SLEEP LOSS- TREATMENTS
In the previous post, we have seen a comprehensive encyclopedia of sleep and insomnia and their maps. In this emotional modern lifestyle insomnia with its various forms becomes a common problem. Even after lying in the bed getting a night of good sleep is a difficult procedure for many individuals.
Hence this post is dedicated to being guidance and treatment to tackle the problems of insomnia.
Guidances
The following general procedures are helpful to have a good hygienic sleep. The followings are the nonmedical approaches:-
1.Establishing a regular bedtime
2.Going to bed when tired and ready to sleep
3. If anxiety interferes get out of the bed and have a relaxed short walk, read some relaxing books, have a warm bath, or do some relaxing exercises.
4. Avoid hard exercises at bedtime.
5. Avoid alcohol because it will break sleep into fragments.
6. Avoid stimulants such as coffee, PPA, nicotine, and pseudoephedrine
7. Make sure that bedroom and bed are comfortable
8. Avoid small afternoon naps.
Treatments
Drug Treatments of Transient and Short term Insomnia:-
In general wakefulness and sleep, are antagonizing each other to control brain activities. Several nerve transmitters are involving in these antagonizing activities.serotonin and gamma-aminobutyric acid is the two known central neurotransmitters that slowly promote sleep.
Acetylcholine a central transmitter is maintaining REM sleep.
Catecholamines such as noradrenaline, adrenaline, and dopamine are the central neurotransmitters that cause wakefulness and antagonizing sleep.
Individuals may vary greatly in their natural levels of neurotransmitters and their sensitivity to these chemicals.
These theories are helpful to describe the actions of some medications on sleep patterns.
Hypnotics have their effects by modifying the secretions and receptor responses of serotonin, GABA, acetylcholine histamine and catecholamines
The goals of the hypnotic treatments of short term and transient insomnia are to restore day time work capacity and to eliminate the self-induction of anxiety-provoking thoughts.
The general norms of the hypnotic treatments are advising the patients not to take hypnotic drugs to more than three consecutive nights followed by one-night medicine free. This is to minimize tolerance and habit formation and to have a self-practice to control the stress that night.
Prescription hypnotic agents
Benzodiazepines are the drugs of choice for treating transient and short term insomnia.
The mechanism of action is by acting on its receptors situated adjacent to the GABA receptors, they facilitate and enhance the actions of GABA the sleep-promoting hormone on its own receptor.
Benzodiazepines are available as follows
Short-Acting (2 to 8 hours)
1.Oxazepam
2.Clonazepam
3.Midazolam
4.Triazolam
Intermediates (10 to 20 hours)
1.Temazepam
3.Lorazepam
4.Alprazolam
Long Actings(1 to 3 days)
1.Chlordiazepoxide
2.Diazepam
3.Flurazepam
The route of administration of benzodiazepines are both oral and by I.V or i.m. injections
Since benzodiazepines are metabolized in the liver and excreted through urine caution should be taken while using these medications during renal and liver insufficiencies.
Many of the metabolites of benzodiazepines are very active.
Drug dependence
Prolonged use can produce dependence.
Sudden withdrawal may cause confusion, anxiety, and agitation.
Side Effects
1.Drowsiness and confusion (the most common side effects)
2.Ataxia (dysfunctions and noncooperative nerve movements)
3.Dizziness
4.If taken with other CNS depressants benzodiazepines will cause respiratory depression and death.
Flumazenil is the antidote for benzodiazepine poisoning its effects lasts for 1 hour only and hence repeated dose is necessary for heavy poisoning.
Zolpidem
It is a newer drug and has an advantage over benzodiazepines by having minimum side effects and withdrawal symptoms.
Even though it is not a benzodiazepine it acts on the benzodiazepine receptor to produce the effects.
Side effects
1.Nightmares
2.Agitations
3.Headaches
4.GI distress
5.Dizziness
6.Daytime drowsiness
Barbiturates are less commonly prescribed to treat insomnia because of its serious and excessive respiratory depressing effects.
OTC DRUGS
The FDA has approved two antihistamines such as Diphenhydramine and Doxylamine
These antihistamines are commonly used in cough syrups and because of their serious anticholinergic effects caution should be taken by those who have extrapyramidal effects such as tardive dyskinesia, Akathesia, and Parkinson disease. Also, it should be taken with caution by those who have Prostatic enlargement.
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