Purpose of Review
To review promising treatment options (pharmacologic and nonpharmacologic) and sequence of treatments for addressing disordered sleep in patients with painful diabetic neuropathy (PDN). To review the efficacy of various medications and treatments in improving pain and/or sleep quality in the PDN population. Additionally, adverse effects, tolerability, longevity, and costs of these treatments are considered.
Recent Findings
Disordered sleep and PDN have a complex multidirectional relationship; pain symptoms from PDN can disrupt sleep patterns, and disordered sleep can exacerbate pain symptoms. Treating disordered sleep in patients with PDN has potential to improve pain severity, comorbid conditions, and quality of life. There are no consensus guidelines for the best sequence of treatments for insomnia in PDN. Treatments need to be individualized based on patients’ comorbidities, adherence to sleep interventions, medication profile, and patient preferences.
Summary
90 original research studies, reviews and meta-analyses of subjects experiencing disordered sleep and/or pain (neuropathic or general) were reviewed. Possible effective options for treating disordered sleep in PDN include tricyclic antidepressants (TCAs), gabapentinoids, melatonin agonists, and orexin antagonists (pharmacologic); and cognitive behavioral therapy for insomnia (CBT-I), acupuncture, and possibly neurostimulation (non-pharmacologic options). We hope this review will help guide clinicians regarding the best available treatment options for disordered sleep in patients with PDN, and drive researchers to further investigate new treatment options and pathophysiology of these closely related disorders.
