Insomnia

Question 1

What are the types of insomnia?

Answer 1

Transient
- Env factors (jet lag)
- 1-2 doses of SA hypnotics

Short term
- Emotional or serious illness
- Intermittent SA hypnotic <3W

Chronic
- Psychiatric or physical illness
- Treat underlying cause

Question 2

What are the different types of z drugs?

Answer 2

Avoid in elderly, if needed offer SA

Short acting: sleep onset insomnia, little hangover effect:
- Zopiclone (taste disturbance)
- Zolpidem (GI disturbance, leave 8 hours before driving)

Question 3

What are the different types of benzo?

Answer 3

Long acting: sleep maintenance insomnia, hangover effect, anxiolytic effect during day (diazepam single dose at night)
- Nitrazepam
- Diazepam (dental procedures)

Short acting: sleep onset insomnia, little hangover effect
- Temazepam (CD 3, preferred for dental procedures)
- Lorazepam (dental procedures, insomnia associated w anxiety
- Oxazepam (insomnia associated w anxiety)

Question 4

What is the MOA of Z drugs?

Answer 4

Acts on benzodiazepine sites on GABAa receptors + enhances binding of GABA

Question 5

What is the indication of Z drugs?

Answer 5

Severe insomnia (short term)

Question 6

What are the side effects of Z drugs?

Answer 6

Day time sleepiness

Respiratory depression

Dependence + tolerance

Rebound insomnia - sleep disturbance that occurs on discontinuation of benzodiazepine hypnotic drugs

Question 7

What are the interactions of Z drugs

Answer 7

INC CNS depression (sedation)
- Alcohol
- Opioids
- Sedating antihistamines
- Antipsychotics
- Enzyme inhibitors