• 수면정신생리
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• 제2권2호
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• pp.138-145
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• 1995

The causes of complicated chronic insomnia are very various and interact with vicious circle. Patient with this insomnia has generally a strong fear and frustration about failing to control of sleep and a deep mistrust toward doctor. To solve this complicated problems detailed history taking and sleep questionnaires are needed with objective polysomnography. Through these procedures, doctor should clarify causes of insomnia and explain them to patient in details and kindly. This process would be very helpful to restore the mistrustful relationship between patient and doctor and reduce patient's vague fear for insomnia. In treatment of complicated chronic insomnia, it is most important for patient to understand his problems and participate in the treatment schedule actively with assurance. Also doctor should encourage patient persistently not to be drop out. Most important factor for prognosis is patient's personality. Causes of complicated chronic insomnia are like these, overdose of hypnotics and sedatives, daily drinking alcohol with hypnotics, insomnia associated depression, delayed sleep phase syndrome, sleep state misperception, marked fear for insomnia, hyperarousal at bed, insomnia associated periodic leg movement and sleep apnea, chronic hypnotic insomnia, and immature personality. And possible treatments of these insomnias were discussed.

• 동의신경정신과학회지
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• 제28권2호
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• pp.137-143
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• 2017

Objectives: Insomnia is a common disease in the general population. The purpose of this paper was to suggest that insomnia subtype of blood stasis can be effectively treated with Danggwisu-san and acupuncture. Methods: This is a clinical case report of a patient with chronic insomnia that was diagnosed with blood stasis subtype. I treated him with Danggwisu-san (Dangguixu-san) two to three times daily and with acupuncture and moxibustion two to three times weekly. Results: After short-term treatment, the patient was gradually recovering from deteriorating chronic insomnia and multiple accompanying symptoms such as severe constipation, spontaneous bleeding and edema, darkened face, depressive moods, etc. Conclusions: Results revealed a possibility that chronic insomnia subtype of blood stasis may be successfully treated with Danggwisu-san and acupuncture and moxibustion.

• 중환자간호학회지
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• 제1권1호
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• pp.19-31
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• 2008

Purpose: This study was conducted to exam the effects of the Abbreviated Cognitive Behavioral Therapy(ACBT) on chronic insomnia. Methods: Study was one-group interrupted time series study that involved 13 adults(mean age=51.7, aged 25-77 years) with chronic primary insomnia who visited sleep disorder clinic of S Hospital from November 2004 to October 2005. The subjects received 2-session individual ACBT with 2 week-interval($1^{st}$: 1.5- 2hrs, $2^{nd}$: 20-30min). To measure the subjective insomnia severity and sleep patterns, 3 times of insomnia severity index and sleep logs were completed(before ACBT, after ACBT, and 3-month after ACBT). The main outcomes were subjective insomnia severity and sleep patterns(sleep onset latency, waking after sleep onset, and total sleep time, sleep efficiency). The data were analyzed with SPSS 10.0 version program by Friedman test, Wilcoxon signed rank test with Bonferroni correction. Results: There were statistically significant decrease in insomnia severity index, sleep onset latency, and waking after sleep onset, and increase total sleep time and sleep efficiency. Conclusion: ACBT was effective in reducing subjective insomnia severity and improving sleep patterns. Sleep improvement was better sustained over time with ACBT.

• 대한상한금궤의학회지
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• 제13권1호
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• pp.165-178
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• 2021

Objective: This study aimed to report the improvement of a patient with chronic insomnia who was treated with Baekho-tang based on the Shanghanlun disease pattern identification diagnostic system (DPIDS). Methods: The patient's symptoms were checked on days 19, 37, and 52 after taking Baekho-tang. Chronic insomnia was evaluated by the degree of insomnia, hours spent asleep, and the number of times the patient woke up during the night, which were all assessed by a visual analog scale (VAS) with the Leeds Sleep Evaluation Questionnaire. In addition, new clinical implications for the interpretation of the 350th Shanghanlun provision were reviewed. Results: After administering Baekho-tang for 52 days, based on the 350th Shanghanlun provision according to the DPIDS, the VAS score decreased from 10 to 1. Conclusions: The patient recovered from chronic insomnia. This case report suggests that the words "滑," "厥," and "裏" in the 350th provision of Shanghanlun mean physical and psychological causes of insomnia. In addition, Baekho-tang had a therapeutic effect in improving the chief complaint of the patient. Therefore, the interpretation of the 350th Shanghanlun provision requires a new definition that includes the patient's lifestyle, family conflict, and past history of the patient as a cause of chronic insomnia.

• The Korean Journal of Pain
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• 제27권3호
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• pp.285-289
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• 2014

Transcranial magnetic stimulation (TMS) is a noninvasive and safe technique for motor cortex stimulation. TMS is used to treat neurological and psychiatric disorders, including mood and movement disorders. TMS can also treat several types of chronic neuropathic pain. The pain relief mechanism of cortical stimulation is caused by modifications in neuronal excitability. Depression is a common co-morbidity with chronic pain. Pain and depression should be treated concurrently to achieve a positive outcome. Insomnia also frequently occurs with chronic lower back pain. Several studies have proposed hypotheses for TMS pain management. Herein, we report two cases with positive results for the treatment of depression and insomnia with chronic low back pain by TMS.

• 수면정신생리
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• 제10권1호
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• pp.20-25
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• 2003

Many people suffer from chronic insomnia. Inappropriate sleep causes attention difficulties, decreased work efficiency, and increased traffic accidents and disasters. Evaluating the precise causes of insomnia prior to treatment is very important, because chronic insomnia can be a secondary symptom of other medical, psychiatric, and sleep disorders. Medication and behavior therapy are not exclusive of each other, and both treatments are beneficial to some patients, but currently many physicians and patients tend to be dependent only on medication. While long-term medication causes various degrees of dependency, tolerance, and withdrawal symptoms, behavior therapy has a stable effect over a long period. Behavior therapy is one of the most important treatment modalities for chronic insomnia. It shortens sleep latency, and decreases frequency of awakening during sleep. The rationale and practice of currently used behavior therapy and light therapy will be reviewed in this study.

• 대한통합의학회지
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• 제9권2호
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• pp.43-52
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• 2021

Purpose : Chronic neck pain negatively impacts the quality of life and causes various problems in daily life due to pain, insomnia, and sleep disturbances in patients with this condition. Therapeutic interventions to solve these problems in rehabilitation and physical therapy are being introduced; however, the evidence of the efficacy of myofascial release (MFR) is still insufficient. This study aimed to investigate the effects of applying MFR on pain, insomnia, and sleep disturbances in patients with chronic neck pain. Methods : Ten patients with chronic neck pain were randomly selected and grouped into the experimental group (n₁ = 10) and control group (n₂ = 10) by cross-over design. Pain was measured before and after MFR intervention. Moreover, insomnia was measured only after MFR intervention. Polysomnography was performed after MFR intervention. Wilcoxon signed rank test and Mann-Whitney U test were used for the visual analog scale (VAS). Independent sample t-test was separately performed to measure insomnia and sleep. Results : After MFR intervention, the VAS score of the experimental group (p = 0.005) significantly decreased than that of the control group (p = 0.002). The insomnia score of the experimental group significantly decreased than that of the control group (p = 0.001). The total sleep time (p = 0.001), sleep efficiency (p = 0.001), and sleep latency (p = 0.001) of the experimental group significantly increased than those of the control group in the polysomnographic measurement. Conclusion : The application of MFR of the neck and upper trunk may have a positive effect on pain, insomnia, and sleep disturbances in patients with chronic neck pain. It was also suggested that an objective and quantitative polysomnography can be used more often in the field of rehabilitation and physical therapy.

• The Korean Journal of Pain
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• 제28권2호
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• pp.137-143
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• 2015

Background: Insomnia is becoming increasingly recognized as a clinically important symptom in patients with chronic low back pain (CLBP). In this retrospective study, we have determined risk factors associated with clinical insomnia in CLBP patients in a university hospital in Korea. Methods: Data from four-hundred and eighty one CLBP patients was analyzed in this study. The Insomnia Severity Index (ISI) was used to determine the presence of clinical insomnia (ISI score ${\geq}15$). Patients' demographics and pain-related factors were evaluated by logistic regression analysis to identify risk factors of clinical insomnia in CLBP. Results: It was found that 43% of patients reported mild to severe insomnia after the development of back pain. In addition, 20% of patients met the criteria for clinically significant insomnia (ISI score ${\geq}15$). In a stepwise multivariate analysis, high pain intensity, the presence of comorbid musculoskeletal pain and neuropathic pain components, and high level of depression were strongly associated with clinical insomnia in CLBP. Among these factors, the presence of comorbid musculoskeletal pain other than back pain was the strongest determinant, with the highest odds ratio of 8.074 (95% CI 4.250 to 15.339) for predicting clinical insomnia. Conclusions: Insomnia should be addressed as an integral part of pain management in CLBP patients with these risk factors, especially in patients suffering from CLBP with comorbid musculoskeletal pain.

• 수면정신생리
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• 제1권1호
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• pp.3-8
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• 1994

With the recent development of sleep medicine, insomnia has been perceived as a disease from a simple symptom. As there are various causes in a disease, proper treatment according to each cause is necessary for a more effective treatment In general, insomnia is classified into five categrories of physical, physiological, psychological, psychiatric and pharmacological aspects. However, such categorizations are often insufficient in treating insomnia. Furthermore understanding of the developmental mechanisms of insomnia is required. The function of sleep is developed and maintained through the balance of the reciprocal forces of sleep and arousal. These forces are contantly regulated by what is called a circadian rhythm. Sleep is induced by this rhythm which is affected by factors such as awakening time in the morning, amount of intellectual function, amount and time length of physical exercise and sunlight Insomnia could develop when this rhythm is delayed and leads to a "forbidden zone" which is a very difficult period for inducing sleep about two to four hours before the routine bedtime. Whereas sleep gradually develops in line with the circardian rhythm, arousal can occur very abruptly by any cause triggered by emotional discomfort or anxiety. Such characteristic and emotional factors as perfectionism, separation anxiety, secondary gain, insecurity, and negative cognition may provoke the inner anxiety and fear for insomnia, which can lead acute insomnia to a chronic one. As chronic insomnia is developed by multiple causes and factors, integrated approaches through analysis of above mentioned factors will be more effective in the treatment of insomnia than a simple administration of hypnotics.

• 대한한의학회지
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• 제21권4호
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• pp.271-275
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• 2000

A growing number of people are concerned about their sleep. There are many people with chronic sleep disorders. As there are various causes in a disease, proper treatment according to each cause is necessary for a more effective treatment. In general, insomnia is classified into five categories of physical, physiological, psychological, psychiatric and pharmacological aspects. Sedative-hypnotics including benzodiazepine and non-benzodiazepine have widely been used in chronic insomniacs. However, most hypnotics including non-benzodiazepine cause some of dependence, tolerance, impaired daytime function and rebound insomnia. Therefore, we are looking forward to proposing an effective oriental treatment for insomnia. A 71-year-old male who had suffered from cerebral infarction was admitted to our department for oriental treatment of stroke and insomnia. Initial treatment modalities with administration of paroxetine were not effective. However administration of oriental medicine' Gochimmuwoo-san(Gaozhenwuyou-san)' achieved a desirable effect.