Page 51 - Demo

CONTINUING PROFESSIONAL DEVELOPMENT
THE COMPLEMENTARY APPROACH
References
1. Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest 2015;147(4):1179–92.
2. Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev 2011;15(2):99–106.
3. Combs D, Goodwin JL, Quan SF, et al. Insomnia, health-related quality of life and health outcomes in children: a seven year longitudinal cohort. Scientific reports 2016;6:27921.
4. Castro-Diehl C, Diez Roux AV, Redline S, et al. Association of sleep duration and quality with alterations in the hypothalamic-pituitary adrenocortical axis: the multi-ethnic study of atherosclerosis (MESA). J Clin Endocrinol Metab 2015;100(8):3149–58.
5. Anderson GD, Elmer GW, Taibi DM, et al. Pharmacokinetics of valerenic acid after single and multiple doses of valerian in older women. Phytother Res 2010;24(10):1442–6.
6. Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data. Arch Intern Med 2006;166(16):1775–82.
7. Block KI, Gyllenhaal C, Mead MN. Safety and efficacy of herbal sedatives in cancer care. Integr Cancer Ther 2004;3(2):128–48.
8. Schroeck JL, Ford J, Conway EL, et al. Review of safety and efficacy of sleep medicines in older adults. Clinical therapeutics 2016.
9. Trauer JM, Qian MY, Doyle JS, et al. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Internal Med 2015;163(3):191–204.
10. Wu JQ, Appleman ER, Salazar RD, et al. Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Intern Med 2015;175(9):1461–72.
11. Morawetz D. Insomnia and depression: which comes first? Sleep Research Online 2003;5(2):77–81.
12. Morawetz D. Sleep better without drugs: a 4-to-6 week self-help program. Melbourne, Australia. 2016. At: www.sleepbetter.com.au
13. Rahimi A, Ahmadpanah M, Shamsaei F, et al. Effect of adjuvant sleep hygiene psychoeducation and lorazepam on depression and sleep quality in patients with major depressive disorders: results from a randomized three-arm intervention. Neuropsychiatr Dis Treat 2016;12:1507–15.
14. Lack LC, Wright HR. Treating chronobiological components of chronic insomnia. Sleep Med 2007;8(6):637–44.
15. Gringras P, Middleton B, Skene DJ, et al. Bigger, brighter, bluer-better? current light-emitting devices - adverse sleep properties and preventative strategies. Front Public Health 2015;3:233.
16. Cunnington D, Junge MF, Fernando AT. Insomnia: prevalence, consequences and effective treatment. Med J Aust 2013;199(8):36–40.
17. Ong JC, Manber R, Segal Z, et al. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep 2014;37(9):1553–63.
18. Zeidan F, Emerson NM, Farris SR, et al. Mindfulness meditation-based pain relief employs different neural mechanisms than placebo and sham mindfulness meditation-induced analgesia. J Neurosci 2015;35(46):15307–25.
19. Black DS, O’Reilly GA, Olmstead R, et al. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Internal Med 2015;175(4):494–501.
20. Yurcheshen M, Seehuus M, Pigeon W. Updates on nutraceutical sleep therapeutics and investigational research. Evid Based Complement Alternat Med 2015;2015:105256.
21. Pigeon WR, Carr M, Gorman C, et al. Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study. J Med Food 2010;13(3):579–83.
22. Ziegler G, Ploch M, Miettinen-Baumann A, et al. Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non- organic insomnia--a randomized, double-blind, comparative clinical study. Eur J Med Res 2002;7(11):480–6.
23. Maroo N, Hazra A, Das T. Efficacy and safety of a polyherbal sedative-hypnotic formulation NSF-3 in primary insomnia in comparison to zolpidem: a randomized controlled trial. Indian J Pharmacol 2013;45(1):34–9.
24. Taavoni S, Nazem Ekbatani N, Haghani H. Valerian/lemon balm use for sleep disorders during menopause. Complement Ther Clin Pract 2013;19(4):193–6.
25. Braun L, Cohen M. Herbs & natural supplements: an evidence based guide. 4th edn. Sydney: Elsevier; 2015.
26. Sarris J, LaPorte E, Schweitzer I. Kava: a comprehensive review of efficacy, safety, and psychopharmacology. Aust N Z J Psychiatry 2011;45(1):27–35.
27. Lehrl S. Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. J Affect Disord 2004;78(2):101–10.
28. Sarris J, Stough C, Teschke R, et al. Kava for the treatment of generalized anxiety disorder RCT: analysis of adverse reactions, liver function, addiction, and sexual effects. Phytother Res 2013;27(11):1723–8.
29. Ngan A, Conduit R. A double-blind, placebo-controlled investigation of the effects of passiflora incarnata (passionflower) herbal tea on subjective sleep quality. Phytother Res 2011;25(8):1153–9.
1
CPD CREDIT
GROUP 2
4. Why might relaxation techniques be
recommended as part of an overall strategy to assist people with persistent sleep disorders?
a) Relaxation techniques may assist with stress reduction and emotional regulation.
b) Relaxation techniques cause drowsiness and sedation, so if practised before bed, they can have a beneficial effect on sleep.
c) Relaxation techniques practised in the middle of the day play an important role in controlling periodic circadian (24-hour) cycles.
d) Relaxation techniques should be avoided by people who experience sleep disorders as they can cause drowsiness.
KEY LEARNING POINTS
• Non-ingestive interventions such as CBT, sleep hygiene education and stress management techniques should be recommended as first-line treatments for insomnia and can be used safely as an adjunct to other therapies.
• A therapeutic trial of herbal medicines such as sour cherry, valerian, kava or passionflower may be warranted for those unable or unwilling to take pharmaceutical medicines.
QUESTIONS
Each question has only one correct answer.
1. Which of the following is considered first-line treatment for persistent sleep disorders?
a) Concentratedvalerian600mgdailytaken for at least 1 week.
b) A combination of valerian, passionflower and hops.
c) A benzodiazepine taken for 1 month.
d) Non-pharmacological approaches
such as cognitive behavioural therapy, sleep hygiene and stress management techniques.
2. What advice might you give to a person experiencing disrupted sleep patterns with regard to the effects of light/dark cycles on sleep?
a) Attempttoensureexposuretosunlight during the day and limit exposure to light (especially light at the warmer end of the colour spectrum) before bedtime.
b) Attempttoensureexposuretolightinthe early evening and limit exposure to blue light in the morning.
c) Attempt to ensure exposure to light during the day and limit exposure to light (especially blue light) before bedtime.
d) Attempt to ensure exposure to blue light in the evening and limit exposure to light at the warmer end of the colour spectrum in the mornings.
3. Which of the following statements about people experiencing insomnia describes the MOST suitable candidate for a therapeutic trial with kava?
a) Apersonwithalcoholdependencewhois unable to take pharmaceutical hypnotics due to hepatic impairment.
b) A person who experiences mild-to- moderate anxiety that affects their sleep, but does not wish to take pharmaceutical medicines.
c) A person who is unable to take pharmaceutical hypnotics due to positive hepatitis C status.
d) ApersonwhohasParkinson’sdisease.
Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd. 49
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