OTC: insomnia and drowsiness

insomnia 2 types

• trouble falling asleep (latency)

• trouble staying asleep (maintenance)

sleep cycles

stage 1: transitional stage

• OTC help to here

stage 2: light sleep, 50% of the time

stage 3 and 4: deep sleep

REM: rapid restful sleep short periods

insomnia classification duration/etiology

duration:

• transient: self limiting, < 1 week (OTC)

• short term: 1 - 3 week (OTC)

• chronic: > 3 week

etiology:

• primary: general medical disorder

• secondary: identifiable cause exists

medical conditions associated with insomnia

1. pain disorders (arthritis)

2. psychiatry disorders (anxiety)

3. respiratory disorders (copd, asthma)

medications: stimulating medications

• amphetamines, anti-depressants, decongestants, agonists

exclusions for self care for insomnia

• < 12 years of age

• > 65 years

• pregnancy

• frequent nocturnal awakenings

• early morning awakenings

• chronic insomnia > 3 weeks

• secondary causes of the insomnia (other medical disorders)

insomnia nonpharm option

better sleep hygiene:

• establish normal sleep cycle

• relax before bed

• avoid caffeine before bed

• avoid exercise before bed

• limit napping

pharmacologic treatment for insomnia

diphenhydramine → histamine antagonist OTC

• short-term sleep difficult indication latency

tolerance: do not use more than 3 nights in a row

SE: anticholinergic effects: “drowsiness”

• dry mouth/throat, constipation, urinary retention, can’t see

• paradoxical excitation may occur

• cant see, pee, spit, shit

1st Generation Antihistamines

• “-amine” ending drugs treat insomnia

diphenhydramine, doxylamine, pheniramine, chlorphenamine, clemastine, chlorcyclizine

insomnia special populations

pregnancy: diphenhydramine sleep aid of choice

lactation: increased CNS effects in breastfed infants

• use of low dose minimizes infant exposure in milk

children: diphenhydramine may cause paradoxical sx (more hyper)

geriatrics: BEER’s criteria

• avoid anticholinergics (aka no diphenhydramine)

exclusions to drowsiness/sleepiness OTC

• < 12 years of age

• pregnancy

• breastfeeding

• uncontrolled heart disease

• anxiety

• medication induced drowsiness

• chronic fatigue

pharm option for drowsiness/sleepiness

OTC: caffeine

• increases 3’5 cAMP: CNS stimulant

• restore mental alertness or wakefulness

Dosing: 100-200 mg every 3-4 hours as needed

rapid tolerance seen

caffeine counseling

• those who smoke cigarettes will clear caffeine faster (experience less of a caffeine effect)

contraindications:

• MAOI’s

• Patients with coronary artery disease

• uncontrolled hypertension

caffeine special populations

pregnancy:

• caffeine class B: can cross placenta

• < 200 mg a day is acceptable

children:

• more susceptible to cardiovascular and CNS impacts

older adults:

• elimination half-life of caffeine is prolonged

• cannot clear it as fast → potential overdose