Chronic Primary Insomnia
For this assignment, I choose to appraise Jiang, Zhang, Yue, Yi & Gao (2013) on chronic primary insomnia. The current medical treatment of chronic insomnia has underlying problems such as drug abuse, dependence, and withdrawal syndrome (Addiction Center, 2020). Thus, there is a need for an effective and safe treatment method. One may contend that the non-medical treatment of chronic anemia would mitigate such problems. Jiang, Zhang, Yue, Yi & Gao’s (2013) work seeks to answer the question of whether non-medical treatment such as repetitive transcranial magnetic stimulation (rTMS) is more effective than medical methods in treating chronic primary insomnia. The study sample comprises of patients diagnosed with chronic primary insomnia through the DSM-5 in one hospital. A total of 120 patients are grouped into three study groups. Each group is treated independently through rTMS, or medication, or psychotherapy, where the last two are control methods. The outcomes of each medication are assessed using the Pittsburgh sleep quality index, where rTMS is compared with the two control methods. It is expected that the group which is treated with rTMS will reveal better outcomes, hence declare it as the effective treatment for chronic primary insomnia. Jiang, Zhang, Yue, Yi & Gao (2013) do the study for eight months, with each patient sample receiving treatment for two weeks consecutively.
Methodology
Jiang, Zhang, Yue, Yi & Gao’s (2013) objective is to nullify that rTMS is more effective compared to the medical and psychological treatment of chronic primary insomnia. The study is designed such that the efficacy of rTMS compares to medical and psychological treatment. Therefore, 40 patients are distributed into three groups randomly, and each group is treated on either the rTMS, medicine, or psychotherapy. All patients are similar in that they are selected through a standard criterion, and treated for two weeks. The efficacy of each method is analyzed based on changes in polysomnography parameters, Pittsburgh sleep quality index and indices of HPA and HPT axes. The outcome is measured by comparing the sleep efficiency and latency, total sleep time, sleep stages I, II, and III, and the REM sleep cycle, using LDS and ANOVA. Statistical data is analyzed using the Chi-square test, where p<0.05 is statistically significant.
Results
The study results are presented as polysomnographic, where the sleep efficiency and latency, total sleep time, sleep stages I, II, and III, and REM sleep cycle are comparable for the three treatment methods. The first observation is that patients in all the treatment revealed desirable health outcomes, where p = 0.05 versus before treatment. Secondly, the rTMS caused the most desirable treatment outcome among the three treatment methods. Statistical data measured p<0.05 for rTMS compared to medical treatment and psychotherapy. Concerning the indices of HPA and HPT axes, rTMS compared favorably with a statistical value p<0.05 against medical treatment and psychotherapy.
Clinical Implications
Jiang, Zhang, Yue, Yi & Gao (2013) investigates whether non-medical treatment such as rTMS is more effective than medical methods in treating chronic primary insomnia. Their methodology indicates that rTMS is a safe and more effective treatment method for chronic primary insomnia compared to medication or psychotherapy. This is a potential practice shift from medicinal treatment, which has adverse side effects such as drug abuse, dependence, and hypotonic treatment (Addiction Center, 2020). Besides, the method was validated by the hospital’s ethical committee. However, it is crucial to identify any side effects before adopting the method into clinical practice.
References
Addiction Center. (2020). Sleeping Pill Addiction and Abuse – Understanding Sedative-Hypnotics. Retrieved 16 June 2020, from https://www.addictioncenter.com/sleeping-pills/
Jiang, C., Zhang, T., Yue, F., Yi, M., & Gao, D. (2013). Efficacy of Repetitive Transcranial Magnetic Stimulation in the Treatment of Patients with Chronic Primary Insomnia. Cell Biochemistry And Biophysics, 67(1), 169-173. doi: 10.1007/s12013-013-9529-4