Sleep disorders

Diagnosis chronic insomnia

Symptoms at least 3 times per week for at least three months

First line for chronic insomnia

CBT (and sleep hygeine)

Natural products for sleep

melatonin, valerian, kava, chamomile tea

Valerain and kava not recommended due to

hepatoxicityM

Melatonin substrate of what

CYP1A2

Drug mainstay of chronic insomnia

Sedatives

Drugs for FALLING asleep

Eszopiclone, zolpidem, ramelteon, zaleplon

drugs for STAYING asleep

eszopiclone, zolpidem, doxepin, suvorexant

drugs for FALLING AND STAYING asleep

eszopiclone, zolpidem

Self treatment insomnia (short term)

first generation diphenhydramine, doxylamine

Short term treatment BZDs for insomnia

L-O-T

Non-BZD hypnotics moa

selective BZD receptors to increase GABA

Non-BZD hypnotics list

eszopiclone, zolpidem, zaleplon

Orexin receptor antagonist moa

Orexin promotes wakefullness; drugs block the signalling system, causing drowsiness

Orexin receptor antagonists drug lists

Daridorexant, lemborexant, suvorexant

Orexin receptor antagonists substrates of what

CYP3A4

Melatonis receptor agonists moa

Agonist at MT1/MT2 melatonin receptors- promote sleepiness and regulat circadian rhythm

Melatonin receptor agonists drug list

Ramelteon, tasimelteon

TCA moa for insomnia

blockage of acetylcholine and histamine receptors

TCA for sleep

doxepin/silenor

Restless leg syndrome (RLS) is what

urge to move the lower legs (creeping sensation) worse at night, relieved with movement (thought to be dysfunction with dopamine)

RLS treatment

dopamine agonists/anticonvulsant gabapentin

Dopamine agonists in RLS

Pramipexole and ropinirole (IR)- taken 1-3 hrs before bedtime

Gabapentin in RLS

horizant- ER, taken at 5pm

Nacrolepsy is what

excessive daytime sleepingess with cataplexy and sleep paralysis

Sleep attacks last how long

few seconds to several minutes

Nacrolepsy drug treatment (stimulants)

modafinil, armodafinil, sodium oxybate

Nacrolepsy drug treatment (histamine 3 receptor antagonist/inverse agonist)

pitolisant

Nacrolepsy drug treatment (dopamine and NE reuptake inhibitor)

solriamfetol