Suzanne M. Bertisch

National use of prescription medications for insomnia: NHANES 1999-2010.

STUDY OBJECTIVES To determine current patterns and predictors of use of prescription medications commonly used for insomnia (MCUFI) in the U.S. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey, 1999-2010. PARTICIPANTS 32,328 noninstitutionalized community-dwelling U.S. adults. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS WE DEFINED MCUFI USE AS USE OF ANY OF THE FOLLOWING MEDICATIONS IN THE PRECEDING MONTH: benzodiazepine receptor agonists (eszopiclone, zaleplon, zolpidem, estazolam, flurazepam, quazepam, temazepam, triazolam), barbiturates (amobarbital, amobarbitalsecobarbital, chloral hydrate), doxepin, quetiapine, ramelteon, and trazodone. We estimated prevalence of MCUFI use and concurrent use of another sedating medication. We determined predictors of MCUFI use using multivariate logistic regression. Overall, 3% percent of adults used a MCUFI within the preceding month. Zolpidem and trazodone were used most commonly. Overall MCUFI use increased between 1999-2000 and 2009-2010 (P value for trend < 0.001). Concurrent use of other sedating medications was high, with 55% of MCUFI users taking at least one other sedating medication and 10% taking ≥ 3 other sedating medications. Concurrent use of MCUFIs with opioids (24.6%) and non-MCUFI benzodiazepines (19.5%) were most common. After adjustment, adults seeing a mental health provider (aOR 4.68, 95% C.I. 3.79, 5.77), using other sedating medications (aOR 4.18, 95% C.I. 3.36, 5.19), and age ≥ 80 years (aOR 2.55, 95% C.I. 1.63, 4.01) had highest likelihood of MCUFI use. CONCLUSION In this nationally representative sample, reported use of prescription medications commonly used for insomnia (MCUFIs) within the preceding month was common, particularly among older adults and those seeing a mental health provider, with high use of sedative polypharmacy among MCUFI users.

Misoprostol administered by epithelial routes: Drug absorption and uterine response.

OBJECTIVE: To quantify and compare serum levels and uterine effects following vaginal (dry), vaginal (moistened), buccal, and rectal misoprostol administration. METHODS: Forty women seeking elective abortion between 6 and 12 6/7 weeks were randomly assigned to receive 400 μg of misoprostol by one of four routes. A 2.5-mm pressure monitoring catheter was placed through the cervix to the uterine fundus to record uterine tone and activity during the 5-hour observation period. Serum levels of misoprostol acid were measured at 15 and 30 minutes, then every 30 minutes. RESULTS: The four groups were similar in age, race or ethnicity, body mass index, parity, and gestation. Serum levels after vaginal, vaginal moistened and buccal administration rose gradually, peaked between 15 and 120 minutes and fell slowly. Vaginal and vaginal moistened routes produced higher peak serum levels than buccal and rectal (445.9 and 427.1 compared with 264.8 and 202.2 pg/mL; P=.03) and higher serum concentration area under the curve at 5 hours (1,025.0 and 1279.4 compared with 519.6 and 312.5 pg-hr/mL; P<.001). Uterine tone and activity, however, were similar for buccal and the two vaginal routes. After rectal administration, serum levels peaked earlier (P<.001) then dropped more abruptly, and peak uterine tone (P<.001) and total activity (P=.04) were lower than after the other routes. CONCLUSION: Although serum levels were lower for buccal compared with the vaginal routes, the three routes produced similar uterine tone and activity. Rectal administration produced lower uterine tone and activity. Vaginal serum levels were two to three and a half times higher than those observed in prior misoprostol pharmacokinetic studies. LEVEL OF EVIDENCE: II-1

Alternative Mind-Body Therapies Used by Adults with Medical Conditions

OBJECTIVE Mind-body therapies (MBT) are used by 16.6% of adults in the United States. Little is known about the patterns of and reasons for use of MBT by adults with common medical conditions. METHODS We analyzed data on MBT use from the 2002 National Health Interview Survey Alternative Medicine Supplement (n=31,044). MBT included relaxation techniques (deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation), yoga, tai chi, and qigong. To identify medical conditions associated with use of MBT overall and of individual MBT, we used multivariable models adjusted for sociodemographic factors, insurance status, and health habits. Among users of MBT (n=5170), we assessed which medical conditions were most frequently treated with MBT, additional rationale for using MBT, and perceived helpfulness. RESULTS We found a positive association between MBT use and several medical conditions including various pain syndromes and anxiety/depression. Among adults using MBT to treat specific medical conditions, MBT was most commonly used for anxiety/depression and musculoskeletal pain syndromes. More than 50% of respondents used MBT in conjunction with conventional medical care, and 20% used MBT for conditions they thought conventional medicine would not help. Overall, we found high rates (68-90%) of perceived helpfulness of MBT for specific medical conditions. DISCUSSION MBT is commonly used by patients with prevalent medical conditions. Further research is needed to determine the reasons for widespread use of MBT for treatment of specific medical conditions and to evaluate the efficacy of MBT.

Complementary and alternative medicine use among adults with migraines/severe headaches.

(Headache 2011;51:1087‐1097)

Use of Complementary and Alternative Therapies by Overweight and Obese Adults

Objective: Obesity is associated with higher health‐care costs due, in part, to higher use of traditional health care. Few data are available on the relationship between obesity and the use of complementary and alternative medicine (CAM).

Simvastatin and vitamin D for migraine prevention: A randomized, controlled trial

The aim of this work was to assess efficacy and tolerability of simvastatin plus vitamin D for migraine prevention in adults with episodic migraine.

25-hydroxyvitamin D concentration and sleep duration and continuity: Multi-ethnic study of atherosclerosis

STUDY OBJECTIVES To determine the associations of 25-hydroxyvitamin D (25(OH)D) concentration with sleep continuity, quality, and symptoms, and to explore race/ethnic variation. DESIGN Cross-sectional study. SETTING Multi-Ethnic Study of Atherosclerosis (MESA). PARTICIPANTS There were 1,721 adults. MEASUREMENTS AND RESULTS Sleep outcomes were measured by polysomnography, actigraphy, and questionnaires. Serum 25(OH)D concentration was expressed by clinical thresholds (< 20, 20-29, ≥ 30 ng/mL) and continuously. Using linear regression, we determined the associations between 25(OH)D concentration and sleep duration, efficiency, and symptoms, and assessed race/ethnic variation. Mean age was 68.2 ± 9.1 y, and 37.2% were white, 27.7% African American, 11.9% Chinese Americans, and 23.2% Hispanic. Mean 25(OH)D concentration was 25.4 ± 10.5 ng/mL. 25(OH)D deficient participants had the shortest sleep duration, lowest sleep efficiency, and highest sleepiness scores. After adjusting for demographics, obesity, and health habits, deficient individuals slept an average of 13.0 min (95% confidence interval, -22.8, -3.2) shorter than sufficient individuals. Race/ethnic-stratified analyses indicated that the strongest associations were in African Americans, in whom adjusted sleep duration was 25.6 ± 11.7 min shorter in deficient versus sufficient individuals (P = 0.04), and in Chinese Americans, adjusted apnea-hypopnea index (AHI) was 7.5 ± 3.3 events/h higher in deficient versus sufficient individuals. CONCLUSION Overall, there were modest associations between 25-hydroxyvitamin D (25(OH)D) concentration and sleep traits. However, race-stratified analyses suggested the association between 25(OH)D concentration and sleep traits varied by race/ethnicity. Vitamin D deficiency was most strongly associated with short sleep duration in African Americans and with elevated apnea-hypopnea index in Chinese Americans, suggesting that race/ethnicity may modify these associations.

Use of relaxation techniques and complementary and alternative medicine by American adults with insomnia symptoms: results from a national survey.

INTRODUCTION Though relaxation training is recommended for insomnia, national patterns of use remain unknown. Similarly, rates of complementary and alternative medicine (CAM) use by adults with insomnia are not well established. We sought to elucidate the patterns and reasons for use of relaxation techniques and CAM use by adults with insomnia symptoms. METHODS We used the 2007 National Health Interview Survey (n = 23,358) to estimate prevalence of use among adults by self-reported insomnia symptom status. Among adults reporting insomnia symptoms (n = 4,415), we examined reasons for use and disclosure to medical professionals. We employed logistic regression to determine the adjusted associations between relaxation techniques use, CAM use, and insomnia symptoms. RESULTS Among adults with insomnia symptoms, 23% used relaxation techniques and 45% used CAM annually. After adjustment, adults with insomnia symptoms had higher likelihood of using relaxation techniques (aOR 1.48, 95% CI 1.32, 1.66) and CAM (aOR 1.29, 95% CI 1.15, 1.44) compared with adults without insomnia. Deep breathing exercise was the most commonly used relaxation technique. Fewer than 2% of adults with insomnia used CAM specifically for insomnia. Only 26% of adults with insomnia symptoms disclosed their relaxation techniques use to medical professionals. Being male, lower educational and physical activity levels, income <

The impact of psychological factors on placebo responses in a randomized controlled trial comparing sham device to dummy pill

20,000, living in South, and hypertension were associated with lower likelihood of relaxation techniques use among adults with insomnia symptoms. CONCLUSION While adults with insomnia symptoms commonly use relaxation techniques and CAM, few are using for their insomnia. Facilitating discussions about relaxation techniques may foster targeted use for insomnia.

Impact of Restless Legs Syndrome on Cardiovascular Autonomic Control

OBJECTIVES To explore to what extent psychological factors such as expectation, depression, anxiety and belief in alternative medicine impact placebo response and differential responses to separate placebo interventions. METHODS We analysed data from a randomized controlled trial designed to compare the clinical response of two distinct placebo treatments (sham acupuncture device and placebo pill) in 119 participants with persistent distal upper arm pain due to repetitive stress injury. We used a multivariable linear regression model to identify potential correlates of self-reported upper extremity pain at the end of treatment in both placebo arms of the study combined. We also performed stratified analyses by placebo treatment. RESULTS We did not find any of the psychological factors of interest to be associated with pain at the end of treatment in our combined analysis. We found higher baseline pain score and pain for longer than 1 years duration to be significantly associated with higher pain scores at the end of treatment for the placebo treatments combined. In stratified analyses, for the sham acupuncture group, we found higher baseline depression score, higher baseline pain score and younger age to be independently correlated with higher pain score at the end of treatment. For the placebo pill group, only baseline pain was significantly correlated to pain score at the end of treatment. CONCLUSION In this trial, neither expectancy nor psychological states were associated with response to placebo, with the exception of baseline depression score for the sham acupuncture arm.