To the Editor: In their study of treatment of chronic primary insomnia in older adults, Dr Sivertsen and colleagues1 found that cognitive behavioral therapy (CBT) resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures.
However, they did not have data specifically addressing daytime sleepiness as an outcome measure, which they note would have been interesting to compare with the observed changes in slow-wave sleep. The absence of this information limits the implications of this study; I believe that research in this area should concentrate more on daytime functioning as an outcome measure of this widespread disorder.
Insomnia research is shifting to conceptualize the disorder as one in which a more fundamental and widespread alteration in arousal physiology is occurring throughout the day—not simply a problem that manifests only at night.2 Patients with insomnia generally appear more alert than individuals without insomnia during the daytime3 and it is possible that individuals with insomnia are too constantly aroused to fall asleep. Evidence suggests that the greater arousal of patients with insomnia is a 24-hour phenomenon, with substantial daytime as well as night-time symptoms.2 Individuals with insomnia may have elevated heart rates, body temperatures, cortisol levels, and whole-body metabolic rates, all of which are associated with chronic sympathetic hyperactivity.2
CBT may have general effects on a person beyond those specific to the particular disorder for which it is being used.4 If insomnia has more widespread effects than night-time symptoms, this could explain the benefits found by Sivertsen et al.1
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.