• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.11-16
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• 2005

Sleep can be easily disrupted by variety of conditions. Most of medical illnesses could be a primary condition causing secondary insomnia. The common underlying mechanism of secondary insomnia is presumed to be stress effects on sleep. The assessment and treatment of secondary insomnia are often complicated. Establishing an causal inference between primary condition and insomnia is the key to assessment. However, it can be difficult even for experienced clinicians due to diagnostic ambiguity of secondary insomnia. Therefore, through medical evaluation and integrative understanding of primary condition is essential to manage secondary insomnia properly. Although treatment have been usually focused on the primary medical illnesses per se, nonpharmacologic interventions, such as sleep hygiene, might be effective in many cases.

• Korean Journal of Biological Psychiatry
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• v.25 no.1
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• pp.1-8
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• 2018

Insomnia is a common sleep-related symptom which occurs in many populations, however, the neural mechanism underlying insomnia is not yet known. The hyperarousal model explains the neural mechanism of insomnia to some extent, and the frontal cortex dysfunction has been known to be related to primary insomnia. In this review, we discuss studies that applied resting state and/or task-related functional magnetic resonance imaging to demonstrate the deficits/dysfunctions of functional activation and network in primary insomnia. Empirical evidence of the hyperarousal model and proposed relation between the frontal cortex and other brain regions in primary insomnia are examined. Reviewing these studies could provide critical insights regarding the pathophysiology, brain network and cerebral activation in insomnia and the development of novel methodologies for the diagnosis and treatment of insomnia.

• Journal of Sasang Constitutional Medicine
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• v.28 no.4
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• pp.350-360
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• 2016

Objective The aim of this study was to report significant improvement of primary insomnia in a Soyangin Cold-related diarrhea accompanied by abdominal pain Symptomatic pattern Patient. Methods The patients were diagnosed with Soyangin Cold-related diarrhea accompanied by abdominal pain Symptomatology(身寒腹痛亡陰證) and treated with Hyungbangjihwang-tang(荊防地黃湯). The primary outcome measures for this study were condition of sleep using a questionnaire with Pittsburgh Sleep Quality Index (PSQI) Secondary outcome assessment included change of original symptoms such as patient's digestion, sweating and feces. Result The symptoms of primary insomnia improved by the end of the a treatment period without side effect. original symptoms were also changed. Conclusions This result show Hyungbangjihwang-tang(荊防地黃湯) can be used to treat primary insomnia in a Soyangin Cold related Mangeum Symptomatic Pattern accompanied by abdominal pain Symptomatology(身寒腹痛亡陰證). Meaning and process of primary insomnia are different according to Sasang Constitutions.

• Journal of Korean Medicine Rehabilitation
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• v.26 no.3
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• pp.79-84
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• 2016

Objectives To evaluate the evidence supporting the effectiveness of Chuna manual therapy for primary insomnia. Methods The researcher conducted search across the 3 electronic databases (Pubmed, CAJ and Oasis) to find all of randomized controlled clinical trials(RCTs) that used Chuna manual therapy as a treatment for primary insomnia. Results Four RCTs met inclusion criteria. The meta-analysis showed positive results for the use of Chuna manual therapy in terms of the PSQI when compared to medication treatments alone. Positive results were also obtained, in terms of the PSQI, when comparing Chuna manual therapy combined with acupuncture therapy to acupuncture therapy alone, but was not statistically significant. Conclusions The review found encouraging but limited evidence of Chuna manual therapy for primary insomnia. We recommend clinical trials which compare the effectiveness of Chuna manual therapy with usual care to obtain stronger evidence without the demerits of trial design.

• Sleep Medicine and Psychophysiology
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• v.17 no.1
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• pp.34-40
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• 2010

Objectives: This study aimed to evaluate the clinical efficacy of individual cognitive behavioral therapy (CBT) for Patients with Primary or Secondary Insomnia. Methods: Participants were recruited from a primary care sleep clinic from January 2008 to June 2009. The study sample included 64 outpatients with primary insomnia (n=30) and secondary insomnia (n=34) according to the criteria of DSM-IV. Participants completed sleep diaries, Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS), State-Trait Anxiety Inventory (STAI) before CBT and shortly after completion of CBT. CBT was provided in 7 weekly, 40-50-minute individual therapy sessions. Results: Both groups of patients with primary and secondary insomnia showed significant improvement in the DBAS and sleep parameters including sleep onset latency, total sleep time, and sleep efficiency. Repeated-measures ANOVA of the DBAS and sleep parameters showed no significant group-by-time interactions between patients with primary and secondary insomnia, suggesting the efficacy of CBT for patients with secondary insomnia was equivalent to that of CBT for patients with primary insomnia. Conclusion: This study suggests that CBT is effective for the management of primary and secondary insomnia in a primary care setting.

• 대한상한금궤의학회지
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• v.7 no.1
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• pp.45-52
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• 2015

Objective : This case report aims to demonstrate the effect of Oryeong-san on Insomnia. Methods : A 26 year old woman suffered from insomnia with mental and physical exhaustion, reduced stamina, lack of concentration in daytime. According to Diagnostic system based on Shanghanlun provisions, the patient was diagnosed with Taeyang-byung and treated by Oryeong-san decoction. The result of administration was evaluated by Insomnia Severity Index. Results : After administration of Oryeong-san decoction for 1 month, Insomnia Severity Index was decreased from 24(clinical insomnia, severe) to 1(no clinically significant insomnia). Conclusions : The patient completely recovered from insomnia and daytime symptoms as treated by Oryeong-san decoction according to Diagnostic system based on Shanghanlun provisions.

• Journal of Oriental Neuropsychiatry
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• v.28 no.4
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• pp.319-332
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• 2017

Objectives: The present study aimed to provide clinical evidence on the effect of herbal medicine, Hyeolbuchukeo-tang or Xuefu Zhuyu decoction for the treatment of primary insomnia using a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: This study included RCTs that verified the effects of Hyeolbuchukeo-tang or Xuefu Zhuyu decoction for the treatment of primary insomnia. Literature searches of English, Chinese and Korean databases were performed, and the selected literature was assessed for investigating the risk of bias. Results: The analysis included 10 RCTs. The Chinese Classification of Mental Disorders-3 was most frequently used to define the diagnostic criteria for Hyeolbuchukeo-tang or Xuefu Zhuyu decoction intervention in patients with primary insomnia. The effective rate was the most commonly used outcome measure. A meta-analysis revealed that the effective rate, the Pittsburgh Sleep Quality Index, and the Athens Insomnia Scale in the Modified Xuefu Zhuyu decoction (MXZD) group were higher compared to Western Medicine (WM) group (RR: 1.17, 95% Cl: 1.08 to 1.26, p<0.0001, $I^2$=0/MD: -1.29, 95% Cl: -2.09 to -0.49, p=0.002, $I^2$=0%/MD: -0.99, 95% Cl: -1.81 to -0.18, p=0.02, $I^2$=15%). The effective rate of the MXZD+WM group was significantly different compared to the WM group (RR: 1.28, 95% Cl: 1.11 to 1.47, p=0.0006, $I^2$=2%). The included RCTs were of relatively poor quality and had small sample sizes. Conclusions: Treatment with Hyeolbuchukeo-tang or Xuefu Zhuyu decoction was found to be effective in treating primary insomnia. However, the included RCTs were of relatively poor quality and had small sample sizes. It is hypothesized that this study could serve as a foundation for further clinical studies on the development of diagnosis and treatment methods for primary insomnia based on Korean medicine.

• Sleep Medicine and Psychophysiology
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• v.4 no.1
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• pp.77-88
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• 1997

The purpose of this study was to investigate the prevalence, primary causes, and management of insomnia newly admitted patients in a university hospital. Subjects consisted of 168 adult patients (95 men and 73 women, 88 medical and 94 surgical patients) newly admitted to Gyeongsang National University Hospital from September 7 through September 27, 1996. Sleep patterns of all subjects in the usual nights before admission(UN), the previous night to admission(PN), the night on admission(ON), and the 5th night after admission(5N) were investigated using the Korean version of the St. Mary's Hospital Sleep Questionaire. In addition, all insomnia patients and their doctors and nurses in charge were interviewed by psychiatric residents. Additionally, their medical records were reviewed. Prevalence of insomnia were 22.6% in the UN, 42.9% in PN, 51.8% in ON, and 43.5% in 5N. The prevalence of insomnia was significantly increased immediately before and after admission. There were no significant differences in the prevalence of insomnia by age and sex. The most ammon primary causes of insomnia were somatic symptoms and psychological factors in PN, somatic symptoms and noise in ON and 5n. Only 17 (10.1%) of insomnia patients took medicstions for insomnia control(analgesics in 15, hypnotics in 2). These results shorred that the prevalence of insomnia was significantly increased on hospitalization due to somatic symptoms, environmental factors, and psychological factors, but nearly none were adequately managed.

• Sleep Medicine and Psychophysiology
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• v.19 no.1
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• pp.42-46
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• 2012

Introduction: The objective of the present study was to investigate the defense style of insomnia patients and to grasp the differences in defense style between primary insomnia patients and insomnia patients with history of major depressive disorder. Methods: Forty three subjects with insomnia (11 subjects with primary insomnia and 32 subjects with major depressive disorder) and 138 control subjects participated in this study. To diagnose insomnia and major depressive disorder, interviews including structured clinical interview for DSM-IV (SCID-IV) were done. To assess the defense style, self-reported Korean version of Defense Style Questionnaire (K-DSQ) were completed by the participants. Results: Compared to normal controls, subjects with insomnia used more acting out (t=3.25, p<0.01), consumption (t=2.66, p<0.01), fantasy (t=3.51, p<0.001), resignation (t=5.42, p<0.001), suppression (t=3.28, p<0.01), projection (t=3.92, p<0.01), splitting (t=4.31, p<0.01), undoing (t=2.66, p<0.01), withdrawal (t=6.72, p<0.001) and isolation (t=3.80, p<0.001), and less omnipotence (t=4.08, p<0.001) and humor (t=3.20, p<0.01). Compared to normal controls, subjects with primary insomnia used more undoing and withdrawal. Compared to subjects with primary insomnia, subjects with insomnia with history of major depressive disorder used more resignation and withdrawal, and less humor. Conclusion: In the current study, there were differences in defenses between primary insomnia patients and insomnia patients with major depressive disorder history. To evaluate the pattern of defenses through the K-DSQ might provide important clues to differentiate these two conditions.

• Journal of Oriental Neuropsychiatry
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• v.29 no.4
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• pp.267-280
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• 2018

Objectives: The objective of this study was to provide clinical evidence to support the use of a herbal medicine (Cheonwangbosim-Dan/Tianwangbuxin-Pellet (TWBXP)) for insomnia. Methods: Randomized controlled trials that verified effects of Herbal Medicine (Cheonwangbosim-Dan, Tianwangbuxin-Pellet) treating primary insomnia were carried out. A literature search of English, Chinese, Korean databases was also performed. The selected literature were assessed by Risk of Bias (RoB). Results: The total number of selected trials was 13 RCTs. Among the 13 RCTs, 10 were meta-analyzed. The Chinese Classification of Mental Disorders-3 (CCMD-3) was frequently used as the diagnostic criteria for interventions during the analysis of the use of herbal medicine (Cheonwangbosim-Dan/Tianwangbuxin-Pellet) for management of primary insomnia. As for outcome measurement, the effective rate was used. From the Meta-analysis of the studies, it was established that the insomnia cure effective rate in the TWBXP group was higher than that in the Western Medicine (WM) group (RR: 1.15, 95% CI: 1.07 to 1.24, p<0.0001, $I^2=33%$). Also, the effective rate in the TWBXP+ACU group was significantly different compared to the WM group (RR: 1.32, 95% CI: 1.13 to 1.54, p=0.0004, $I^2=0%$). The quality of the selected RCTs was low. Conclusions: Herbal medicine (Cheonwangbosim-Dan/Tianwangbuxin-Pellet) is effective for treating primary insomnia. It is worth noting that this studies were of relatively poor quality. The sample sizes were also small. Therefore, further investigations into the diagnosis and treatment of insomnia are warranted.