Medications for the Treatment of Sleep Disorders

Abstract

Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep. Conversely, medications may be used therapeutically for specific sleep disorders. For example, restless legs syndrome and periodic limb movement disorder may be treated with dopamine agonists. An understanding of the disorders of sleep and the effects of medications is required for the appropriate use of medications affecting sleep.

Consumption of benzodiazepines without prescription among first-year nursing students at the University of Guayaquil, school of nursing, Ecuador

“…Sedation and sleepiness can deteriorate mental and motor functions, reduce the capability of attention, concentration and decision and cause anterograde amnesia. Therefore, it is important to call attention to these effects, which can be presented as an overdose when combined with other depressants of the CNS (2) .They produce physical dependence when used for a long time and, when interrupted in an abrupt way, this can cause the abstinence syndrome (4) . Acute intoxication, either accidental or suicidal, with these drugs is very frequent, even though mortality by overdose is very low (less than 1%) (5) .They are also used for phobic confusion, panic, post-traumatic stress, convulsive disorders, syndrome of alcohol abstinence and barbiturates, in insomnia crises and, also, in cases of anxiety (used worldwide) (6) .…”

Behavior Therapy: Evidence-Based Practice, Clinical Applications, Unresolved Issues

“…With prevalence rates as high as 44% in older persons (National Sleep Foundation, 2003), it is estimated that fewer than 15% of chronic insomnia sufferers receive treatment (Mellinger and Balter, 1995). Sleep disorders generally fall into one of three categories: (1) insomnia (i.e., complaints of difficulty falling asleep, staying asleep, and nonrestorative sleep), (2) daytime sleepiness (e.g., narcolepsy), and (3) disorders of arousal that result in disruptive behaviors during sleep (e.g., breathing-related problems like sleep apnea) (Pagel and Parnes, 2001). Among these, insomnia, particularly staying asleep or sleep maintenance, is the most common problem in older persons with sleep disturbances (McCall, 2004).…”

In vitro and in vivo evaluation of nano-based films for buccal delivery of zolpidem

“…However, side effects, such as hangover, dependency, and rebound insomnia, can occur with declining use. 8 Thus, benzodiazepines still fall short of being ideal compounds for promoting physiological sleep.…”