| Description |
The review summarizes the current possibilities of diagnosis and treat-ment of chronic insomnia and reflects the specifics of the Czech environment (the availability of individual drugs, possibilities of cognitive-behavioral therapy). It is based on recently updated international clinical recommendations in the field of somnology (European Sleep Research Society, American Academy of Sleep Medicine) as well as on the recommendations of professional societies of the Czech Medical Association (CzMA). According to guidelines of the European Sleep Research Society, American Academy of Sleep Medicine and Czech Psychiatric Association (CzMA) is Cognitive behavioral therapy the first-choice therapy, and in case of unavailability or insufficient effect it is recommended to administer benzodiazepine receptor agonists (zolpidem, zopiclone; for maximum of four weeks). In case of comorbid insomnia and depression should be used selected antidepressants (agomelatine, amitriptyline, mirtazapine). All these guidelines are in concordance that below cited drugs (and therapies) arent recommended: antihistamines (promethazine), antipsychotics (chlorprothixene, levomepromazine, quetiapine, olanzapine), phytopharmaceuticals (lemon balm, passionflower, valerian drops), homeopathy and acupuncture. Usage of melatonin is recommended according to Guidelines of the Czech Psychiatric Association (CzMA) and Czech Society of General Practice (CzMA), but isn´t recommended according to European Sleep Research Society and American Academy of Sleep Medicine. Trazodone is not recommended for the risk of side effects (or lack of the data on their side effects) according to American guide-lines, but is recommended according to all others cited guidelines. Guidelines of the Czech Society of General Practice (CzMA) mentioned psychotherapy marginally and only as a list of regime rules and stimulus controls. These guidelines are in concordance with other cited guidelines in recommendation of usage Anti-depressants (trazodone, mirtazapine, agomelatine), antiepileptics (lamotrigine, valproate de-vices), mood stabilizers (lithium) and in usage of zolpidem (but only in patients over 65 and only in long-term scheme - in conflict with other cited guidelines and summary of product characteristics). The second-generation antipsychotics (tiapride, olanzapine, risperidone) and anticonvulsants (lamotrigine, valproate acid) are preferred for the potential to synchronize biological rhythms. Indications of summary product characteristics as well as adverse reactions and risks of drugs were not accounted. In patients over 65 years, zolpidem, alprazolam and bromazepam are recommended as a long-term substitution of lack of "endogenous benzodiazepine". The role of phytopharmaceuticals (L-tryptophan, Valerian drops) is "not negligible".
|