Insomnia Flashcards
3 MC types of insomnia
Adjustment insomnia- Associated with identifiable stressor.
Psycophysiologic Insomnia- Preoccupation with sleep problem causing further wakefulness.
Insomnia 2˚ to mental disorder- Depression, dysthymic, bipolar, anxiety disorders
Benzos for sleep
Use limited by tolerance, anterograde amnesia and rebound insomnia.
Given only 2 weeks- avoid tolerance & withdrawal.
Restoril
Temazepam
Pts with frequent awakenings. Peak sedative effect is 3 hours after dose. Early awakenings may occur. Low incidence of residual daytime drowsiness
Halcion
Triazolam. Short acting BZD. Good for sleep induction. Tolerance in a few days
Prosom
Estazolam. Intermediate acting BZD. Short term tx for insomnia.
Non-BZD Tx for Insomnia
Effect same receptor. Less potential for rebound insomnia and withdrawal effects.
Have been associated with abnormal thinking & behavior ∆. Decreased inhibition, aggression, agitation, hallucinations, amnesia, sleep driving, cooking, shopping.
Zolpidem
Ambien®, Ambien CR. Non-BZD hypnotic (action on BZD receptors).
Used short term
Rapid onset of action.
DI: CYP 450 substrate, CNS depressors
Zolpidem AEs
CNS: Dizziness, HA, amnesia, confusion, depression, nightmares
CV: Increase BP, palpitations
GI/Endocrine: abd pain, appetite disturbance, mild withdrawal effects possible
Zalpelon
Sonata. Very similar to zolpidem. Shorter t 1/2- better sleep latency. DI: CYP 450, CNS depressors AE: fewer than zolipidem. Less daytime drowsiness.
Eszopiclone
Lunesta.
Non-BZD hypnotic. Rapid absorption (peaks in 1 hour)
DI: CYP 450, CNS depressants.
Effective up to 6 months of continuous use
AE: Anxiety, xerostomia, HA, peripheral edema, somnolence, unpleasant taste.
Ramelteon
Rozerem. Melatonin agonist
Promotes sleep, helps maintain circadian rhythm.
Melatonin: naturally occurring chemical released in response to darkness, promotes sleep.
TCA’s
Amitriptyline (Elavil),
Trazodone (Desyrel)- particularly effective for insomnia caused by other antidepressants
