sleep disorders therapeutics

What is primary insomnia

No known or identifiable underlying disease state causes

Insomnia is the primary diagnosis/problem

What is secondary insomnia

Insomnia which is a direct result of symptom from another primary illness or condition.

Mental Illness

Substance Use disorder

What are the non pharm management of Insomnia

Sleep Hygiene

CBT

BBT

What is the role of antihistamines for insomina

Not reccomended

Very sedating and anticholinergic

What is the role of Melatonin in Insomnia

Only effective for sleep onset

Take 1-2 hours before bedtime

What are the Z drugs

Eszopiclone

Zaleplan

Zolpidem

What benzodiazepines are used for insomnia

Triazolam

Temazepam

Which Orexin Receptor Antagonists are used for insomnia

Suvorexant

Daridorexant

Lemborexant

Which Melatonin receptor agonists are used for Insomnia

Ramelton

What are the measurable outcomes for insomnia

The time to fall asleep

Reduced WASO

What is the only medication approved for insomnia

Ramelton

What is Ramelton indicated for

Sleep onset insomnia can be used long term

What is the AE of Ramelton

Daytime Somnolence

What is Tasimelton indicated for

Non-24 hour sleep wake disorder

What is the role of Zaleplon

Shortest acting Z drug

For sleep Onset

Pts should only take if they will get 4+ hours of sleep

What is the role of Zolpidem

Longer half life than zaleplon

For sleep onset and sleep maintence insomnia

SL tab can be used for middle of the night awakening

Pts should get 7-8 hours of sleep

What is the role of Eszopiclone

Longest acting

For sleep onset and sleep maintenance

What are the FDA warnings with Z-drugs

Complex sleep behaviors

Abnormal thinking/ behavioral changes

Psychological dependence

How long should Z drugs be used

Not longer than a few weeks. Should be reevaluated every 7-10 days

What should be avoided with Z drugs

Alcohol

What schedule are Z drugs

Schedule IV

What is the role of Suvorexant

ORA

For sleep onset and sleep maintence

What is the role of Lemborexant

ORA

Sleep maintence and sleep onset

What is the role of Daridorexant

ORA

Fastest onset of action

Sleep onset and sleep maintence

What are some FDA warning swith ORAs

CNS depressant

Sleep parylasis

Pts with compromised respiratory functions need to be carefu

Need to evaluate comorbid diagnoses

Patients with narcolepsy cannot take which sleep drugs

ORAs

What is the role of triazolam

BZD

Short acting for sleep onset

What is the role of Temazepam

Immediate acting can be used for sleep onset and maintenance

When would Lorazepam and Clonazepam be used

In patients with comorbid anxiety disorders

What other BZDs are approved for insomnia

Estazolam, quazepam, flurazepam and oxazepam

What are the Warnings of BZD

risk of repiratory depression

Physical dependence

abuse, misuse and addiction

Which BZD are preffered in elderly

Lorazepam and Tamazepam

What is contraindicated with BZD

Alcohol

When are antidepressants used for insomnia

If patient has comorbid diagnosis of major depressive disorder except for doxepin

Which antidepressants are used for insomnia

Trazodone

Mirtazapine

Which meds worsen restless leg syndrome

Antihistamines

Theophylline

Lithium

BB

antidepressants

atypical neuroleptics

What is used first line for restless leg syndrome

Gabapentin enacarbil

PregablinW

What is second line for Restless leg syndrome

Pramipexole

Ropinirole

Rotigotine

What is narcolepsy

Sleep disorder with excessive daytime sleepiness

Which meds are used for narcolepsy tx

Modafinil

Armodafinil

Methylpenidate

Amphetamine

What meds used to treat Cataplexy

Sodium oxybate

Lumyz

Pitolisant