Histamine-1 receptor antagonism for treatment of insomnia

Griend, Joseph P. Vande; Anderson, Sarah L.

doi:10.1331/japha.2012.12051

Cited by 66 publications

(41 citation statements)

References 46 publications

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“…However, efficacy of other antihistaminic agents in insomnia has not been demonstrated consistently. 72 Furthermore, these agents can be limited by their anticholinergic adverse effects which include precipitating narrow angle glaucoma or urinary retention. Trazodone is commonly used for insomnia.…”

mentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

141

116

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors-some of them unique to COPD-can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPDan association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifi cally in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Keywords: COPD, insomnia, obstructive sleep apnea, restless legs syndrome, hypoventilation Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259-270.pii: jc-00080-14 http://dx.doi.org/10.5664/jcsm.4540 T hat sleep is adversely affected in chronic obstructive pulmonary disease (COPD) has been long recognized. 1 COPD affects 5% to 10% of the adult population in the United States and is a major contributor to global disease burden. 2 The prevalence of insomnia symptoms, insomnia disorder, restless leg syndrome, and hypoxemia is increased in COPD. [3][4][5] Furthermore, polysomnographic (PSG) evaluation generally reveals decreased sleep effi ciency and lower mean overnight oxygen saturation in COPD patients compared to controls. 6 In COPD, the pathogenesis of sleep disorders appears to be a complex and multifactorial process, likely consequent to one or more of the following: physiological changes associated with sleep, hypoxemia, hypercapnia, infl ammation, COPD medications, and/or nicotine use. Comorbid disorders as well as primary sleep disturbances may also contribute to disrupted sleep in COPD patients. For example, nocturnal gastroesophageal refl ux (GERD) is associated with both symptoms of sleep apnea and COPD, and may contribute to the pathogenesis, and concomitant occurrence of both disorders.7 GERD may also infl uence sleep quality which could potentially contribute to some of the sleep complaints reported by persons with COPD. 8 The following sections describe the diverse sleep disorders and sleep-related abnormalities encountered in patients with COPD. Sleep Disorders in Chronic Obstructiv...

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mentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

141

116

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“…At lower dose, mirtazapine has more affinity with histamine receptors, thus causes sedation. But at higher doses it does not block histamine receptor, so causes less sedation [2,5]. At higher doses, mirtazapine increases noradrenergic transmission.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacokinetics of mirtazapine is age and gender dependent [5]. Female and elderly show higher plasma levels.…”

Section: Discussionmentioning

confidence: 99%

Urinary retention by mirtazapine: A case report

Raje¹

2017

Case Rep Int

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Introduction: Mirtazapine is considered to be safest and versatile antidepressant. However, sedation is known to be dose dependent side effect. 7.5 mg/day mirtazapine induces more sedation than 15 mg/day mirtazapine. There is no other side effect of mirtazapine which is reported to be dose dependent. Case Report: Here is a case, where dose dependent urinary retention is detected. A 38-year-old married female reported with array of recurring symptoms like dysphoria, insomnia, loss of appetite, burning all over, uneasiness, increased frequency of micturation and stool, irritability, frustration, weeping often. She was symptomatic since last five to six years, despite regular psychiatric treatment. Her earlier psychiatrist had expressed inability to treat recurrence and intensity of her symptoms. She was kept on mirtazapine 7.5 mg per day to begin with. She responded favorably. To gain more relief dose of mirtazapine was increased to 15 mg/day. Within one to two days she complained of inability to pass urine. Her complaint was specific that she was not able to empty her bladder completely. After completing the act of micturation she used to experience much discomfort in pelvic region. Further investigations revealed significant urinary retention. Lowering of dose brought her relief immediately. Conclusion: Mirtazapine

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“…52 In addition to trazodone, other 5-HT and H 1 antagonist antidepressants such as amitriptyline and mirtazapine are sometimes used for treating insomnia, but large, randomized, controlled trials are lacking to measure their efficacy and tolerability. 53 Sedating antidepressants may be considered for patients who do not respond to first-line insomnia treatment, but long-term use is not recommended. 53 Patients with insomnia secondary to depression or anxiety, or those who should not be prescribed controlled substances, may be the best candidates for antidepressant treatment of insomnia.…”

Section: Off-label Prescription Medications For Insomniamentioning

confidence: 99%

“…53 Sedating antidepressants may be considered for patients who do not respond to first-line insomnia treatment, but long-term use is not recommended. 53 Patients with insomnia secondary to depression or anxiety, or those who should not be prescribed controlled substances, may be the best candidates for antidepressant treatment of insomnia.…”

Section: Off-label Prescription Medications For Insomniamentioning

confidence: 99%