Clinical and pharmacological approaches for treatment of insomnia Flashcards
define insomnia
habitual sleeplessness
effects of insomnia
easy fatigue, disturbed concentration, memory loss, anxiety, agitation, increased risk of depression
epidemiology of insomnia
more common in the elderly and in women more than men
type of insomnia in 18-30 yo
difficulty w/ sleep initiation
type of insomnia in elderly yo
difficulty w/ sleep maintenance
types of insomnia
acute sleeplessnes
moderate
chronic
acute sleeplessnes
1 to several nights, causes
- noise,
- changes in diurnal rhythm,
- changes in environmental temperature,
- use of excitatory CNS drugs
Moderate sleepless-
disturbances for several weeks to a month
Chronic sleepless
more than a month
usually linked to chronic disorders
-apnea
-arthritic pain
approaches in insomnia of the young
hypnotic
fast onset
short DOA
to facilitate sleep initiation and minimise morning fatigue
approaches in insomnia of the elderly
long acting hypnotic with duration of action of 6-8 hrs
to prevent sleep breaks
approaches in insomnia of mixed type
combination
initial non pharm approach
avoid stim drinks (coffee)
drink hot cocoa
early dinner
comfy bed
quiet room
first line rx of insomnia when non pharm fails
natural sedatives
- melissa herb
- valeriana
rx when sedativss fail
hypnotics w/
- short 1/2 life
- no active metabolites
to decrease morning drowsiness ADR
why are benzodiazepines EUHYPNOTICS
dont disturb normal REM sleep
effects of benzo’
sedation at half dose of barb
antiepileptic effect
anti axiolytic effect
benzo antidote
FLUMAZENIL
-comp binds w/ gabaergic receptors
benzo used in young insomnia
TRIAZOLAM
- fast onset
short doa
benzo in old
TEMAZEPAM
- long acting
benzo phk
abs: good oral abs due to lipophillic nature
benzo class
short acting;
- triazolam
- oxazepam
moderate
- alprazolam
- temazepam
long acting
- clonazepam
- diazepam
benzo ADR
Dependance and tolerance
slowed reflexes and myorelaxation
antegrade amnesia
conraindication of benzo
PREG- cross pb
elderly- amnesia
liver insuff- lipophilic
childhood-
benzo drug intrxn
ez inducer
reduced effect of
1) phenytoin
2) phenobarbital
Enzyme inhibitors
chloramphenicol, omeprazole
cimetidine
why are barbiturates less commonly used to rx insomnia
abolish REM phase of sleep
active met cause morning sleepiness
supress Resp centre in brain
phenobarb tab 100mg effects
anti epileptic
megaloblastic anemia after long-term use, positive Wassermann test
adrs
Morning sleepiness
Easy fatigue
Tolerance and dependence
Ataxia
benzo like drugs
zolpidem tab. 10mg
zopiclon tab. 7.5mg
bind to GABA- ergic receptors in the CNS
difference between the benzo like drugs
zolpiDEM
- tolerance
-fast acting
zolpiCLON
- no tolerrance
-long doa 6-8 HR SLEEP
