CNS - INSOMNIA

Question 1

What is normally used to treat insomnia?

Answer 1

hypnotics and anxiolytics e.g. benzos, z drugs etc

Question 2

When would short acting hypnotics be preferable? e.g. temazapam, lorazepam

Answer 2

• elderly patients

- for patients with sleep onset insomnia (struggle getting to sleep), where they don’t want sedation the next day

Question 3

When are long acting hypnotics indicated? e.g. diazepam, nitrazepam, flurazepam

Answer 3

• in patients with poor sleep maintenance (e.g. wake up early)
• when sedation the following day is acceptable
• if insomnia is linked with daytime anxiety then diazepam may be most appropriate as a single dose at night to treat both things

Question 4

In short term insomnia, what is the maximum amount of time a hypnotic should be given for?

Answer 4

3 weeks

Question 5

When would barbiturates be recommended?

Answer 5

in severe intractable insomnia in patients already taking barbiturates

Question 6

Which drugs should be avoided in the elderly and why?

Answer 6

• benzos and z drugs

- at greater risk of becoming ataxic and confused - increased risk of falls

Question 7

Which drug could be most appropriate for the elderly?

Answer 7

clomethiazole - due to its freedom from hangover