depressants

types and stages of sleep

insomnia: inability to fall asleep (initial: can’t get to sleep / middle: can’t stay asleep)

REM: difficult to wake up (dreaming) if woken up —> disoriented

NREM: stage 1-4 (5th stage is REM)

sedative hypnotics

sedatives (most common): treat sleep disorders, recommended for short term use

sedative hypnotics: barbiturates, benzodiazepines, nonbenzodiazepines, melatonin agonists, sedative hypnotics for older adults

practice good sleep hygiene (nonpharmacological interventions before sedatives)

sedative hypnotics (2)

side effects: residual drowsiness (hangover), vivid dreams/nightmares, drug dependence (can be dependent and not addicted), drug tolerance (how much is needed for an effect), excessive depression, respiratory depression, hypersensitivity

sedative hypnotics: benzodiazepines

end in lam and pam

ex: alprazolam, estazolam, lorazepam, temazepam, triazolam

used for insomnia caused by anxiety

schedule IV

interacts with neurotransmitter GABA to reduce neuron excitability

sedative hypnotics: benzodiazepines (2)

side effects: vivid dreams/nightmares (REM rebound), anterograde amnesia, sleep-related behaviors (worse combined with opioid or alcohol), drowsiness, dizziness

contraindications: respiratory depression, alcohol intoxication, psychotic reactions

caution in: older adults, renal/liver dysfunction, suicidal ideation, substance abuse, sleep apnea

sedative hypnotics: nonbenzodiazepines

zolpidem

short term use (less than 10 days)

neurotransmitter inhibition leads to CNS depression (action duration lasts 6-8 hours) (not. strong hangover)

side effects: drowsiness, hangover, anterograde amnesia, nightmares, binge eating, erectile dysfunction

sedative hypnotics: melatonin agonists

ramelteon (not a controlled substance)

selectively targets melatonin receptors to regulate circadian rhythms

adverse effects: drowsiness, dizziness, fatigue, headache, nausea, suicidal ideation

sedative hypnotics for older adults

decreased renal function can make the half life longer (poor filtration)

use nonpharmacologic methods first

short to intermediate acting (benzos: estazolam, temazepam, triazolam) —> safer for older adults

avoid benzos: flurazepam, quazepam, diazepam (longer half life)