Midazolam and sleep in insomniac patients.

Monti, J.M.; Debellis, J.; Alterwain, Paulo; D'Angelo, Luisa

doi:10.1111/j.1365-2125.1983.tb02276.x

Cited by 8 publications

(4 citation statements)

References 2 publications

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“…In performance studies, midazolam was superior to o x a~e p a m~~ and f l u r a~e p a m ,~~ and generally, a 20-mg dose of midazolam did not cause residual effects 9 hours after ingestion.72. 73 Midazolam was effective in intermediate-term administration to insomniac 69 In addition to intranight rebounds in insomniac pat i e n t~,~' withdrawal of midazolam was followed by rebound insomnia with increased sleep latency, total wake time and wake time after sleep ~n s e t .~~.~' This has not been confirmed in other studies. "…”

Section: Insomniac Patientsmentioning

confidence: 89%

“…In subacute studies in insomniac patients, midazolam, generally in doses of 10-30 mg, shortened sleep latency to sleep stage 2, decreased stage 1 sleep, increased stage 2 sleep, reduced wake time and the number of awakenings after sleep onset and increased total sleep time. The total amount of slowwave sleep decreased and onset of the first REM period was delayed, although the total amount of REM sleep i n c r e a~e d .~~ [69][70][71][72][73] The amount of REM sleep was not affected in all 7n 73 and only a moderate increment in total sleep time was observed after the 15-mg dose. 'jg The effects of 5 mg were those of placebo.…”

Section: Insomniac Patientsmentioning

confidence: 94%

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Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Kanto

1985

Pharmacotherapy

175

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Midazolam is a 1,4-benzodiazepine derivative with a unique chemical structure: depending on environmental pH, the drug can produce highly water-soluble salts (pH less than 4) or exist in lipophilic diazepine ring-closed form (pH greater than 4). This characteristic contributes to rapid onset of action and to good local tolerance after parenteral administration. After both oral and parenteral administration, midazolam has a fast absorption rate and is rapidly excreted, with a half-life of only about 2 hours. A reasonably good correlation has been found between plasma levels and clinical effects, indicating a fast but brief response. As a hypnotic, midazolam is mainly indicated in insomniac patients with difficulties in falling asleep or having a pathologic sleep pattern during the first half of the night. No marked hangover effects are present the next morning. In anesthesiology, midazolam appears to be a useful, short-acting, sedative-anxiolytic and amnesic premedicant after both oral and parenteral administration. In minor surgery, however, the slow, unpredictable onset and variable duration of action, as compared with thiopental, may inhibit its routine use as an induction agent, especially in young patients, without heavy premedication. In major surgery, midazolam is an alternative to thiopental for induction of anesthesia in spite of its slow, variable induction time. Its advantages include good cardiovascular stability, transient and mild respiratory depression, low frequency of venous irritation, production of anterograde amnesia and short duration of action in comparison with other benzodiazepines.

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Section: Insomniac Patientsmentioning

confidence: 89%

Section: Insomniac Patientsmentioning

confidence: 94%

Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Kanto

1985

Pharmacotherapy

175

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“…Differing opinions on the effect of midazolam on REM sleep are held by a number of other investigators. Monti et al (1983) and Vogel & Vogel (1983) have reported that midazolam slightly decreases REM sleep, while Hauri et al (1983) be unchanged. Others report an increase in REM sleep, especially during the latter part of the night (Gath et al, 1981;A.…”

Section: Subjective Clinical Evaluation Ofefficacy Parametersmentioning

confidence: 96%

Automatic scoring of polygraphic sleep recordings: midazolam in insomniacs.

Gath¹,

Bar-On²,

Rogowski³

et al. 1983

Brit J Clinical Pharma

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I Midazolam in doses of 0.21-0.46 mg/kg was given to four insomniacs for 27 days, and to a fifth insomniac for an additional 124 days, to assess its short, intermediate, long-term and long-standing efficacy. 2 Automatic analysis of the polygraphic sleep recordings was carried out employing real-time signal processing (based on linear prediction), and an off-line sequential fuzzy clustering. 3 Total sleep length did not vary significantly during medication, whereas other efficacy parameters such as sleep onset latency, wake time after sleep onset and number of nightly awakenings decreased significantly throughout the period of active medication. In one patient, midazolam was still effective after 151 days of administration. 4 The ultrashort action (probably 3-4 h) of midazolam could be demonstrated by the distribution of the efficacy parameters, dividing the night into 2-h periods, by the unchanged total sleep length during medication compared with baseline and by the lack of any subjective clinical symptoms of hangover. 5 The quantitative analysis of the signals showed that, although a decrease in the total amount of slow-wave sleep during long-term medication and withdrawal was detected, the total relative power in the delta band increased during drug administration. This was interpreted as redistribution of the delta activity during active medication. 6 A lengthening of REM sleep was found during active medication probably attributable to intranight rebound. This was not followed by any clinical symptom of clinical REM rebound.7 Midazolam would thus be indicated mainly in insomnic patients with difficulties in falling asleep, or having a pathological sleep pattern during the first half of the night.

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“…Nesse sentido, nesta revisão sistemática foram analisados oito estudos científicos relacionados a temática da pesquisa e que corresponderam satisfatoriamente aos critérios de inclusão. Dessa forma, mesmo que os benzodiazepínicos sejam diferentes quanto ao tempo de ação, absorção e potência, como classe, observou-se nesta revisão que eles reduzem a latência do sono, aumentam o tempo total de sono, diminuem os despertares após o início do sono e melhoram a sua qualidade, no entanto, devem ser usados com cautela, priorizando quadros agudos devido ao seu potencial de desenvolvimento de tolerância, abstinência e insônia rebote (KALES et al, 1991;KALES et al,1988;MONTI et al, 1983;MONTI et al,1993).…”

Section: Metodologiaunclassified

Manejo da insônia na atenção primária: uma revisão sistemática

Campos¹,

Campos²,

Oliveira³

et al. 2023

Braz. J. Hea. Rev.

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A insônia pode ser definida como uma condição subjetiva de sono inadequado, relacionada à dificuldade no seu início ou manutenção. É o distúrbio do sono mais comum, com taxas de prevalência variando de 5 a 48% e devido a sua importância requer diagnóstico preciso e tratamento eficiente. Atualmente os profissionais da atenção primária ainda dependem fortemente da higiene do sono e da farmacoterapia como opções terapêuticas principais. Assim, esta pesquisa teve como finalidade comparar os estudos já realizados sobre as medicações fornecidas pelo SUS que frequentemente são usadas no tratamento da insônia. Trata-se de uma revisão sistemática realizada no banco de dados da plataforma BVS usando as palavras-chave “Insomnia” and “Treatment” e o filtro “estudo clínico controlado”. Foram incluídos ensaios clínicos randomizados realizados com indivíduos acima de 18 anos sem comorbidades, que comparassem medicações usadas para insônia presentes na Relação Nacional de Medicamentos Essenciais com placebo e avaliados por medidas objetivas. Foram analisados oito estudos científicos relacionados a temática da pesquisa e que corresponderam satisfatoriamente aos critérios de inclusão. Através dessa revisão conclui-se que os benzodiazepínicos devem ser utilizados com cautela e a curto prazo devido ao perfil de efeitos colaterais. Anti-histamínicos ou antidepressivos não apresentaram evidências suficientes de resposta que indiquem seu uso para tratamento da insônia primária. Já a quetiapina demonstrou dados promissores que indicam que possivelmente seria uma boa opção para substituição dos hipnóticos tradicionais.

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Midazolam and sleep in insomniac patients.

Cited by 8 publications

References 2 publications

Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Midazolam: The First Water‐soluble Benzodiazepine; Pharmacology, Pharmacokinetics and Efficacy in Insomnia and Anesthesia

Automatic scoring of polygraphic sleep recordings: midazolam in insomniacs.

Manejo da insônia na atenção primária: uma revisão sistemática

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