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Insomnia 411

Insomnia

QuestionAnswer
Transient Insomnia 2-3 nights
Short-term insomnia less than 3 weeks
Chronic Insomnia longer than 3 weeks
Younger pts complaints delays in sleep onset
Older pts complaints nocturnal awakenings and shorter time periods of sleep
Acute stress, environmental disruptions, drug-related causes Transient Insomnia
Complet diagnostic evaluation-physical exam, mental status evaluation, lab tests, meds/substance history, screening questions Chronic Insomnia
BZDs for insomnia MOA decrease time to sleep onset, decrease nocturnal awakenings, increase sleep time
BZDs for insomnia use should not exceed 3 weeks, decrease REM sleep
BZDs for insomnia ADRs decrease REM sleep, daytime sedation, tolerance, anterograde amnesia, CNS effects, rebound insomnia
Use a rapid acting agent if: patient has trouble falling asleep
Use a longer acting agent if: Patient has trouble staying asleep
Zolpidem (Ambien) MOA Selective benzodiazepine, acts at BZ1 receptor, minimal effect on sleep stages
Zolpidem (Ambien) ADRs No tolerance effect or rebound insomnia, no muscle relaxant or anticonvulsant effects, minimal anxiolytic properties, efficacy comparable to BZDs, do get hangover effect,
Zoplidem (Ambien) Onset 30 mins
Zolpidem (Ambien) Duration 6-8 hrs
Zolpidem use Limit to 7-10 days
Zaleplon (Sonata) Onset 15-30 mins
Zaleplon (Sonata) Duration 3-5 hrs
Zaleplon (Sonata) ADRs No rebound insomnia, memory impairment, or hangover effect
Antidepressants for insomnia advantages increase sleep continuity and sleep time
Antidepressants for insomnia disadvantages Suppress REM sleep
Antihistamines for insomnia Effective for about a week, limited use b/c of ADRs (anticolinergic, hangover)
2 insomnia drugs that suppress/decrease REM sleep BZDs & Antidepressants
No tolerance development or rebound insomnia Zolpidem
No rebound insomnia, memory impairment, or hangover effect Zaleplon (Sonata)
Created by: lbreimeir
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