7. Sleep disorders

Question 1

Insomnia symptoms

Answer 1

• Difficulty staying sleeping
• Difficulty getting to sleep
• Poor sleep quality
• Early morning awaking

Question 2

Types of insomnia

Answer 2

Transient: Environmental factors such as jet lag, shift work

Short term: Resulting from emotional or serious illness

Chronic: Psychiatric (e.g anxiety, depression) or physical illness

Question 3

Insomnia treatment with types

Answer 3

Transient: 1-2 doses of short-acting hypnotic

Short-term: Short-acting hypnotic to be used for less than 3 weeks

Chronic: treat underlying cause

Question 4

Hypnotics list

Answer 4

Z-drugs (CD4 Part 1)
short-acting - - preferred in patients who do not want to experience drowsines the next day or who drive

Zoplicone (taste disturbance)
Zolpidem (GI disturbance)

Benzodiazepines (CD4 Part 1)
Long-acting
Diazepam
Nitrazepam
Flurazepam

Short-acting - preferred in patients who do not want to experience drowsines the next day or who drive
Lorazepam
Temazepam
Loprazolam

Hyponotics should not be used in elderly, can cause ataxia and confusion. If used, reduce dose and use short-acting

Question 5

Z-drugs mechanism of action

Answer 5

Act on benzodiazepines sites on GABA-A receptors, to enhance the binding of GABA - inhibitory neurotransmission, to promote effects like sedation.

Question 6

Z-drugs

Answer 6

Used short term for severe insomnia - up to 4 weeks

Side effects (similar to benzodiazepines)

• Drowsiness
• Reduced alterness, confusion
• Respiratory depression (increased risk when taken with opioids)
• Dependence and tolerance - can cause rebound insomnia when withdrawn

Z-drugs are benzodiazepine like drugs, so will present with similar side effects to them

Question 7

Z-drugs interactions

Answer 7

• Increased risk of CNS depression, when taken with drugs that also cause CNS depression:
  Alcohol, opioids, sedating antihistamines, antipsychotics, benzodiazepines
• Cytochrome P450 enzyme inhibitors, reduce the rate of metabolism of Z-drugs, increasing their concentration in the blood:
  Azole antifungals, clarithromycin, erythromcyin, diltiazem, verapamil
• Increased risk of respiratory depression when taken with:
  benzodiazepines or opioids