WEIGHT CONTROL AND SLEEP AIDS-PART-V

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.

 

   

WEIGHT CONTROL AND SLEEP AIDS- PART IV

SLEEP AIDS

Sleep is the healthy process of the body to keep it healthier. So many healthier procedures are performed during the process of sleep, such as growth, preparation of waste products like creatinine, urea, and lactic acid to be excreted in the urine. sleep maintains our body's metabolism and growth in a normal way. The digestive system is regulated. During sleeping the workloads of all our involuntary smooth muscles like heart, lungs, and visceral organs are minimized in order to boost them with fresh energy. Sleep refreshes our nervous system. Our blood is cleaned from waste and toxic products by healthy sleep.

Sleep time and quality vary among individuals. The usual range of sleep time per night is 5 to 10 hours.

Sleep requirements are changing according to the person's age. Newborns may sleep up to 18 hours. Preteens usually fall asleep within 5 to 10 minutes with deep sleep. By adulthood, 7 to 8 hours of sleep gives good rest. In the old age, six hours may suffice. In general, according to the modern theory, it is not the length of the sleep but it is the deepness of the sleep is more important.

Polysomnography includes Electro Encephalo Gram (EEG), the Electro Oculo Gram (EOG) and the Electro Myo Gram (EMG) recordings to note the changs during sleep 

Stages

By using polysomnography the scientists discovered five stages of sleep

1.One rapid eye movement (REM) stage

2.Four nonrapid eye movement (NREM) stages.

In normal sleep, REM occupies 25% by leaving the remaining 75% in the NREM stages.

In the NREM stages, the last third and fourth stages are considered as deep sleep stages or collectively known as delta sleep stages.

Most dreams occur during the REM stage and the degree of the restfulness of sleep depending on the amount of REM stage.

Most medications used to treat sleeplessness including the OTC medicines interfere with some parts of the sleep stages especially with the REM stage.
INSOMNIA
Insomnia is the interrupted sleep cycle or insufficient sleep that results in impaired daytime performances. Insomnia must be defined more with the depth of the sleep than with the length of the sleep.
Insomnia should be diagnosed with the deficiencies in the day time performances and not the number of hours  slept as the primary determinant of the diagnosis
Occasional one or two sleepless nights or with insufficient sleep is not important to be considered as insomnia. The pathologically concerning the situation with long time sleeplessness if it contains frequent microsleeps or extreme tiredness otherwise no need to worry.
Patients after a restful night sleep if they wake up in the morning with full freshness and satisfactory and feel no need to have an afternoon nap can reassure themselves that they have no insomnia. It is not necessary to have a sleep of 8 hours. Oftentimes a simple reassurance can be a cure for insomnia.
Insomnia is of three types as follows:-
1.Transient 
In this case, if a person cannot have a night sleep in less than 7 days then it is known as transient insomnia. Causes include shift work or acute anxiety
2.Short -term
This type lasts for 1-3 weeks. Causes of short term insomnia can be usually identifiable and self-limiting such as grief, pain, noise, or a tension provoking situation.
3.Long- term  
This type of insomnia lasts for more than 3 weeks. Chronic insomnia is caused by some underlying diseases most probably such as Hyperthyroidism or Arthritis and requires a thorough diagnoses of patients' physical and mental health.

General causes of insomnia

1.Intrinsic causes 

A. Psychophysiologic insomnia is a condition in which the patient associated with increased wakefulness with the bedroom and the sleep time routine.

B. Restless legs syndrome is characterized by extremely uncomfortable sensations in the leg muscle at rest which are relieved by moving the legs up and around.

C. Sleep Apnea can be obstructive or centrally mediated. The hallmark is breathing that stops for short periods during sleep. Patients with sleep apnea should not use hypnotics or OTC medicines.

2.Extrinsic causes 

A. Adjustment sleep disorders are prompted by a stressful situation.

B. Inadequate sleep hygiene  is caused by a lifestyle that reduces the amount of quality sleep

C. Hypnotic, stimulant, or alcohol dependency is caused by dependence, tolerance, or over-reliance on a particular drug of abuse.

3.Circadian sleep disorders

A. Delayed sleep phase syndrome occurs in people whose natural sleep times are altered due to work.

e.g.If a person should be at work at 8 a.m but gets tired after 2 a.m. and wakes at 10 a.m.would be affected by this disorder.

B. The jet lag syndrome is a problem primarily for people who frequently travel across several time zones.

4. Psychiatric disorders

such as major depressive disorders result in poor sleep that usually improves on proper antidepressant treatments