title: [An integral approach to insomnia in primary care: Non-pharmacological and phytotherapy measures compared to standard treatment].
abstract: BACKGROUND
  Insomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep. At some point in life, 50% of adults suffer from it, usually in stress situations.
  
  
  OBJECTIVE
  To evaluate the impact of sleep hygiene measures, relaxations techniques, and herbal medicine to deal with insomnia, compared with standard measures (drug treatment).
  
  
  METHODS
  An experimental, retrospective, non-randomized study was conducted by means of a review of patients diagnosed with insomnia (2008-2010). Patients in the intervention group (IG) received an integrative approach (hygiene measures, relaxation techniques, and herbal medicine) and a control group (CG) with conventional treatment. A comparison was made of the resources used in the two groups (average monthly visits pre- and post-diagnosis), type of prescribed drug therapy and total dose. Sleep quality was evaluated at 18-24 months (Epworth test).
  
  
  RESULTS
  A total of 48 patients were included in the IG and 47 in the CG (70% women, mean age 46 years (SD: 14.3). Average monthly visit pre-diagnosis was 0.54 (SD: 0.42) in the IG and 0.53 (SD: 0.53) in the CG (P=.88). Post-diagnosis it was 0.36 (SD: 0.24) and 0.65 (SD: 0.46), respectively (P<.0001), with a statistically significant reduction being observed in the IG. More than half (52.5%) of the IG patients and 93.6% in the CG had received a benzodiazepine (P<.0001). Alprazolam and lorazepam were the most prescribed in the CG and with higher cumulative dose. In the subsequent evaluation, 17% of patients in the IG and 5% in CG did not have insomnia. Severe insomnia was present in 13% of patients in the IG and none in CG (P<.0001).
  
  
  CONCLUSIONS
  The integrative approach to insomnia may be worthwhile as it reduces resource use and side effects, as well as dependence to benzodiazepines.
authors.affiliation: Médico especialista en Medicina Familiar y Comunitaria, Tutora docente de residentes en Medicina Familiar y Comunitaria, CAP María Bernades, Viladecans, Barcelona, España. Electronic address: adelaviniegra@yahoo.es.
authors.forename: M Adela
authors.initials: MA
authors.lastname: Viniegra Domínguez
authors.affiliation: Especialista en Salud Pública, Técnico de salud en DAP Costa de Ponent, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Neus
authors.initials: N
authors.lastname: Parellada Esquius
authors.affiliation: Médico especialista en Medicina Familiar y Comunitaria, Residente de Medicina de Familia entre 2009 y 2013, CAP María Bernades, Viladecans, Barcelona, España.
authors.forename: Rafaela
authors.initials: R
authors.lastname: Miranda de Moraes Ribeiro
authors.affiliation: Médico especialista en Medicina Familiar y Comunitaria, Residente de Medicina de Familia entre 2009 y 2013, CAP María Bernades, Viladecans, Barcelona, España.
authors.forename: Laura Mar
authors.initials: LM
authors.lastname: Parellada Pérez
authors.affiliation: Médico especialista en Medicina Familiar y Comunitaria, Residente de Medicina de Familia entre 2009 y 2013, CAP María Bernades, Viladecans, Barcelona, España.
authors.forename: Carme
authors.initials: C
authors.lastname: Planas Olives
authors.affiliation: Médico especialista en Medicina Familiar y Comunitaria, ABS Sant Climent de Llobregat, Sant Climent de Llobregat, Barcelona, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Momblan Trejo
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy; D011320:Primary Health Care; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*
keywords: Benzodiacepinas; Benzodiazepines; Fitoterapia; Insomnia; Insomnio; Integrative medicine; Medicina integrativa; Phytotherapy