In adults with primary insomnia, doxepin 1 mg, 3 mg, and 6 mg was well-tolerated and produced improvement in objective and subjective sleep maintenance and duration endpoints that persisted into the final hour of the night. The side-effect profile was comparable to placebo, with no reported anticholinergic effects, no memory impairment, and no significant hangover/next-day residual effects. These data demonstrate that doxepin 1 mg, 3 mg, and 6 mg is efficacious in improving the sleep of patients with chronic primary insomnia.

We tested the hypothesis that continuous positive airway pressure (CPAP) use and outcomes can be improved by an autotitrating CPAP device in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) who require higher CPAP (10 cm H2O or more). In this multisite randomized single-blind cross-over study, 44 patients (mean age, 49 +/- 10 years) were randomized to 6 weeks at laboratory-determined fixed pressure and 6 weeks on autotitrating CPAP. Average nightly use was greater in automatic mode (306 versus 271 minutes, p = 0.005); median and 95th centile pressures in automatic mode were lower (p < 0.002). Automatic CPAP resulted in better SF-36 Vitality scores (65 +/- 20 versus 58 +/- 23, p < 0.05) and mental health scores (80 +/- 14 versus 75 +/- 18, p < 0.05), but no significant difference in Epworth score (p = 0.065). During automatic therapy, patients reported more restful sleep, better quality sleep, less discomfort from pressure, and less trouble getting to sleep for both the first week of therapy and for the averaged scores for Weeks 2-6 (all p values < 0.006). Patients who require higher fixed CPAP use autotitrating CPAP more and report greater benefit from this therapy.

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ClinicalTrials.gov identifier, NCT00991276; http://clinicaltrials.gov/show/NCT00991276.

This study confirms that NRS can occur independently of other components of insomnia. Daytime symptoms were as severe in individuals with NRS-only as those whose NRS symptoms were combined with DIS or DMS.

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Objective: To evaluate the effi cacy and tolerability of armodafi nil in patients with excessive sleepiness following mild or moderate closed traumatic brain injury (TBI). S C I E N T I F I C I N V E S T I G A T I O N SE ach year, approximately 1.7 million people in the US experience a traumatic brain injury (TBI), 1 of which 75% are classifi ed as mild in severity.2 Sleep disturbances including obstructive sleep apnea, hypersomnia, insomnia, periodic limb movement, and narcolepsy have all been reported among patients with TBI.3-5 Excessive sleepiness-or the more broad condition of hypersomnia-is particularly common among post acute TBI patients, ranging from 25% to 53% depending on the defi nitions of the condition and assessments employed.4,6-8 This is considerably greater than the rate of excessive sleepiness reported in the general population (4.0% to 20.6%). 9The appreciable effects of sleep disorders on the TBI population are not fully known, although some evidence suggests that they may contribute to cognitive impairment, mood disturbance, and disrupt recovery or rehabilitation. 4,[10][11][12][13] Despite the high prevalence of hypersomnia in the TBI population, the literature is sparse regarding treatment recommendations. Recommended strategies include addressing any underlying medical or psychiatric conditions (e.g., nasal continuous positive