CNS sleep disorders Flashcards
3 types of sleep disorders
transient insomnia
short term insomnia
chronic insomnia
what is TRANSIENT INSOMNIA?
external factors- noise, shift work & jet lag
Give rapidly eliminated hypnotic eg Nytol otc/ Zolpidem- only 1 or 2 doses
what is SHORT-TERM INSOMNIA?
emotional problem/serious medical illness
Hypnotic (zolpidem/ zopiclone) is useful, don’t give more than 3 weeks (1 week ideal)
else risk of dependency develops
what is CHRONIC INSOMINA?
cause: anxiety/depression/alcohol/drug abuse
Treat underlying psychiatric complaint
can adjust med i.e. if depression, mirtazapine at night
BENZODIAZEPINES
LONG-ACTING BENZODIAZEPINEs? DNF
diazepam
nitazepam
flurazepam
which benzo type may be used for sleep maintenance and why
long acting DNF
Higher hangover effect following day
Used for sleep maintenance
BENZODIAZEPINES
SHORT-ACTING BENZODIAZEPINES? LLT
Loporazolam/Lormetazepam/Temazepam
which benzo type SA/LA may be used for sleep onset?
Short acting
Little/no hangover effects
Used for sleep onset
Higher chance of withdrawal symptoms
2 examples of Z-hypnotics
Zolpidem/Zopiclone
what do Z hypnotics do to lead to cns depression
increase GABA (inhibitory neurotransmitter)
when does dependency occur for z hypnotics
Occurs within 3-14 days of use
Z-HYPNOTICS
When to take it?
Max. duration?
When to take it? Taken intermittently
Max. duration? Use for 4 weeks max.
Z-HYPNOTICS
Benzodiazepines (clonazepma, lorazepam) + Z-drugs should be avoided in elderly why?
Avoid in elderly due to risks of fall and injury
Z-HYPNOTICS
SIDE-EFFECTS? PDD
Paradoxical side-effects
Drowsiness
Dependance - depends how long take them for.
with z hypnotics, whats major SE of long term use?
rebound insomnia and withdrawal syndrome
