Sleep disorder

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Author:
timothy.pdlt
ID:
212252
Filename:
Sleep disorder
Updated:
2013-04-09 07:53:54
Tags:
sleep disorder insomnia
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Description:
therapeutics, side-effects, drug interaction
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  1. GoT of sleep disorder Tx
    • promote restorative sleep
    • minimize external (stress, noise) and internal (ie. pain, mood) factors
    • reduce daytime impairment
    • improve effectiveness of behavioral interventions
  2. Causes of insomnia
    • primary: psychophysiological
    • secondary: psychiatric, medications, substance abuse
  3. Classification of insomnia by duration
    • 1. transient: 2-3days
    • 2. short-term: <3weeks
    • 3. long-term: >3weeks
  4. Drugs associated with insomnia
    • 1. antidepressants: TCA, fluoxetine, SNRI, bupropion, MAOI
    • 2. anti-hypertensives: BB, methyldopa
    • 3. nicotine
    • 4. sympathomimetic amines: caffeine, amphetamines, cocaine, sibutramine, decongestants
    • 5. miscellaneous: CC, levothyroxine, PHT, levodopa, quinidine
  5. Non-pharm options for insomnia
    • relaxation exercises
    • stimulus control
    • sleep restriction
    • sleep diary
    • aerobic exercise earlier in the day
    • CBT
  6. Sleep hygiene
    • regular sleep and waking schedule
    • limit daily "in-bed" time
    • avoid sleeping in/daytime naps
    • avoid offending substances
    • avoid evening stimulation/large meals
    • 20min warm bath near bedtime
    • use bedroom only for sleep and intimacy
  7. BDZ pharmacokinetics table
  8. BDZ doses for insomnia Tx
    • 1. triazolam 0.125-0.25mg
    • 2. oxazepam 15-30mg
    • 3. temazepam 7.5-30mg
    • 4. lorazepam 0.5-1mg
  9. Short-term problems with BDZ
    • AEs
    • carry-over effects (ie. effects lasting too long)
    • cognition changes
    • anterograde amnesia
  10. Long-term problems with BDZ
    • tolerance
    • deprendence
    • rebound insomnia
    • withdrawal s/s
  11. S/E of BDZs
    • drowsiness
    • fatigue
    • decreased cognition
    • anterograde amnesia
    • incoordination
    • respiratory depression
    • paradoxical effects
    • tolerance
    • dependence
  12. Risk factors for BDZ withdrawal
    • dose and potency
    • duration of Tx (limit use to up to 4weeks)
    • speed of withdrawal
    • elimination t1/2
  13. BDZ withdrawal S/S
    • confusion
    • delirium
    • ataxia
    • irritability
    • psychosis
    • seizures
    • depression
    • anxiety
    • insomnia
    • fatigue
    • blurred vision
    • nausea
    • hyperreflexia
    • psychomotor agitation
    • musculoskeletal aches
  14. Zopiclone doses for insomnia Tx
    zopiclone 3.75-7.5mg

    • *maximum 4 weeks
    • t1/2= 6 hours
  15. Advantages of zopiclone (non-BDZ hypnotic) over BDZ
    • less cortical effects
    • less amnesia
    • less rebound insomnia
    • less tolerance and dependence
    • less excitation in children
  16. S/E of zopiclone
    • bitter, metallic taste
    • dry mouth

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