Drugs Used for Sedation and Sleep

Definition: A state of unconsciousness from which a person can be aroused by appropriate stimulus, essential for immune strength and psychiatric equilibrium.
Sleep Cycle: A healthy young adult completes a cycle through NREM and REM in a $90\text{-minute}$ period.
NREM Phase (Four Stages): * Stage 1: Transition from wakefulness; accounts for $2\% \text{ to } 5\%$ of sleep time. * Stage 2: Experienced as drifting or floating; accounts for $50\%$ of sleep time. * Stage 3: Transition from lighter to deeper sleep. * Stage 4: "Delta sleep"; deep and restful; accounts for $10\% \text{ to } 15\%$ of sleep time in young adults.
REM Phase: Associated with dreaming.

Insomnia Types: * Initial: Difficulty falling asleep. * Intermittent: Difficulty staying asleep. * Terminal: Waking and being unable to fall back to sleep.
Drug Definitions: * Sedative: A drug that induces relaxation and rest without necessarily causing sleep. * Hypnotic: A drug that produces sleep.
General Effects: These agents increase total sleep time (especially in stages $2$ and $4$ ) but decrease total REM cycles, potentially leading to REM rebound upon discontinuation.

Actions: Affect type $1$ and type $2$ GABA receptors to stimulate the release of GABA.
Characteristics: High safety margin with over $2000$ derivatives; used as anticonvulsants, antianxiety agents, and for conscious sedation.
Adverse Effects: * Common: Drowsiness, hangover, sedation, and lethargy. * Serious: Confusion, amnesia, and hepatotoxicity.
Antidote: Flumazenil is the specific agent used for managing benzodiazepine overdose.
Monitoring: Routine lab studies for blood dyscrasias and liver function tests are required for extended use.

Action: Variable effects on REM sleep; preferred because they interfere less with natural sleep cycles.
Adverse Effects: Drowsiness, transient hypotension, and restlessness.
Drug Interactions: Includes Fluvoxamine, rifampin, and food.

Assessments: Monitor CNS function, vital signs, respiratory status, and alcohol intake.
Non-Pharmacologic Interventions: Use environmental control, backrubs, and stress management as alternatives to medication.
Education: Advise patients to avoid heavy meals in the evening and maintain personal comfort and exercise routines.

Question 1: Which NREM stage accounts for the largest amount of normal sleep time for an adult? * Answer: Stage $2$ .
Question 2: How many hours of sleep per night are thought to be optimal for good health? * Answer: $7 \text{ to } 8$ hours.
Question 3: Which medication would be most effective for an oriented but restless patient experiencing insomnia due to anxiety about a procedure after non-pharmacologic interventions have failed? * Answer: Sedative.
Question 4: A low-dose sedative-hypnotic agent may be prescribed for a patient with which condition? * Answer: Inability to sleep.
Question 5: Why are the newer, nonbenzodiazepine medications for insomnia preferred over older medications? * Answer: They interfere less with natural sleep cycles.