Hypnotics And Sleep Disorders

Question 1

What is the primary treatment option for sleep disorders?

Answer 1

Lifestyle changes

Question 2

What are the two main types of sleep disorders?

Answer 2

Dyssomnias - various disturbances in the quality, amount or timing of sleep (e.g insomnia)

Parasomnia: abnormal movements, behaviours, emotions, perceptions, and dreams during sleep (e.g. sleep walking)

Question 3

What are the five “p”s of insomnia?

Answer 3

Physical, physiological, psychological, psychiatric, pharmacological

Question 4

What is the treatment of RLS?

Answer 4

Correct any iron deficiency,
Dopaminergic agonists such as Ropinirole

Question 5

How is sleep apnoea syndrome treated?

Answer 5

Continuous positive pressure - stream of low pressure air through the nose

Question 6

What are the pharmacological causes of sleep disorders?

Answer 6

• Drugs with stimulant action e.g. decongestants
• many psychotropics e.g. SSRIs
• beta blockers, such as propranolol

Question 7

Why are barbiturates no longer used to treat sleep disorders?

Answer 7

Poor safety profile (NTW) - respiratory depression

Question 8

What are examples of short and long acting benzodiazepines and how long are they licensed for use for insomnia?

Answer 8

Long acting - Nitrazepam and Diazepam
Short acting - Loprazolam, Temazepam

2-4 weeks max

Question 9

What are the disadvantages of hypnotics?

Answer 9

• All have tolerance and dependence concerns
• Long acting - “hangover” like symptoms (very long half life)
• Short acting - will not help waking at night
• Rebound insomnia on withdrawal
• Diversion to drug abusers
• Questionable long term efficacy

Question 10

What is the target of benzodiazepines?

Answer 10

Post synaptic GABAa receptors - enhancing the inhibitory effect of the GABAa-gamma subunit

Question 11

What is the GABAa receptor?

Answer 11

An inhibitory ligand gated ion channel, selectively permitting entry of Cl- ions

Question 12

What are examples of non-benzodiazepine hypnotics - “Z-drugs” and what is their major advantage?

Answer 12

Zalepon, Zolpidem, Zopiclone

Major advantage is short half life

Question 13

How long are Z drugs licensed for, what is their target and what patient group would they have limited use in?

Answer 13

Short Term use (usually 2-4 weeks)

GABAa receptors (highest affinity for alpha-1 = sedative effects)

Patients who wake early - benzodiazepines more useful in this context

Question 14

What is melatonin used for?

Answer 14

• Transient insomnia
• Short Term insomnia in the elderly
• induction of sleep for children with ADHD (specialist supervision)