Sleep Disorders

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Presentation Transcript

Sleep Disorders: 

Sleep Disorders Brooke Y. Patterson, PharmD, BCPS NU 7080 Advanced Pharmacology Research College of Nursing

Epidemiology: 

Epidemiology 35% of US population reports sleep difficulties We spend approximately 1/3 of our life asleep Amount of sleep required varies from person to person Changes with age More than 40% of patients with sleep disorders self-medicate with OTC medications

Definitions: 

Definitions Several ways to categorize sleep disorders Primary disorders Primary insomnia Sleep disorders related to another mental disorder Other sleep disorders Substance-induced Medical condition induced

Insomnia: 

Insomnia Inability to initiate or maintain sleep Transient Lasts 2-3 days, associated with acute stressors Short-term Lasts less than 3 weeks, associated with an acute stressor of ongoing nature Chronic Lasts greater than 3 weeks, not associated with an acute stressor Patient should be carefully evaluated for an underlying medical or psychiatric cause

Sleep Hygiene: 

Sleep Hygiene Maintain regular bedtimes and awakenings Don’t go to bed unless you are sleepy Sleep long enough to avoid feeling tired, but no more Optimize the bedroom conditions Develop a bedtime ritual that allows you to unwind If you cannot go to sleep, or awaken and can’t go back to sleep, do not stay in bed more than 15-20 minutes

Sleep Hygiene: 

Sleep Hygiene Do not go to bed hungry, but do not stuff yourself prior to bed Avoid activities in the bedroom except sleeping and sex Do not lie there and watch the clock Avoid naps during the day Avoid stimulants throughout the day Avoid alcohol Exercise regularly, but not close to bedtime

Pharmacologic Therapy: 

Pharmacologic Therapy Should be considered adjunctive therapy for short-term or chronic insomnia Part of a therapeutic plan that addresses causes and encourages good sleep hygiene Several classes of medication Benzodiazepines (BZDs) Non-benzodiazepines (Non-BZDs) Melatonin agonists

Benzodiazepines: 

Benzodiazepines Only 5 drugs in the class are approved for insomnia Rapidly absorbed Quick-acting Short-acting Disadvantages to use Tolerance Residual daytime sedation Rebound insomnia Anterograde amnesia

Benzodiazepines: 

Benzodiazepines Withdrawal Physical dependence occurs with long-term use Worsening insomnia Auditory and visual hypersensitivity Seizures (rare)

Non-Benzodiazepines: 

Non-Benzodiazepines Mechanism of Action Bind to BZD-1 receptors GABA agonists Addiction/dependence less than BZDs Non-BZDs are controlled substances (CIV) Mild side effects GI complaints Daytime somnolence Dizziness

Non-Benzodiazepines: 

Non-Benzodiazepines

Ramelteon (Rozarem®): 

Ramelteon (Rozarem®) Mechanism of Action Melatonin agonist Dose: 8 mg PO HS Not associated with dependence NOT a controlled substance May be used chronically

OTC Medications: 

OTC Medications Antihistamines Sedating property Diphenhydramine (Benadryl®) and doxylamine (Unisom®) used most commonly Do not maintain efficacy beyond 3-5 days Higher incidence of daytime sedation Use of these agents routinely for insomnia is not recommended

Herbal Sleep Products: 

Herbal Sleep Products Valerian BZD-like activity Takes 2-4 weeks of use before sedative effects are seen Alluna® (combination of valerian and hops) Kava Anxiolytic Use in persons with insomnia related to anxiety Dermatologic problems possible Use beyond 3 months is NOT recommended

Herbal Sleep Products: 

Herbal Sleep Products Melatonin Hormone secreted by pineal gland that is responsible for circadian rhythms HA, fatigue, abdominal cramps, and irritability possible May worsen depression Not recommended

Slide17: 

Life is something that happens when you can't get to sleep. -Fran Lebowitz