quantity23qualitycomplaintsignificantlydisruptedsleepimpairedfunctioningexcessiveshouldnecessarilyrequirecomparedyoungeradultswakefragmentedwithinterruptednapsREMstagesreducedsleep SleepDistur ID: 940360
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(fatigue,cognitive,social/workdysfunction, quantity!,2,3,qualitycomplaintsignificantlydisruptedsleepimpairedfunctioningexcessiveshouldnecessarilyrequirecomparedyoungeradults.wakefragmentedwithinterruptednaps.REM(stagesreduced;sleep SleepDisturbance:Contributing Codeine,oxycodone(noteopioidsleep) Salbutamoltheophylline,ipratropium Amphetaminederivatives,cocaine,ephedrinederivatives,methylphenidate,modafinil Acetylcholinesteraseinhibitorsdonepezil),antineoplastics,levodopa,nicotine,medroxyprogesterone,phenytoin,thyroidsupplements =benignprostaticCOPD=chronicobstructivepulmonarydiseasefailure   MAOI=monoamineoxidaseinhibitor=restlessleg Alzheimersdiseasesleep8,9{seeonlineextrasmorebehavioursTheseoftenmoreexceednongeriatricpopulation.Behaviouralshouldpossible. behavioural(CBT)7,11,13,14        Demonstratedonset component individualtechniques). =6 whereas pharmacotherapybenefitdiscontinuation. specialistsbarriers. behaviourale.g.45minvisit,30minf/u,phonecalls showprimarycare. Components Stimulustherapy (reassociate bedwhen bed/bedroom studiesDSMtrazodone.existingnotforcut,evidencerecommendationsusetrazodoneinsomnia. mechanismactionnotunderstood.ThoughtweakspecificsynaptosomalHT).antagonisticactionextentadrenoceptors.pharmacologicallyotherTrazodonewelloraladministrationafterwhentakenemptywhentakenfood offlabelforinsomnia;evidence slow;e.g.dose:50mgdose:100mg(lowerantidepressantdosewhich15
0600mg younger11.6elderly whattrazodonesadverselowdosesMostcommon10%)doses75mg/day500mg/daydrowsiness29.1%50%)21.9%(1030%)mouth17.7%33.8%)nausea/vomitingconstipationtoleratingtrazodonethan50mg/daycontrolledtrazodoneforDrops(2560%)discontinuationsSedation:nextdaywithtrazodone,whenadministereddepressedbetween100mghs.Cardiacsafety:(hypotension,orthostaticwithventriculararrhythmias,conductiondisturbances,exacerbationischemicattack)(100600mg/day),orthostaticbeenelderlylower(50175mg/day)concomitantCardiactrazodonefrom300mg/day.withantidepressants,trazodoneFDAmajorityoccurredwithdoses150mg/daytypicallyinsomnia).occurredwithinthetreatment.Difficulttreat.theorizedtrazodonesblockingpropertiesinduction adverseeffects)TolerancedevelopmentnotpermittingtermpotentialTrazodonewhichhowever,orthostaticarrhythmias Evidence2005:Reviewforsafetytrazodone identifiedMajoritystudiesareverysmalltrazodonelimiteddurationtrialstreatmentweeks;exceededtreatmentweredoublecontrolleddesigntheseemployedobjectivemeasuresdepressedbrofarominetreatmentdurationweek)weredepressedpopulationswhichwaseitherinducedtrazodonessleepidentifiedexaminedtrazodonesnondepressedsleepdisordersprimary(1998) Comparedhypnotictrazodone50mg10mgplaceboweekswere(selfreportedsleepawakenings,wakesleepmorningofficewereobjectivemeasurements.Week placebo,reportedsignificantimprovementsubjectivesleeplatency,sleepduration,sleepqualitytrazodonezolpidem(p0.02)repo
rtedwaszolpidemtrazodone(p037).Week trazodonegroupdidnotdiffersignificantlyplacebogroup.However,significantimprovementcomparedforsleep(p=0.037)durationthoughtheplacebogroupdemonstratedsleepoverperiodabovebaselineminutes2).tolerance(1999) withdosefinding,compared75mg100mg/daytrazodone42.515.6statewithtrazodone100mg/dayawakening,sound(2011) vs.primaryinsomnia,n=16Shortdays)nextimpairmentassociatednighttimedosingtrazodoneimpairmentsshorttermmemory,sway Trazodonenotofficiallyfor treatmentoptionelderlyinitiateddose 50mghs).Bewarepotentialeffectsincreased AlzheimersdiseasesleepdisturbanceAlzheimersdiseaseverycommonNocturnaldisturbanceincreaseddaytimefrequentlydirectmanifestation:maintenanceinsomnia,disturbedcircadiandaytimenapping).Sundowningsymptomsdelirium,disturbanceneuronssuprachiasmaticendogenousmelatoninsecretioncontrols)contributingcircadianrhythm.behavioursmeasuredsystematicallyusingindependentbehaviours,ratherrandombehaviorswanderingbehaviorsphysical4:30agitationtogether,behaviourssunsethourssundowningallstudiesreportkindtemporalspecificity).Alsoapparent).AD,patientsspendproportionhoursconsistsdoesremotelyslow(SWS)Cholinesteraseinhibitorsinsomniadisturbance Clinicalassistingwhostopbenzodiazepinesdrugs AssesspersonsConsiderationshouldgivencanappropriatelyprimaryundertakendrugscheduleflexibleshouldproblemsprovideencouragement.doeshttp://cks.nice.org.uk/benzodiazepinewithdrawal#!topicsummary
(Expert AvoiddosingotherdiureticsInstructhourspatchtakeAvoidexcessiveuse(excessiveuseuncontrolledrespiratorydisorder)Avoidhoursafternoon sleepDescription/Comment                Relaxedwavesleep)minutes)hypnoticmedicationstypicallyincreaserestorativefunctions;diminishesnonexistentpersons      Activelearningregulation;dreamsoccursexualrestorativespendsroughlysleep InsitituteforandClinicalKnowledgeSummaries:Insomnia.2009.Available:http://cks.nice.org.uk/insomnia#!scenariorecommendation:1 LanctôtKL,HerrmannN,SprouleSedativehypnoticsinolderpeopleinsomnia:metaanalysisofrisksbenefits.19;331(7526):1169.VandermeerFriesenTreatmentsforChronicAdults:metaanalysisRCTs.1350.HardelandNeurobiology,pathophysiology,melatonindysfunction.ScientificWorldJournal.2012;2012:640389.AlbertaServices.Gravol.2010.Available:http://www.albertahealthservices.ca/addictionssubstanceabuse/higravol.pdf RichardsonGS,RoehrsRosenthalKoshorekTolerancedaytimesedativeeffectsPsychopharmacol2002;22:511515.KurupWilliamsonMuraleecerebrovasculareventsdeathelderlywithdementiawhenantipsychoticmedications:evidence.AlzheimersOther2011;26:10http://aja.sagepub.com/content/26/1/10.ab
stract?rss=1SchneiderTariotKS,HsiaoEffectivenessatypicalantipsychoticpatientsAlzheimersdisease.SchneiderTariotKS,HsiaoEffectivenessatypicalantipsychoticpatientsAlzheimersdisease.CanadaAdvisory.Canadaconsumersimportantinformationantipsychoticanddementiaasc/media/advisoriesavis/_2005/2005_63eng.phpHealthAdvisory:AntipsychoticsElderlyPatientsDisturbances.Available:http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPayInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm053171.htmSmithTG.AntipsychoticsdementiamortalityEvidSchneiderDagermandeathantipsychotictreatmentfordementia:metaanalysisplacebocontrolledtrials.JAMA.SublinoxProductMonograph.PreparedSolna,Sweden.DateAugust Insomnia detailedinformation, a 4 ClinicalConern indicationsinsomnia ECONGESTANTS Phenylephrine ComprehensivePhenylephrine:ENYLINIMETAPPUDAFEDRIAMINICLLERGYcombinationproductPseudoephedrine ComprehensivePseudoephedrine:OLDERIUSLLEGRALLERGYENYLINUCKLEYLARITINOACTIFEDIMETAPPRISTANRIXORALITRANLLERGYOBITUSSINUDAFEDRIAMINICOMPLETE INSOMNIA Moderate;Strong confusion HOSPHODIESTERASENZYME HYLLOCONTINHEOPHYLLINENIPHYL INSOMNIA Moderate;Strongstimulation TIMULANTRUGS DDERALLDextroamphetamineEXEDRINEYVANSEMethylphenidateIPHENTINONCERTAITALIN INSOMNIA Moderate;Strongstimulation(aggression,drowsiness,lability,hypervigilance,irritability,nervousness,restlessness,vertigo) a& IORINALcombinationproduct YEARS Moderate;
Strong dependenceToleranceoverdose(narrowwindow) â¦CHLORAL HYDRATE YEARS Low;StrongToleranceoccursdaysriskoverdoserecommended =Medication=MedicationSTOPP=Medicationtaperingupondiscontinuation;Evidence;SR=StrengthRecommendation restriction timebeddeprivation â homeostaticdriveefficiency) Cognitivetherapy beliefsattitudesabout (biofeedback;relaxationRelaxmusclesthroughoutbody,attentionfromeverydayusingmentalfocusingrepetitive Tailorbehaviourindividualanddiaryassessmentrecommended shouldsupplementedpossible. MirtazapineEMERON3.75 anydrug/substanceDiscontinueunnecessarymedications;Changethemedications) Antidepressants, Buproprion,citalopram,duloxetine,escitalopram,fluoxetine,paroxetine,venlafaxine Cardiovascularblockers(tamsulosin),(salbutamol)blockers(propranolol,metoprolol),statins DecongestantsPhenylephrine,pseudoephedrine DiureticsChlorthalidone,ethacrynicfurosemide,hydrochlorothiazide,indapamide,metolazone,spironolactone OpioidsCodeine,oxycodonepresent,opioidsleep) RespiratoryIpratropium,salbutamol,theophylline StimulantsAmphetaminederivatives,cocaine,ephedrinederivatives,methylphenidate,modafinil Neurodegenerativedisorders(especiallyAlzheimer'sdiseaseseniledementia)diabetes diseasesdisorders)melatoninsecretion. ProductsNaturalProductNumberhavesomequality. benzodiazepinehypnotics: ZopicloneMOVANEHOVANE2.53.75mgbedtime ZolpidemUBLINOX Intermediateactingbenzodiazepines: ESTORIL15mg TIVAN0
.5mg OxazepamERAX Insomnia thePharmacologicOptions?shouldfunction.thisappropriatemeasureparticipationpreviouslyideallyTryappropriatebenefits(e.g.NNH=6initiatemedicationcannotcompletelydiscontinued,dose Benefits reboundinsomnia Insomnia detailedinformation, a 4 ClinicalConern indicationsinsomnia ECONGESTANTS Phenylephrine ComprehensivePhenylephrine:ENYLINIMETAPPUDAFEDRIAMINICLLERGYcombinationproductPseudoephedrine ComprehensivePseudoephedrine:OLDERIUSLLEGRALLERGYENYLINUCKLEYLARITINOACTIFEDIMETAPPRISTANRIXORALITRANLLERGYOBITUSSINUDAFEDRIAMINICOMPLETE INSOMNIA Moderate;Strong confusion HOSPHODIESTERASENZYME HYLLOCONTINHEOPHYLLINENIPHYL INSOMNIA Moderate;Strongstimulation TIMULANTRUGS DDERALLDextroamphetamineEXEDRINEYVANSEMethylphenidateIPHENTINONCERTAITALIN INSOMNIA Moderate;Strongstimulation(aggression,drowsiness,lability,hypervigilance,irritability,nervousness,restlessness,vertigo) a& IORINALcombinationproduct YEARS Moderate;Strong dependenceToleranceoverdose(narrowwindow) â¦CHLORAL HYDRATE YEARS Low;StrongToleranceoccursdaysriskoverdoserecommended =Medication=MedicationSTOPP=Medicationtaperingupondiscontinuation;Evidence;SR=StrengthRecommendation Insomnia detailedinformation, a 4 ClinicalConern &precautions NTIHISTAMINESGENERATION product) YEARS High(HydroxyzinePromethazine) others);Strong ChlorpheniramineRIPOLONCyproheptadineERIACTINDimenhydrinateDiphenhydramineENADRYLcombinationproductDoxyla
mineICLECTINTARAXHENERGANTriprolidine FORWEEK antihistamines stronganticholinergicsideurinaryretentionotheranticholinergiceffects/toxicity)rapidlyusedagedyears,occurred ENZODIAZEPINES INSOMNIA High;Strong intermediate ANAX1/2 ~ 12 hoursECTOPAMt1/2 ~ 20 hoursLorazepamTIVANt1/2 ~ 15 hourst1/2 ~ 8 hoursESTORILt1/2 ~ 11 hoursALCIONt1/2 ~ 2 hours Chlordiazepoxide 1/2 ~ 100 hoursIVOTRIL1/2 ~ 34 hours1/2 ~ 100 hoursALIUM1/2 ~ 100+ hoursALMANE1/2 ~ 100+ hoursOGADON1/2 ~ 30 hours havesensitivitybenzodiazepinesimpairment,delirium,motoraccidentsBenzodiazepineslowerinhibitionspossibleworseningbehaviourssexualdisinhibition, EUROLEPTICSNTIPSYCHOTICS Generation Agents: ChlorpromazineARGACTILFluphenazineODITENHaloperidolALDOLYLACOZINANRILAFONIPORTILProchlorperazineTEMETILAVANEERFLUZINELOPIXOLGenerationAgents: BILIFYAsenapineAPHRISLOZARILLurasidoneATUDAYPREXANVEGA EROQUELRisperidoneISPERDAL ELDOX HYPNOTIC confusion,hypotension,fracturesbehaviouralpsychological3.1)behaviouralpsychological1.6;ARNNH=87/12wks)appropriatelyshortsevereaggressionbehaviourharmfulsame ONBENZODIAZEPINEHYPNOTICS MOVANEHOVANE1/2 ~ 5 hoursUBLINOX1/2 ~ 2.85 hours*In healthy adults (range: 1.57-6.73 hours) : In one study of 8 subjects� 70 years, the mean by 32%. BC Moderate;StrongAdverseeventssimilaradultsMVAs)improvementsleepduration =Medication=MedicationSTOPP=Medicationrequirestaperingupondiscontinuation;Evidence;SR=StrengthRecommen
dation restriction timebeddeprivation â homeostaticdriveefficiency) Cognitivetherapy beliefsattitudesabout (biofeedback;relaxationRelaxmusclesthroughoutbody,attentionfromeverydayusingmentalfocusingrepetitive Tailorbehaviourindividualanddiaryassessmentrecommended shouldsupplementedpossible. MirtazapineEMERON3.75 anydrug/substanceDiscontinueunnecessarymedications;Changethemedications) Antidepressants, Buproprion,citalopram,duloxetine,escitalopram,fluoxetine,paroxetine,venlafaxine Cardiovascularblockers(tamsulosin),(salbutamol)blockers(propranolol,metoprolol),statins DecongestantsPhenylephrine,pseudoephedrine DiureticsChlorthalidone,ethacrynicfurosemide,hydrochlorothiazide,indapamide,metolazone,spironolactone OpioidsCodeine,oxycodonepresent,opioidsleep) RespiratoryIpratropium,salbutamol,theophylline StimulantsAmphetaminederivatives,cocaine,ephedrinederivatives,methylphenidate,modafinil Neurodegenerativedisorders(especiallyAlzheimer'sdiseaseseniledementia)diabetes diseasesdisorders)melatoninsecretion. ProductsNaturalProductNumberhavesomequality. benzodiazepinehypnotics: ZopicloneMOVANEHOVANE2.53.75mgbedtime ZolpidemUBLINOX Intermediateactingbenzodiazepines: ESTORIL15mg TIVAN0.5mg OxazepamERAX Insomnia thePharmacologicOptions?shouldfunction.thisappropriatemeasureparticipationpreviouslyideallyTryappropriatebenefits(e.g.NNH=6initiatemedicationcannotcompletelydiscontinued,dose Benefits reboundinsomn