Using recreational cannabis to treat insomnia: Evidence from over-the-counter sleep aid sales in Colorado

This study seeks to understand whether people substitute between recreational cannabis and conventional over-the-counter (OTC) sleep medications. UPC-level grocery store scanner data in a multivariable panel regression design were used to compare the change in the monthly market share of sleep aids with varying dispensary-based recreational cannabis access (existence, sales, and count) in Colorado counties between 12/2013 and 12/2014. We measured annually-differenced market shares for sleep aids as a portion of the overall OTC medication market, thus accounting for store-level demand shifts in OTC medication markets and seasonality, and used the monthly changes in stores’ sleep aid market share to control for short-term trends. Relative to the overall OTC medication market, sleep aid market shares were growing prior to recreational cannabis availability. The trend reverses (a 236% decrease) with dispensary entry (−0.33 percentage points, 95% CI −0.43 to −0.24, p < 0.01) from a mean market share growth of 0.14 ± 0.97. The magnitude of the market share decline increases as more dispensaries enter a county and with higher county-level cannabis sales. The negative associations are driven by diphenhydramine- and doxylamine-based sleep aids rather than herbal sleep aids and melatonin. These findings support survey evidence that many individuals use cannabis to treat insomnia, although sleep disturbances are not a specific qualifying condition under any U.S. state-level medical cannabis law. Investigations designed to measure the relative effectiveness and side effect profiles of conventional OTC sleep aids and cannabis-based products are urgently needed to improve treatment of sleep disturbances while minimizing potentially serious negative side effects.     

Limitations of current medical treatments for depression: Disturbed circadian rhythms as a possible therapeutic target

The proportion of diagnosed depressives prescribed antidepressants has increased markedly over the last 20 years, mainly following the introduction of the selective serotonin reuptake inhibitors. However, currently available antidepressants have notable limitations, relating to their only moderate efficacy relative to placebo, relatively slow onset of action, possible withdrawal symptoms, and problems of compliance. Sleep disturbances are often used to identify newly presenting depressive patients, and may be part of a more general alteration of bodily rhythms. There are links between pharmacological treatments and circadian rhythms in depression, which might represent another, new option for the development of a therapeutic approach to depression treatment. Many antidepressants affect sleep, some are sedative, and others have been used specifically in severely insomniac depressives. Disturbances in circadian rhythms may be an integral part of depressive mechanisms, and normalising them via an innovative mechanism of antidepressant action may be a fruitful avenue in the search for improved antidepressant agents.     

健康教育对改善失眠症患者睡眠质量影响的研究

目的探讨健康教育在改善社区失眠症患者睡眠质量中的作用。方法将在北京某社区卫生服务站就诊的100例失眠症患者随机分为实验组和对照组,每组50例。分别两组患者进行健康教育和常规治疗。健康教育包括改变失眠症患者对睡眠的不正确认识和态度,培养良好的睡眠习惯。6个月后对两组人员进行睡眠状况评价。结果失眠症的发病原因是经济压力、学习工作压力为主。两组患者健康教育后匹兹堡睡眠质量指数各因子分及总分比较有显著性差异（P〈0.05,P〈0.01）。实验组睡眠状况明显改善的为80%,对照组睡眠状况明显改善的为8%,有显著性差异（P〈0.01）。结论健康教育可以改善失眠症患者的睡眠状况,提高睡眠质量。     

Heart rate changes in chronic insomnia

This study assessed physiological activity in patients with chronic insomnia before sleep, during sleep and in response to acute stress. Twenty-four subjects with chronic insomnia and 25 normal sleepers slept in the laboratory overnight and were given a stressful performance task in the morning. Heart rate was significantly higher in the insomniac group at night. The next morning, heart rate was not different at baseline, but was significantly higher during the performance task in the insomniac group. These results are discussed as supporting the notion that insomniacs have greater physiological responsivity to stress. Further research is needed to determine if altered physiological activity is a cause or consequence of insomnia.     

综合医院精神科会诊患者失眠的临床研究

目的：探讨综合医院精神科会诊患者失眠的临床特征及与其它精神障碍的关系。方法：对168例精神科会诊患者进行分析。结果：128例(76、2％)会诊患者有失眠．其中61．7％(79／128)为慢性失眠。原发性失眠仅占5．5％(7／128)，85．1％(109／128)是与其它精神障碍有关的失眠。常见的精神障碍诊断为焦虑障碍、心境障碍和谵妄。60．9％的失眠患者在会诊前得到了处理。结论：应对临床医师进行精神卫生教育，提高他们对失眠等常见精神障碍的识别和处理能力。     

The zurich study

Summary This study describes sleep behaviour and insomnia in a representative cohort of a Swiss population. Interviews were carried out prospectively from age 20–21 to 27–28 years, starting with 292 males and 299 females. Females usually go to bed earlier and sleep 30 min longer than males. Taking into account length and periodicity of insomnia we can distinguish occasional insomnia (OI), repeated brief insomnia (RBI), and continued insomnia (CI), defined by operational criteria. The prevalence of sleep problems is stable from age 21–28, at 36%–40%. CI (prevalence 8%–10%) and RBI (13%–19%) are both medical problems in terms of treatment by professionals (10%–17%) or self-medication (7%–12%). The majority of insomniacs cope with sleep problems in various other ways. Frequency and patterns of symptoms of insomnia are described.The authors thank P. J. Clayton, M.D., University of Minnesota, Minneapolis, for advice and critical suggestions and for the coining of the terms repeated brief insomnia and continued insomnia.Project supported by grant 3.948.0.85 from the Swiss National Science Foundation.Parts of this article were presented on the occasion of the inauguration ceremony of the Department of Psychiatry of the University of Mainz on April 2 and 3, 1987     

基诺族睡眠状况调查及分析

目的:了解基诺族睡眠的一些基本情况、失眠症的发生率和治疗情况.方法:使用自拟的"基诺族睡眠情况调查表",通过入户调查和现场访谈对126名基诺族人进行调查.结果:随年龄增长基诺族人的睡眠时间渐减少.<30岁年龄组有午睡习惯的比例高于30岁以上年龄组,差异有统计学显著性.34.12%(43人)符合失眠症诊断,失眠原因以各种精神疾病(41.86%)和酒依赖(30.23%)最为常见.失眠患者中, 就诊率为25.58% (11例).结论:基诺族睡眠的基本情况与国内其他人群相比有一些共同之处;失眠发生率较高,但由于本研究样本量和样本选择的不足,此结果还需进一步证实.     

失眠的评估

失眠是困扰许多人的最常见的睡眠问题。失眠引起白天困倦、疲劳、情绪烦恼、工作效率下降，甚至可造成致命性的结果。虽然失眠发病率很高，但大多数失眠者并未被临床医生所识别。对失眠恰当的评估对患者非常重要。本文将回顾近年来对失眠评定方面的研究，内容包括睡眠史、自评方法、心理评估，心理生理评估、医学评估、多导睡眠图及其它睡眠评估方法。     

和胃安神方对失眠模型大鼠5-羟色胺、多巴胺及去甲肾上腺素水平的影响

目的：探讨和胃安神方对失眠模型大鼠下丘脑5-羟色胺（5-HT）、多巴胺（DA）和去甲肾上腺素（NE）水平的影响。方法：将60只雄性Wistar大鼠随机分为6组,即正常对照组、失眠模型组、地西泮组、和胃安神方低剂量组、和胃安神方中剂量组、和胃安神方高剂量组。采用酶联免疫吸附试验（ELISA）检测各组大鼠下丘脑组织5-HT、DA、NE的水平。结果：与正常对照组比较,失眠模型组大鼠5-HT水平显著下降,差异有统计学意义（P<0.05),DA、NE水平较正常对照组显著升高,差异有统计学意义（P<0.05);与失眠模型组比较,地西泮组、和胃安神方低剂量组5-HT、DA、NE水平差异均无统计学意义(均P>0.05);和胃安神方中剂量组、和胃安神方高剂量组5-HT水平均较失眠模型组显著升高,差异有统计学意义(P<0.05),DA、NE水平较失眠模型组显著下降,差异有统计学意义（P<0.05)。结论：和胃安神方治疗失眠症的疗效机制可能与调节脑内5-HT、DA、NE水平有关。     

Risk of insomnia and hypnotics use among emergency physicians

This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.