Insomnia Flashcards
Symptoms
- Difficulty initiating and maintaining sleep
- Early morning waking
- Poor sleep quality
Transient insomnia
- Caused by environmental factors e.g. noise, shift work, jet lag
- Short-acting (rapidly eliminated)
- Give only 1/2 doses
Short term insomnia
- Related to emotional problem or medical illness
- Can last up to a few weeks and recur
- Take intermittently and omit some doses
- No more than 3 weeks treatment
Chronic insomnia
- Caused by psychiatric disorders, alcohol, drug abuse
- Treat underlying cause.
When would short acting hypnotics be used?
e.g. z-drugs
- Sleep onset insomnia
- Elderly patients
- Little hangover effect = can drive/go to work
Z-drugs
Zopiclone
- Taste disturbance
Zolpidem
- GI disturbances
- 8 hours before driving
Zaleplon
- shorter acting
Z drugs - use
Short-term use up to 4 weeks (2 for zaleplon) for severe insomnia that interferes with daily life
What class do z-drugs belong to?
CD4 part 1
Z drugs - side effects
- Paradoxical effects
- Daytime sleepiness
Paradoxical effects
- Increase in hostility and aggression.
- Talkativeness/excitement to aggression/antiscoial acts.
- Increased anxiety and perceptual disorders
- Adjust dose
Z drugs - long term use
AVOID long term use
Dependence + withdrawal reactions
- rebound insomnia
- broken sleep with vivid dreams
- avoid abrupt withdrawal
Tolerance develops in 3-14 days of continuous use
Long acting hypnotics - exampls
Nitrazepam
Flurazepam
Diazepam
- Dental procedures
Long acting hypnotics - USE
- Sleep maintenance insomnia that causes daytime effects
- Anxiolytic effect during day- diazepam single dose at night
-Hangover effect
Shorter acting hynoptics - when would they be used?
- Sleep onset insomnia
- Elderly patients
- Hepatic impairmen
- Little hangover effect = can frive, job
Shorter acting hypnotics - examples
Temazepam
- CD3
- Dental procedures (preferred)
Lorazepam
- Dental procedures
- Insomnia associated with anxiety
Loprazolam
Lormetazepam
Oxazepam
- Insomnia associated with anxiety
