Browsing by Subject "unettomuus"

Introduction: When people age, the composition of sleep changes and sleep becomes more sensitive to external disturbances, making insomnia also more common. Medication is not the first-line treatment option for insomnia. Benzodiazepines or benzodiazepine receptor agonists for the treatment of insomnia have been in the focus of past studies. The content of the dosing instructions for the supplied medicines has not been studied. The dosing instructions should provide clear instructions on how to dose the medicine prescribed to the patient. The aim of this study was to investigate the content and quality of dosing instructions prescribed for the treatment of insomnia for Finns aged ≥75 years in 2020 based on the prospective reimbursement register data by the Social Insurance Institution of Finland (Kela). Materials and methods: The reimbursed purchases of all medicines by persons aged ≥75 years from 1.1.2020 to 31.12.2020 were selected by ATC code from the medicines data according to the Insomnia: Current Care guidelines. The data was gathered from Kela’s dispensations reimbursed under the National Health Insurance scheme. The dataset consisted of 1,080,843 delivery lines, which were screened, and 328,285 lines were included in the analyses. Dosage instructions were reviewed according to the following predetermined five categories: frequency of use, dose, timing, warnings or remarks, and inappropriate instructions. In addition, 1000 dosing instructions were randomly derived to study the phrasing and appropriateness of the dosing instructions in more detail. Results: In 2020, an average of 3.8 reimbursed hypnotic drug deliveries were made per elderly person. Of the deliveries, 68% were for women. 52% of drug deliveries were partially made later and not by original prescription. In the hypnotic dataset, the three most administered drugs were zopiclone (41%), mirtazapine (34%) and zolpidem (12%). The dosage was prescribed in 98–99% of the dosage instructions. Dosing schedule was reported in 83% of dosing instructions and regularity of use was reported in 57% of them. Only 3-6% of the dosing instructions had comments or warnings. 1–2% of the dosing instructions were vague. The duration or regularity of use was clearly indicated in 5% of the dosing instructions. Only 0.1% of dosage instructions contained instructions for discontinuation or reduction. Discussion: The dose and timing of administration were well reported, but the frequency of use was reported in only about half of the dosing instructions. Only few dosing instructions contained remarks or warnings even though hypnotics are at risk for the elderly. Among the three most administered drugs for the treatment of insomnia were two benzodiazepine receptor agonists, zopiclone and zolpidem. However, they may not be suitable for the elderly according to Beers criteria and their use should be avoided. During 2020, an average of four drug deliveries were made per elderly person for the treatment of insomnia, which may indicate prolonged hypnotics use. In addition, more than half of the deliveries were partially made later and not by original prescription. Thus, several drug packages are prescribed for prescriptions, although the drug-based treatment of insomnia should only be short-lived. Conclusions: There are significant deficiencies in the contents and quality in the dosing instructions for drugs delivered to the elderly for insomnia. Minimum information on dose, timing and duration of use was not found in all dosing instructions in this study. Understandable dosing instructions and the reduction in the amount of medication in the prescription could have a further effect on reducing the long-term use of hypnotics, also increasing the safety of medicine use in the elderly.

Introduction: Sleep related problems affect wellbeing extensively. Sleep problems share many common background factors with personality, such as individual way of processing cognitions and emotions. By understanding the interactions between personality and sleep, it is possible to develop better and more individual-friendly ways to treat sleep related problems. In this review, personality is approached from the framework of the Big Five personality traits, which are: extraversion, neuroticism, conscientiousness, agreeableness, and openness. The purpose of this review is to sum up the current results of the research conducted in the field of personality traits and sleep, to direct the future research on the field and to discuss the limitations of the current research. Results: There are interactions between personality traits and sleep. Neuroticism affects the quality and the amount of sleep negatively. However, the causality might go the other way around: sleep deprivation and problems falling asleep might cause later neuroticism. Extraversion has a relationship with better quality of sleep, diminished amount of sleep and fluctuating circadian rhythm between weekdays and weekends. Conscientiousness affects the quality of sleep, the regularity of the circadian rhythm and the morningness of the circadian rhythm. Individuals who have high openness have diminished need for sleep and they have coping-mechanisms that protect them against the negative effects of stress. Agreeableness has a relationship with better sleep in terms of quality and quantity, and with constant circadian rhythm between weekdays and weekends. The personality traits’ interactions include conscientiousness’ protective effect against neuroticism when considering sleep quality. Also, the differences in sleep quantity are statistically best explained with two traits: openness and neuroticism. Discussion: The interaction between personality traits and sleep has been investigated mainly from the point of view of personality traits. When the interactions are studied from the point of view of sleep it is possible to merge the effects of the personality traits and derive preliminary personality trait profiles for different aspects of sleep. The profile for good quality of sleep seems to be high extraversion, high consciousness, high openness, high agreeableness, and low neuroticism. The profile for poor sleep quality is almost reverse: high neuroticism, low extraversion, low consciousness, and low openness. Apart from the quality, it’s also possible to derive subjective sleep deprivation profile: high neuroticism and low extraversion or interestingly high extraversion if only the amount of sleep is being studied. Limitations of the current research in the field include a tendency to use university student samples, self-assessment inventories as the sole information source and the over-simplifying approach of merely studying one personality trait instead of the whole personality profile. Examining the personality trait profiles could lead to more statistically significant results and thus it might increase the practical implications in the field of personality and sleep.

Insomnia and milder sleep problems are common complaints that affect about one third of the adult population. Because of the side-effects of hypnotics there is a growing need for new non-pharmacological treatments for insomnia. In earlier studies mindfulness-based treatments have proven to be effective for example in the treatment of depression and stress symptoms. It has also been demonstrated in multiple studies that mindfulness has many favorable effects on general wellbeing, such as increasing positive affect. The effects of mindfulness on insomnia and sleep have been the focus of large-scale research just for the past few decades. The objective of this thesis was to review the most recent research findings on the effects of mindfulness-based treatments on insomnia and sleep in different contexts, and to evaluate the reliability of these findings and the studies’ limitations. In addition, initial findings on the mechanisms through which mindfulness is thought to improve sleep are reviewed. Latest meta-analyses, systematic reviews, randomized controlled trials and background information were searched form Pubmed and Google Scholar -databases. Three most recent systematic reviews or meta-analyses and six randomised controlled trials published after them were included in the review of the effects of mindfulness on insomnia and sleep. Seven studies were included in the review of the mechanisms between mindfulness and sleep. Research findings accumulated so far indicate quite strongly that mindfulness-based treatments might be an effective approach in treating insomnia and in improving sleep in general. Mindfulness-based therapies might even pose a potential alternative to traditional insomnia treatments. Especially the positive effect of mindfulness on sleep quality was demonstrated in many studies. However, the observed effect sizes varied between different studies. Research findings concerning the mechanisms between mindfulness and sleep suggest that more adaptive cognitive processes seem to play a central role.