Monday, August 19, 2019
One third of the United States population complains of insomnia, with about one More than 40% of those suffering from insomnia self- medicate with over the counter drugs (OTC) or with other substances such as alcohol. 2 half of those are saying itÃ¢â¬â¢s serious.1 Insomnia is defined by inability to initiate or maintain sleep despite of adequate time and opportunity to sleep which results in daytime impairment.2 time itÃ¢â¬â¢s characterized as problems with either sleep onset, sleep maintenance, or non- restorative sleep. Impairments associated with insomnia can lead to: impaired cognitive functioning, increased incidence of bodily pain, increased future risk of psychiatric disorders, increased risk of accidents, and increased healthcare cost.3 also have negative health consequences on obesity, cardiovascular disease and diabetes.4 There are four different types of insomnia.2,5 3 days in duration, most likely cause is acute situational or environmental stressors. Second is short term insomnia less than 3 weeks caused by personal stress of an ongoing nature. Third type is chronic primary insomnia with duration of more than 3 weeks not related to lifestyle may be due to medical causes. Finally the forth type is a chronic secondary insomnia with duration of more than 3 weeks related to lifestyle likely caused psychological illness, substance abuse, behavioral cause(poor sleep hygiene). Secondary chronic insomnia may be caused by comorbid diseases such as: heart failure, depression, anxiety, bipolar disorder, sleep apnea, medications, substance abuse, restless leg syndrome or circadian rhythm sleep disorders. As far as the medications are concerned possible medication classes that cause insomnia are antidepressant... ... choice for sleep onset insomnia. Appropriate drugs may include zaleplon, zolpidem IR, ramelteon and triazolam. However, rebound insomnia may be a problem with short acting benzodiazepines like triazolam. Moreover, sleep maintenance insomnia are most appropriately treated with drugs that have an intermediate duration and no active metabolites to minimize daytime effects such as : zolpidem, eszopiclone, temazepam, and estazolam may be appropriate choices. Also, zaleplon can be taken after awakening in the night if > 4 hr left for sleep. Attached are the tables with drug treatment options for insomnia, and questionnaires to assess the initial insomnia and post treatment. Nevertheless sedative-hypnotics should only be used in the lowest effective dose (to decrease the next day morning impairment) for a short duration of time in treatment of insomnia.