Sedatives & hypnotics (sleep wake disorders) Wilkes N552| 43 questions and answers

What are two stages of sleep-wake cycle 1. Rapid eye movement (REM) sleep 2. Non-rapid eye movement (NREM) Initial/sleep-onset Insomnia Difficulty initiating sleep Middle/sleep maintenance insomnia Frequent nocturnal awakenings Late/sleep offset insomnia Early morning awakenings nonrestorative sleep Waking up feeling fatigue and unrefreshed What is insomnia difficulty falling or remaining asleep What is acute insomnia? Less than 3 months What is chronic insimnia? Lasts more than 3 months to a year Insomnia treatments Sleep hygiene measures Cognitive behavioral therapy (CBT) Chronotherapy (bright light therapy) Benzos (use short term) Non benzos Melatonin, Ambien, Lunesta, Sonata etc.)= Short term treatment; Ambien in elderly patients Antidepressants Trazodone (mostly prescribed sedating antidepressant), Remeron (low doses) What is hypersomnia? Excessive daytime sleeping Zolpidem (Ambien)-Empty stomach Zaleplon(Sonata) Eszopiclone(Lunesta)- helps stay asleep Selectively binds to Omega-1 receptor on GABA-A receptor (responsible for sedation) Non benzo Should be used for short-term of insomnia Reports of anterograde amnesia, hallucinations, parasomnias (sleep walking) and GI effects Note: Recommended Ambien dose Men=10mg Women= 5mg Other pharm sleep options Melatonin Temapazem (restroom) Triazam (halcion). Short acting agent Flurazepam (Dalmane) -long lasting agent -may cause excessive drowsiness -avoid in older adults Antidepressants used for sedating properties Amitriotyline (elavil) Doxepin (Sinequan) Mirtazapine (remeron) Trazadone What med is used for daytime sleepiness associated with OSA Armodafinil (Nuvigil) What is sedative hypnotic safer for elderly? More likely to cause side effects when used ( memory impairment, ataxia, paradoxical excitement and rebound insomnia ) Trazadone is safer. What is narcolepsy? Excessive daytime and falling asleep in inappropriate places. What is cataplexy? Brief episodes of sudden bilateral loss of muscle tone Narcolepsy symptoms cataplexy, hallucinations More in men than women What is etiology of narcolepsy? Loss of hypothalamic neurons that produce hypocretin Narcolepsy management Sleep hygiene Scheduled daytime naps Amphetamines Non-amohetamines Modafinil Methylphenidate What drugs is used for cataplexy? Sodium oxybate Must avoid use with alcohol and other CNS depressants Other meds TCAs Imipramine Desipramine Clomipramine REM suppression drugs SSRI SNRI Prozac Cymbalta Atomoxetine Venlafaxine What is Restless legs syndrome (RLS)? The urge to move legs accompanied by unpleasant sensation in the legs, characterized by relief with movement, aggravation with inactivity Symptoms of RLS Occurs or worsens in evening 1.5-2 times more likely in males Risk factors Age Iron deficiency Antidepressants Antipsychotic Dopamine blocking Antiemetic Antihistamines RLS treatment First line dopamine agonists and benzos Gabapentin (neurontin) Pregablin (lyrics) Remove offending agent Iron replacement insomnia Subjective perception Diphenhydramine (Benadryl) Antihistamine w/ moderate anticholinergic effects Non benzo Most sedating antihistamine (avoid w/ elderly) Ramelteon (Rozerem) Selective Melatonin (MT1 and MT2 agonist) Non benzo Acts on benzodiazepine receptors SLEEP DISORDERS ARE COMMONIN THE GERIATRIC POPULATION Difficulty falling asleep Poor quality sleep Frequent nighttime awakenings Early arousal without the ability to fall back asleep Specific Insomnia Symptoms Difficulty falling asleep Difficulty maintaining sleep Early morning awakening Non-restorative sleep Difficulty falling asleep insomnia potential causes Delayed sleep phase Restless legs syndrome Anxiety Potential causes of difgicukty maintaining sleep insomnia Sleep apnea (obstructive, central) Nocturia Pain Early mornign awakening insomnia Advanced sleep phase Depression Non-reatorative sleep insomnia Fibromyalgia, medical disorde Psychiatric disorders Medications effects