• 수면정신생리
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• 제12권1호
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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.

• 생물정신의학
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• 제25권1호
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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.

• 사상체질의학회지
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• 제28권4호
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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.

• 한방재활의학과학회지
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• 제26권3호
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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.

• 수면정신생리
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• 제17권1호
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• pp.34-40
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• 2010

목 적: 본 연구는 일차성 및 이차성 불면증 환자에서 인지행동치료(Cognitive Behavioral Therapy, 이하 CBT)의 임상적 효능을 평가하고자 하였다. 방 법: 2008년 1월부터 2009년 6월까지 일차의료기관 수면클리닉에 방문한 환자들을 대상으로 하였다. 전체 64명의 외래 환자가 모집되었으며, DSM-IV에 의거하여 진단 된 일차성 불면증 환자는 30명, 이차성 불면증 환자는 34명이었다. 환자들은 CBT 전후로 수면 일지, 수면에 대한 역기능적 신념 및 태도 척도(Dysfunctional Beliefs and Attitudes about Sleep Scale-16, 이하 DBAS) 및 상태-특성 불안척도(State-Trait Anxiety Inventory, 이하 STAI)를 각각 시행하였다. CBT는 1주 간격으로 7회, 1회당 40~50분 동안 개별적으로 진행하였다. 결 과: 일차성, 이차성 불면증 환자군 모두 입면 잠복기, 총 수면 시간, 수면 효율과 같은 수면 지표와 DBAS 점수의 유의한 호전을 보였다. 반복측정 분산분석에서는 두 군간에 시간에 따른 DBAS와 수면 지표의 유의한 차이는 없었다. 이차성 불면증에서의 CBT의 효과는 일차성 불면증에서의 효과와 동등하였다. 결 론: 이번 연구는 CBT가 일차의료 환경에서 일차성 및 이차성 불면증의 치료에 있어 효과적이라는 것을 시사한다.

• 대한상한금궤의학회지
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• 제7권1호
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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.

• 동의신경정신과학회지
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• 제28권4호
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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.

• 수면정신생리
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• 제4권1호
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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.

• 수면정신생리
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• 제19권1호
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• pp.42-46
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• 2012

배 경 : 본 연구에서는 불면증을 가진 사람들의 방어기제를 조사하고, 이들 중 주요우울장애의 병력이 있는 사람과 없는 사람들 사이의 방어기제 차이를 알아보고자 했다. 방 법 : 불면증 환자 43명(주요우울장애 32명, 일차성 불면증 11명)과 정상 대조군 138명이 연구에 참여하였다. 정신과적 진단평가를 위한 구조화 면담과 불면증에 대한 면담을 근거로 불면증과 주요우울장애를 진단하였다. 연구참여자들의 방어기제을 평가하기 위해 한국형 방어유형질문지를 작성하게 하였다. 결 과 : 불면증 환자들의 경우 정상대조군에 비해 행동화(t=3.25, p<0.01), 소비(t=2.66, p<0.01), 공상(t=3.51, p<0.001), 체념(t=5.42, p<0.001), 억제(t=3.28, p<0.01), 투사(t= 3.92, p<0.01), 분열(t=4.31, p<0.001), 취소(t=2.66, p<0.01), 철수(t=6.72, p<0.001), 격리(t=3.80, p<0.001)의 방어기제를 더 많이 사용하였으며, 전능(t=4.08, p<0.001)과 유머(t= 3.20, p<0.01)는 덜 사용하였다. 일차성불면증이 있는 경우 정상대조군에 비해 취소, 철수의 방어기제를 더 많이 사용하였다. 주요우울장애 병력이 있는 불면증 환자들의 경우 일차성 불면증 환자에 비해 체념, 철수의 방어기제를 더 많이 사용하였으며, 유머는 덜 사용하였다. 결 론 : 본 연구에서는 불면증을 가진 사람들 중 일차성 불면증 환자와 주요우울장애의 병력을 가진 환자에서 서로 다른 방어 특성을 보였다. K-DSQ로 측정되는 방어유형을 파악하는 것이 이 두 군을 감별하는 실마리가 될 수 있을 것이다.

• 동의신경정신과학회지
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• 제29권4호
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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.