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Drugs for Sleep Disorders

Central Nervous System Depressants

• Barbiturates

  • Example: Phenobarbital

• Benzodiazepines

  • Chlordiazepoxide (Librium)

  • Lorazepam, Clonazepam

• Non-benzodiazepines

  • Zolpidem

  • Ramelteon

  • Melatonin

Sleep Architecture

• Basic organization of normal sleep

• Two types alternate in cycles:

  • NREM (non-rapid eye movement)

  • REM (rapid eye movement)

Normal Sleep Cycles

• Consists of 4-6 cycles of NREM/REM sleep

• NREM includes:

  • About 75% of sleep time

  • 4 stages of progressively deeper sleep

  • Stage 4: protein synthesis, tissue repair

• REM includes:

  • About 25% of sleep time

  • Refuels creativity

  • Active brain with paralyzed body

Sleep Cycle Duration

• Lasts 90 - 110 minutes in adults

• Must restart at Stage I if awoken

• Progresses with less time in Stages III and IV, more time in REM

Functions of Sleep

• Restores normal activity levels

• Balances parts of the nervous system

• Essential for protein synthesis

• Supports psychological well-being

Sleep Patterns by Age

Adults

• Require 7 - 9 hours of sleep

• Melatonin produced in response to darkness

  • Decreased production in adolescents and older adults

Older Adults

• Earlier sleep/wake times

• Longer latency to fall asleep

• Increased fragmented sleep

• Same sleep needs despite challenges (medical issues)

Non-Drug Sleep Promotion Techniques

• Maintain a consistent schedule

• Limit naps

• Avoid: caffeine, alcohol, nicotine; copious fluids 6 hrs before bedtime

• Relaxing routines: warm baths, quiet music

Sedative-Hypnotics Overview

• Continuum from sedation to anesthesia

• Potential for dependence; big business

• Ideal hypnotics are short-acting without drowsy hangover

• Includes barbiturates, benzodiazepines, non-benzodiazepines

Barbiturates

• Long-acting example: Phenobarbital

• Intermediate and short-acting examples: Secobarbital

• Ultra short-acting: Thiopental Na (prior to general anesthesia)

• Care implications:

  • High abuse potential

  • Not recommended for sleep in elderly due to increased confusion and CNS depression

Benzodiazepines

• Scheduled drugs with various uses: sedative, anxiolytic, antiseizures

• Increase GABA (inhibitory neurotransmitter)

• Can suppress Stage 4 sleep, recommended for short-term use (3-4 weeks max)

• Examples include: Temazepam, Alprazolam, Diazepam (Valium)

Benzodiazepine Overdose Treatment

• Flumazenil: GABA antagonist, injected, short half-life

• Frequent monitoring needed for breathing and level of consciousness

Care Notes for Benzodiazepines

• Risk of CNS depression and paradoxical effects (agitation, rage)

• Common side effects: drowsiness, dizziness, confusion

• Avoid combining with other CNS depressants

• Taper off slowly to avoid withdrawal symptoms

Non-Benzodiazepines

• Zolpidem for short-term insomnia treatment

• Ensure 8 hours of sleep after administration

• Watch for sleepwalking and other dangerous activities

Other Sleep Medications

• Ramelteon: non-controlled, well-tolerated melatonin agonist

• Side effects: dizziness, fatigue, potential hormonal effects

• Melatonin: natural hormone aiding sleep, useful for jet lag, few side effects

Care Implications for Sedatives

• Monitor vital signs and for respiratory depression

• Safety precautions: keep side rails up, avoid driving/operating machinery

• For older clients, prioritize non-pharm methods, short-intermediate acting benzos, and safety measures