Rebound Insomnia and Rebound Anxiety: A Review

Kales, Anthony; Soldatos, Constantin R.; Bixler, Edward O.; Kales, Joyce D.

doi:10.1159/000137794

Cited by 195 publications

(59 citation statements)

References 21 publications

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“…Rather, rebound insomnia was observed on the first withdrawal night, with a return to baseline values on the subsequent withdrawal nights. Comparable findings have been reported with triazolam, another short acting benzodiazepine hypnotic (Kales et al, 1983;Roth et al, 1983). Similarly, the effects of brotizolam on sleep morphology were observed to be similar to those reported previously with triazolam (Johnson & Spinweber, 1981;Pakes et al, 1981;Roth et al, 1983).…”

Section: Discussionsupporting

confidence: 85%

Effects of brotizolam on the sleep of chronic insomniacs.

Mamelak¹,

Csima²,

Price³

1983

Brit J Clinical Pharma

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1 Effects of 0.5 mg brotizolam on the sleep of chronic insomniacs were assessed electroencephalographically and subjectively over 14 days. 2 Brotizolam (0.5 mg) increased total sleep time, decreased drowsy (stage 1) sleep and increased stage 2 sleep. At this dose it also decreased slow wave and rapid eye movement sleep. On withdrawal there was evidence of insomnia in some subjects during the first night. The drug was well tolerated. 3 Further studies are indicated with lower doses of the drug.

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Section: Discussionsupporting

confidence: 85%

Effects of brotizolam on the sleep of chronic insomniacs.

Mamelak¹,

Csima²,

Price³

1983

Brit J Clinical Pharma

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“…The discovery of benzodiazepine receptors in the brain suggests the presence of endoge nous benzodiazepine-like molecules, the pro duction of which would be regulated by con centrations of the circulating molecules or a feedback mechanism [5,86]. Production of endogenous benzodiazepine-like molecules would be decreased if active exogenous ben zodiazepine drugs or metabolites were intro duced.…”

Section: Elimination Ratementioning

confidence: 99%

Benzodiazepine Side Effects: Role of Pharmacokinetics and Pharmacodynamics

Vgontzas

Kales

Bixler³

1995

Pharmacology

Self Cite

103

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Benzodiazepines have a wide variety of indications. However, CNS and psychiatric adverse reactions, tolerance, and withdrawal effects of benzodiazepines are becoming increasingly recognized and must be better understood for proper drug use. Certain benzodiazepines are associated with memory impairment and other cognitive defects and hyperexcitability phenomena during treatment (early-morning insomnia, daytime anxiety) and following withdrawal (rebound insomnia and anxiety, seizures). Elimination half-life, receptor-binding affinity, effects on the locus coeruleus-norepinephrine (LC-NE) and hypothalamic-pituitary-adrenal (HPA) axes, and the interaction of these factors appear to be major determinants of frequency and severity of these untoward effects. Rapid drug elimination and high receptor-binding affinity were initially suggested as primary underlying factors which determine frequency, severity, and type of the side effects of benzodiazepines during administration and withdrawal. Newer data and information on triazolobenzodiazepines indicate that these psychiatric adverse reactions also relate to whether the benzodiazepine has strong direct effects on the LC-NE and HPA systems. Initial suppression of the LC-NE and HPA systems is followed, on an interdose basis, by a significant rebound and activation. This repetitive pattern of suppression followed by rebound results in a neurophysiologic and behavioral sensitization (kindling) of the limbic system and consequently contributes to central nervous system and psychiatric adverse reactions. The tendency of certain of these side effects to worsen over time supports empirically this neurophysiologic and biochemical model.

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“…Studies that have specifically examined rumination and insomnia have found a relationship between rumination and sleep quality in both healthy individuals (Thomsen, Mehlsen, Christensen & Zachariae, 2003) and psychiatric patients (Bertelson & Monroe, 1979;Kales, Caldwell, Soldatos, Bixler & Kales, 1983). Thus, there is strong evidence that cognitive arousal at bedtime is associated with increased sleep disturbance.…”

Section: Introductionmentioning

confidence: 99%

Job strain, work rumination, and sleep in school teachers

Cropley

Dijk

Stanley

2006

European Journal of Work and Organizational Psychology

180

157

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The objectives of this study were, firstly, to examine the association between job strain and sleep quality in a sample of primary and secondary school teachers and, secondly, to assess whether the relationship between job strain and sleep quality is mediated or moderated by an individual's inability to 'switch-off' from work related issues during leisure time. School teachers (N = 143) completed an hourly record of their work related thoughts over a workday evening between 5 pm and bedtime, and then rated their sleep quality the following morning. Individuals were classified as reporting high (n =462) or low (n = 52) job strain using predetermined cut-off scores.Consistent with previous research, the results showed that both groups demonstrated a degree of unwinding and disengagement from work issues over the evening. However, compared to the low job strain group, the high job strain teachers took longer to unwind and ruminated more about work related issues, over the whole evening, including bedtime. There was no difference in total sleep time between the groups, but high job strain individuals reported poorer sleep quality compared to low job strain individuals. With respect to the second objective, across the whole sample (N = 143), work rumination and job strain were significantly correlated with sleep quality, but work rumination was not found to mediate, or moderate the relationship between job strain and sleep quality. It was speculated that the initial low contribution of job strain to sleep quality (r = -.18) may have contributed to this null finding. The current findings may have implications for how we assess and manage sleep disturbance in stressed workers.3

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Rebound Insomnia and Rebound Anxiety: A Review

Cited by 195 publications

References 21 publications

Effects of brotizolam on the sleep of chronic insomniacs.

Effects of brotizolam on the sleep of chronic insomniacs.

Benzodiazepine Side Effects: Role of Pharmacokinetics and Pharmacodynamics

Job strain, work rumination, and sleep in school teachers

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