Pharmacotherapy of insomnia: Practice and prospects

Dingemanse, Jasper

doi:10.1007/bf01875434

Cited by 24 publications

(17 citation statements)

References 96 publications

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“…This so called rebound insomnia, which is presumably related to physical dependence, is especially associated with difficulties in falling and/or staying asleep (reviewed in Ashton 1994;Dingemanse 1995;Lader 1992). To assess the effects of abrupt allopregnanolone withdrawal, we also investigated sleep-wake behavior in the rat during the first two days after drug discontinuation.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, abrupt withdrawal of agonistic modulators of GABA A receptors may produce a transient deterioration of sleep compared to pretreatment levels. This phenomenon-known as rebound insomnia-is particularly reflected by a prolongation of sleep onset latency and a reduction of total sleep time, which may lead to restart hypnotic intake (reviewed in Ashton 1994;Dingemanse 1995;Lader 1992).…”

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confidence: 99%

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The Influence of Subchronic Administration of the Neurosteroid Allopregnanolone on Sleep in the Rat

Damianisch

Rupprecht

Lancel

2001

Neuropsychopharmacology

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Various steroids modulate ␥ -aminobutyric acid (GABA) A receptor-mediated transmission through an allosteric mechanism that is distinct from that of barbiturates and benzodiazepines. Particularly the ring A-reduced metabolites of progesterone: 3 ␣ -hydroxy-5 ␣ -pregnan-20-one (allopregnanolone) and 3 ␣ -hydroxy-5 ␤ -pregnan-20-one (pregnanolone), and of deoxycorticosterone: tetrahydro-DOC (THDOC), are potent naturally occurring agonistic modulators of GABA A receptors (reviewed in Majewska 1992;Rupprecht and Holsboer 1999). Earlier studies demonstrated that these neurosteroids exhibit hypnotic properties. Pregnanolone and THDOC have been shown to rapidly promote nonrapid eye movement sleep (non-REMS) in rats (Edgar et al. 1997;Mendelson et al. 1987). Reportedly, pregnanolone also enhances sleep propensity in humans (Schulz et al. 1996). Likewise, allopregnanolone evokes dose-related sleep changes in rats, including a reduced sleep onset latency, an increase in pre-REMS (a substate of non-REMS, which usually precedes REMS), an attenuation of power in the lower frequencies and an elevation of power in the frequency range of sleep spindles in the electroencephalogram (EEG) within non-REMS (Lancel et al. 1997).The sleep effects of THDOC, pregnanolone and allopregnanolone closely match those of other agonistic

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Influence of Subchronic Administration of the Neurosteroid Allopregnanolone on Sleep in the Rat

Damianisch

Rupprecht

Lancel

2001

Neuropsychopharmacology

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“…Benzodiazepine hypnotics, including triazolam, temazepam and ßurazepam and estazolam, are among the most commonly prescribed medications for the treatment of sleep disorders. Benzodiazepine hypnotics are e¤ective in the treatment of sleep disorders in that they decrease sleep latency, decrease nocturnal awakenings and wake time after sleep onset, increase total sleep time, and improve subject ratings of quality of sleep (e.g., Gillin and Byerley 1990;Maczaj 1993;Dingemanse 1995;Monti and Monti 1995). While they are clinically e¤ective in the management of sleep disorders, the benzodiazepines produce a myriad of side-e¤ects (Woods et al 1987(Woods et al , 1992.…”

Section: Introductionmentioning

confidence: 97%

Trazodone and triazolam: acute subject-rated and performance-impairing effects in healthy volunteers

et al. 1997

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The present study compared the acute subject-rated and performance-impairing effects of trazodone and triazolam in seven healthy humans. Trazodone (50, 100 and 200 mg), triazolam (0.125, 0.25, 0.50 mg) and placebo were administered orally in a double-blind, crossover design. Drug effects were measured approximately 30 min before drug administration and repeatedly afterwards for 6 h. Trazodone and triazolam produced dose-related increases in subject-ratings of drug effect and sedation. The absolute magnitude of trazodone's and triazolam's effects was comparable across these measures, which suggests the doses tested were equivalent on some behavioral dimension. By contrast, triazolam, but not trazodone, increased subject ratings of "dizzy", "excited", "nervous", "restless", "stomach turning" and "itchy skin". Triazolam, but not trazodone, significantly impaired learning, recall and performance. The present findings suggest trazodone may be a viable alternative to benzodiazepine hypnotics like triazolam, especially when needing to minimize drug-induced impairment. Future research could extend the present findings by replicating them in a clinically relevant population such as individuals with histories of drug abuse.

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“…Do not prescribe sedatives for people with significant pulmonary diseases or sleep apneas since they can reduce respiratory function. 32,34,41,42 Anyone subject to unpredictable or early morning awakenings, which require full alertness (e.g., persons on call), should not take a sleeping pill. 34 Drug-to-drug interactions are fortunately not frequent, but alprazolam and triazolam are enhanced by medications which inhibits cytochrome P-450-3A 3/4 , like erythromycin and ketoconazole or related products.…”

Section: S L E E P I N G P I L L P H a R M A C O T H E R A P I E Smentioning

confidence: 99%

“…Benzodiazepines have sedative, anxiolytic, myorelaxant, and anticonvulsant effects derived by binding to gamma-aminobutyric acid (GABA) receptors in the central nervous system, which stimulates the inhibitory effects of GABAergic transmission. 22,41 These drugs have an enviable four decades track record and they are even relatively safe during drug overdose. 42 The primary disadvantage for benzodiazepines has to do with habituation, tolerance, addiction, and withdrawal.…”

Section: T H E B E N Z O D I a Z E P I N E Smentioning

confidence: 99%