Sleep-related meds and treatments

diphenhydramine

OTC 1st gen antihistamine for short-term insomnia

• occassional use

Zolpidem, Zaleplon, eszopiclone

Z drugs

insomnia

• after behavioral therapy fails

• short term

Triazolam, temazepam

benzos

• insomnia

• short term when other options fail

Trazadone

Antidepressant

• insomnia esp w/ depression/abuse potential concern

methylphenidate, dextroamphetamine

stimulants

• narcolepsy

Venlafaxine, Fluoxetine

Antidepressants

• narcolepsy

• increase serotonergic tone

melatonin

circadian disorders, NREM parasomnias, REM sleep behavior disorder, REM parasomnia

bright light phototherapy

circadian rhythm disorder

Clonazepam

Benzo

• REM sleep behavior disorder, NREM parasomnias, REM parasomnia

TCAs

sleep terrors

Insomnia

• underlying cause should be appropriately treated (if there is one)

• first line: behavioral changes

• sleep hygiene should be emphasized

• CBT techniques employed

• Medication considered if other interventions are not effective

• sedating meds contraindicated with elderly

Narcolepsy

• medication is treatment of choice

• pts should be counseled on sleep hygiene and use of short scheduled naps to help reduce symptoms

Modafinil

Narcolepsy

• used to counteract somnolence

Circadian rhythm sleep-wake disorders

• pts should be educated on proper sleep hygiene

• stimulants or modafinil may be helpful for work induced sleepiness

• bright light phototherapy, melatonin

NREM parasomnias

safety measures

good sleep hygiene

sometimes meds like benzos or melatonin

REM parasomnias

• meds (clonazepam, melatonin)

• safe sleep environment

Sleep terrors

• focus on good sleep hygiene and maintaining a good sleep-wake schedule

• meds are reserved for severe/refractory cases

• benzos/TCAs can be considered

• CBT may also be helpful

Sleepwalking

safety measures

good sleep hygiene

sometimes meds like benzos or melatonin

confusional arousal

• prioritize safety

• good sleep hygiene and regular sleep schedule

• medical evaluation if frequent/risky episodes

sleep related eating disorder

• treat underlying sleep disorders

• med review and adjustments

• safety measures in sleep environment

• behavioral therapies

REM sleep behavior disorder

• safety measures

• address triggers and mimics

• pharmacologic options

  • melatonin, clonazepam, Rivastigmine

NREM parasomnias

• sleepwalking

• confusional arousal

• sleep terrors

REM-related parasomnias

• REM sleep behavior disorder

• nightmare disorder

• recurrent isolated sleep paralysis