Sleep disorders

What is narcolepsy

causes person to fall asleep at inappropriate times

What are the symptoms of narcolepsy

sleep attacks

excessive daytime sleepiness

Catalplexy

Sleep paralysis

Excessive dreaming

What are the treatments for Narcolepsy

1.) Modafinil

2.) Methylphenidate

3.) Dexamfetamine

4.) Sodium oxybate

5.) Pitolisant

What are the side effects of Z-drugs

1.) daytime sleepiness: avoid alcohol makes it worse

2.) avoid long term use- leads to dependence or withdrawal reactions

3.) paradoxical effects: such as hostility or aggression

What’s the MOA of Z-drugs

acts on BZD size of GABA receptors to facilitate and enhance binding of GABA to GABA receptors

What is short insomnia

1.) short term insomnia is less than 3 months

2.) managed with sleep hygiene, z-drugs, melatonin, antihistamines, BZDs

3.) use meds for max 2 weeks

What is chronic insomnia

1.) more than 3 months

2.) caused by mental health conditions, substance misuse etc

What Z drugs are used for insomnia

zopiclone- 4 weeks use

zolpidem- 4 weeks use

take for 2-3 nights per week rather than every night

takes 1 hour to work

What are the short acting BZDs used for insomnia

1.)temazepam

2.)Loprazolam

3.) Lormetazepam

4.) Alprazolam

Facts about short acting BZDs

1.) used in patients with sleep onset insomnia

2.) little or no hangover effect

3.) higher chance of withdrawal symptoms

What are long acting BZDs

1.) nitrazepam

2.) diazepam

3.) flurazepam

4.) Clonazepam

5.) Chlordiazepoxide

Facts about long acting BZDs

1.) used in patients with poor sleep maintenance

2.) higher hangover side effect on the following day

Why should you avoid BZDs or Z- drugs for insomnia in elderly px

leads to ataxia, confusion and falls

What are some other drugs for insomnia

1.) Antihistamines

2.) Melatonin

What are the side effects of Z- drugs

1.) causes daytime drowsiness which affects driving and skilled tasks

2.) metallic/bitter taste

3.) 65+ are more common to falls

Melatonin facts

1.) only for adults aged 55 years and above

2.) take 1-2 hours before bedtime and after food

3.) used for 13 weeks

What are the side effects of Melatonin

1.) headaches

2.) increased risk of infection

3.) arthlagia and back pain