Sleep Disorders Flashcards
Hypnotics VS Anxiolytics (‘Sedatives’) AND given an example of each?
Dependence and tolerance seen in both. Both short term use only. Hypnotics cause sedation when given during day VS Anxiolytics which induce sleep when given at night Benzodiazepines = most common of both
Which medications NO longer recommended for sleep disorders?
Meprobamate AND Barbiturates (increased side effects, interactions and risk of dangerous OD)
When can Benzodiazepines be used in Sleep disorder?
1) Short term use (2-4/52) of anxiety that is severe disabling or causing the pt unacceptable distress occurring alone or in association with insomnia
2) Treat insomnia only when severe/disabling or causing pt extreme distress
*To treat short term mild anxiety = INAPPROPRIATE
What is the protocol for withdrawal of long term benzodiazepine use?
Transfer stepwise one dose at time over 1/52 to equivalent daily dose of diazepam to be preferably taken at night
Decrease dose normally by 1-2mg ever 2-4/52 (dependant on their response and sbx)
Decrease diazepam dose more, 500mcg steps towards the end then stop completely
Long term pt = months to year
What is the protocol for withdrawal of long term benzodiazepine use?
Transfer stepwise one dose at time over 1/52 to equivalent daily dose of diazepam to be preferably taken at night
Decrease dose normally by 1-2mg ever 2-4/52 (dependant on their response and sbx)
Decrease diazepam dose more, 500mcg steps towards the end then stop completely
Long term pt = months to year
What should be done prior to Rx of hypnotics?
Cause of insomnia should be established and underlying factors treated where possible.
*some pt have unrealistic notions/sleep expectations and other understate alcohol consumption which can be cause
Short VS Long acting hypnotics (indications)?
Short acting = sleep onset insomnia/sedation following day is not wanted/elderly
Long acting = poor sleep maintenance e.g. early morning waking
What is transient insomnia and what is general treatment?
= normally sleep well but due to strenuous factors e.g. jet lag, stress, shift work or noise.
If indicated hypnotic should be one that is rapidly eliminated and ONLY one or two doses given
What is Short-term insomnia and it’s general treatment?
= related to emotional problem or serous medical illness can last few weeks and recur
Hypnotic (short acting) can be given but < 3 weeks treatment at a time (preferred = 1 week). Intermittent use is best missing some doses.
What is Chronic Insomnia and it’s general treatment?
Rarely bettered by hypnotics and can sometimes be due to irresponsible prescribing of hypnotics. Other common causes = anxiety/depression/abuse of alcohol or drugs.
*Underlying cause should be treated e.g. mirtzapine/clomipramine can be taken NOCTE helping to promote sleep
When can tolerance to hypnotics occur?
Within 3-14 days of continuous use (due to this long term efficacy can’t be guaranteed)
*Withdrawal can cause rebound insomnia and withdrawal syndrome therefore STOP ASAP
Which Benzodiazepines can be used in dental pts?
Temazepam (preferred due to min effect next day) and Diazepam for anxious pts during dental procedures
Which Benzodiazepines can be used as hypnotics?
Nitrazepam and Flurazepam = Prolonged action, residual day time effects, cumulative repeated doses
Loprazolam, Lormetazepam and Temazepam = shorter action, decreased/no effect following day BUT increased risk of withdrawal symptoms
Diazepam = if insomnia linked to day time anxiety as Long action so single night time dose work to treat both
Which Z-drugs are used in SHORT term treatment of insomnia?
Zopiclone and Zolpidem Tartrate (= non-benzodiazepine hypnotics as act on same receptors BUT dependence reported and ONLY licensed for short term use)
*Short duration of action
Which antihistamine is Licensed for use OTC for insomnia?
Promethazine HCL for occasional insomnia, long acting so drowsiness SE following day but can diminish after several days of continued use
SE = Headaches/Psychomotor impairment/ antimuscarinic effects
