Wonder Me!
Insomnia (inability to fall asleep or remain asleep)

Types:

  • Most common: secondary insomnia (symptom of an underlying disorder)
  • Primary insomnia (absence of contributing factors)

Timeline:

  • transient, acute or chronic 
Causes:
  • social (bereavement)
  • meds (decongestants, stimulants)
  • dz (bipolar, obstructive sleep apnea)
Drug classes:
1 - BZD
2 - Hypnotics
3 - Melatonin receptor agonist
4 - TCA
5 - Misc

Drug names:

1 - BZD:
  • estazolam
  • quazepam
  • temazepam
  • triazolam
Mech.: potentiates GABA
Antidote: flumazenil
Use:
  • 1st line therapy
  • avoid alcohol & other CNS depressants
2 - Hypnotics
  • eszopiclone
  • zaleplon------ shortterm only
  • zolpidem----- shortterm only
Mech.: potentiates GABA
Use:
  • 1st line
  • lower risk of withrawal than BZD 


3 - Melatonin receptor agonist


  • ramelteon----ra-MELT-eon (MEL-a-T-ONin)
  • tasimelteon -tasi-MELT-eon(MEL-a-T-ONin)=> wks/mo. for effects (to melt a taxi (tasi) must take months)


4 - TCA
  • doxepin - last line (suicidal ideation side effects)--- the dog racing tricyles to get the dog's a pin (tricycle racing), bc it races tooo much, it becomes sleepy afterwards. You keep counting #'s dogs racing resulting in sleepiness
5 - Misc:
  • sulvoxrexant - place in therapy: to be determined  (drives SUV Volvo is so relaxing that one can sleep without disturbances.) 

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