Insomnia (inability to fall asleep or remain asleep)
Types:
Timeline:
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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