Insomnia

What can cause transient insomnia?

Shift work and jet lag

What is a sedative?

A drug that decreases activity moderates excitement and calms

What is a hypnotic?

A drug that produces drowsiness and facilitates onset and maintenance of sleep

What happens during REM sleep?

Dreaming and low muscle tone occur

What can lack of REM sleep cause?

Irritability and anxiety

What characterises slow-wave sleep?

Deepest level of sleep

What happens to metabolic rate and cortisol during slow-wave sleep?

Both decrease

What hormone increases during slow-wave sleep?

Growth hormone

What effect do most hypnotics have on REM sleep?

They decrease REM sleep

What effect do benzodiazepines have on sleep onset?

They decrease time taken to fall asleep

When do benzodiazepines increase sleep duration?

When sleep is less than 6 hours

What effect do benzodiazepines have on REM sleep?

They decrease REM sleep

Which short-acting benzodiazepine helps avoid hangover effects?

Temazepam

How quickly does tolerance to benzodiazepines develop?

Within 1 to 2 weeks

What can occur after stopping benzodiazepines?

Rebound insomnia and withdrawal

What are Z-drugs?

Drugs that bind the benzodiazepine site but are chemically different

Which GABAA receptor subunit are Z-drugs selective for?

Alpha 1 subunit

Why are Z-drugs not strongly anxiolytic?

Because they selectively target the alpha 1 subunit

What effect do Z-drugs have on sleep onset?

They decrease time taken to fall asleep

What effect do Z-drugs have on sleep duration?

They increase duration if sleeping less than 6 hours

What effect do Z-drugs have on REM sleep?

They decrease REM sleep

How do Z-drug half-lives compare with benzodiazepines?

They are shorter

Which antihistamines are useful as sedatives?

More sedative antihistamines

What effect do tricyclic antidepressants have?

They can cause drowsiness

Why is it important to identify causes of chronic insomnia?

Optimal treatment requires treating the underlying cause