. 317

[47]

GD Jacobs, EF PaceSchott, R Stickgold, MW Otto.

Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.

Arch Intern Med, 164 (2004), pp. 188896

[48]

A Vallières, CM Morin, B Guay, et al.

Sequential treatment for chronic insomnia: a pilot study.

Behav Sleep Med, 2 (2004), pp. 94112

[49]

A Vallières, CM Morin, B Guay.

Sequential combinations of drug and cognitive behavioral therapy for chronic insomnia: an exploratory study.

Behav Res Ther, 43 (2005), pp. 161130

[50]

WF Waters, MJ Hurry, PG Binks, et al.

Behavioral and hypnotic treatments for insomnia subtypes.

Behav Sleep Med, 1 (2003), pp. 81101

[51]

R Wu, J Bao, C Zhang, et al.

Comparison of sleep condition and sleeprelated psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia.

Psychother Psychosom, 75 (2006), pp. 2208

[52]

CE Carney, JD Edinger.

Identifying critical beliefs about sleep in primary insomnia.

Sleep, 29 (2006), pp. 34250

[53]

AG Harvey, S Payne.

The management of unwanted presleep thoughts in insomnia: distraction with imagery versus general distraction.

Behav Res Ther, 40 (2002), pp. 26777

[54]

AG Harvey.

The attempted suppression of presleep cognitive activity in insomnia.

Cognit Ther Res, 27 (2003), pp. 593602

[55]

CM Morin, S BeaulieuBonneau, M LeBlanc, et al.

Selfhelp treatment for insomnia: a randomized controlled trial.

Sleep, 28 (2005), pp. 131927

[56]

L Lack, H Wright, K Kemp, et al.

The treatment of earlymorning awakening insomnia with 2 evenings of bright light.

Sleep, 28 (2005), pp. 61623

[57]

L Lack, H Wright, D Paynter.

The treatment of sleep onset insomnia with bright morning light.

Sleep Biol Rhythms, 5 (2007), pp. 1739

[58]

CA Espie.

“Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment.

Sleep, 32 (2009), pp. 154958

[59]

MY Wang, SY Wang, PS Tsai.

Cognitive behavioural therapy for primary insomnia: a systematic review.

J Adv Nurs, 50 (2005), pp. 55364

[60]

R SalínPascual.

Elementos de medicina de los trastornos del dormir, Lulu.com, (2009),

[61]

U.S. Preventive Task Force.

Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions, Williams and Wilkins, (1989),

Conflictos de interés: las autoras manifiestan que no tienen conflictos de interés en este artículo.

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