Alternative remedies for insomnia: a proposed method for personalized therapeutic trials

Kate Romero,1,2 Balaji Goparaju,1,2 Kathryn Russo,1,2 M Brandon Westover,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Abstract: Insomnia is a common symptom, with chronic insomnia being diagnosed in 5&...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Romero K, Goparaju B, Russo K, Westover MB, Bianchi MT
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	insomnia over-the-counter alternative remedy herbal supplement Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/4633e946450346d996a89682d309ad32
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4633e946450346d996a89682d309ad32
record_format	dspace
spelling	oai:doaj.org-article:4633e946450346d996a89682d309ad322021-12-02T03:10:07ZAlternative remedies for insomnia: a proposed method for personalized therapeutic trials1179-1608https://doaj.org/article/4633e946450346d996a89682d309ad322017-03-01T00:00:00Zhttps://www.dovepress.com/alternative-remedies-for-insomnia-a-proposed-method-for-personalized-t-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Kate Romero,1,2 Balaji Goparaju,1,2 Kathryn Russo,1,2 M Brandon Westover,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Abstract: Insomnia is a common symptom, with chronic insomnia being diagnosed in 5–10% of adults. Although many insomnia patients use prescription therapy for insomnia, the health benefits remain uncertain and adverse risks remain a concern. While similar effectiveness and risk concerns exist for herbal remedies, many individuals turn to such alternatives to prescriptions for insomnia. Like prescription hypnotics, herbal remedies that have undergone clinical testing often show subjective sleep improvements that exceed objective measures, which may relate to interindividual heterogeneity and/or placebo effects. Response heterogeneity can undermine traditional randomized trial approaches, which in some fields has prompted a shift toward stratified trials based on genotype or phenotype, or the so-called n-of-1 method of testing placebo versus active drug in within-person alternating blocks. We reviewed six independent compendiums of herbal agents to assemble a group of over 70 reported to benefit sleep. To bridge the gap between the unfeasible expectation of formal evidence in this space and the reality of common self-medication by those with insomnia, we propose a method for guided self-testing that overcomes certain operational barriers related to inter- and intraindividual sources of phenotypic variability. Patient-chosen outcomes drive a general statistical model that allows personalized self-assessment that can augment the open-label nature of routine practice. The potential advantages of this method include flexibility to implement for other (nonherbal) insomnia interventions. Keywords: insomnia, over the counter, alternative remedy, herbal, supplementRomero KGoparaju BRusso KWestover MBBianchi MTDove Medical Pressarticleinsomniaover-the-counteralternative remedyherbalsupplementPsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol Volume 9, Pp 97-108 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	insomnia over-the-counter alternative remedy herbal supplement Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	insomnia over-the-counter alternative remedy herbal supplement Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Romero K Goparaju B Russo K Westover MB Bianchi MT Alternative remedies for insomnia: a proposed method for personalized therapeutic trials
description	Kate Romero,1,2 Balaji Goparaju,1,2 Kathryn Russo,1,2 M Brandon Westover,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Abstract: Insomnia is a common symptom, with chronic insomnia being diagnosed in 5–10% of adults. Although many insomnia patients use prescription therapy for insomnia, the health benefits remain uncertain and adverse risks remain a concern. While similar effectiveness and risk concerns exist for herbal remedies, many individuals turn to such alternatives to prescriptions for insomnia. Like prescription hypnotics, herbal remedies that have undergone clinical testing often show subjective sleep improvements that exceed objective measures, which may relate to interindividual heterogeneity and/or placebo effects. Response heterogeneity can undermine traditional randomized trial approaches, which in some fields has prompted a shift toward stratified trials based on genotype or phenotype, or the so-called n-of-1 method of testing placebo versus active drug in within-person alternating blocks. We reviewed six independent compendiums of herbal agents to assemble a group of over 70 reported to benefit sleep. To bridge the gap between the unfeasible expectation of formal evidence in this space and the reality of common self-medication by those with insomnia, we propose a method for guided self-testing that overcomes certain operational barriers related to inter- and intraindividual sources of phenotypic variability. Patient-chosen outcomes drive a general statistical model that allows personalized self-assessment that can augment the open-label nature of routine practice. The potential advantages of this method include flexibility to implement for other (nonherbal) insomnia interventions. Keywords: insomnia, over the counter, alternative remedy, herbal, supplement
format	article
author	Romero K Goparaju B Russo K Westover MB Bianchi MT
author_facet	Romero K Goparaju B Russo K Westover MB Bianchi MT
author_sort	Romero K
title	Alternative remedies for insomnia: a proposed method for personalized therapeutic trials
title_short	Alternative remedies for insomnia: a proposed method for personalized therapeutic trials
title_full	Alternative remedies for insomnia: a proposed method for personalized therapeutic trials
title_fullStr	Alternative remedies for insomnia: a proposed method for personalized therapeutic trials
title_full_unstemmed	Alternative remedies for insomnia: a proposed method for personalized therapeutic trials
title_sort	alternative remedies for insomnia: a proposed method for personalized therapeutic trials
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/4633e946450346d996a89682d309ad32
work_keys_str_mv	AT romerok alternativeremediesforinsomniaaproposedmethodforpersonalizedtherapeutictrials AT goparajub alternativeremediesforinsomniaaproposedmethodforpersonalizedtherapeutictrials AT russok alternativeremediesforinsomniaaproposedmethodforpersonalizedtherapeutictrials AT westovermb alternativeremediesforinsomniaaproposedmethodforpersonalizedtherapeutictrials AT bianchimt alternativeremediesforinsomniaaproposedmethodforpersonalizedtherapeutictrials
_version_	1718401912563302400

Alternative remedies for insomnia: a proposed method for personalized therapeutic trials

Ejemplares similares