Sleep Disorders and Tourettes Syndrome

Question 1

Non-pharmacological Tx for insomnia

Answer 1

Sleep hygiene Measures: avoid caffeine, nicotine, exercise prior to hs, regular sleep hours, relaxation techniques

Question 2

Alternative Pharm. tx for insomnia

Answer 2

Melatonin, valerian root, chamomile tea

Question 3

Medications

Answer 3

• Benzodiazepines: Lorazepam / Ativan 0.5 mg po q hs, Temazepam / Restoril 7.5 mg po q hs
• GABA benzodiazepine receptor agonist: Eszopiclone / Lunesta 1-3 mg q hs
• Hypnotics: Zolpidem / Ambien 5 mg po q hs (May lead to amnesic episodes)
• Serotonin modulator: Trazadone / Desyrel 25 mg po q hs
• Melatonin receptor agonist: Ramelteon / Rozerem 8 mg po q hs

Question 4

Tx for sleep apnea

Answer 4

Weight reduction, CPAP, BiPAP, UPPP

Question 5

Tx for narcolepsy

Answer 5

Treat with stimulants
• Dextroamphetamine (Dexedrine) 10 mg po qd (MDD 60 mg) (Schedule II)
• Modafinil (Provigil) 200 mg po qd (MDD 400 mg) (Schedule IV)
• Amodafinil (Nuvigil) 150-250 mg po qd (Schedule IV)

Question 6

Tourette’s sxs

Answer 6

• Motor tics: Sniffing, blinking, frowning, shoulder shrugging, head thrusting.
• Phonic Tics: grunting, Barking, Hissing, Throat clearing

Question 7

Tourette’s Tx

Answer 7

• Haloperidal/Haldol: drug of choice that blocks dopamine receptors, adverse side effects: extrapyramidal sxs
• Clonazepam/Klonopin: Benzodiazepine
• Clonidine/Catapres: central acting alpha agonist