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Related Concept Videos

Management of Insomnia01:19

Management of Insomnia

The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Insomnia01:27

Insomnia

Insomnia is a prevalent sleep disorder characterized by difficulty falling asleep, frequent awakenings during the night, and waking up too early without being able to return to sleep. People with insomnia often experience these disruptions at least three nights a week for at least one month. Chronic insomnia, which lasts for at least three months, can lead to increased anxiety, which in turn can worsen sleep difficulties, creating a cycle of sleeplessness and stress.
Multiple factors contribute...
CNS Depressants: Barbiturates and Benzodiazepines01:14

CNS Depressants: Barbiturates and Benzodiazepines

CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...

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Behavioral and pharmacologic management options for insomnia.

Ruth M Benca1

  • 1Department of Psychiatry, University of Wisconsin Medical School, Madison, WI 53719-1176, USA. rbenca@med.wisc.edu

Postgraduate Medicine
|August 12, 2009
PubMed
Summary
This summary is machine-generated.

Insomnia treatment involves behavioral and pharmacologic therapies. While behavioral therapy offers durable relief, current pharmacologic options have limitations, necessitating further research into long-term hypnotic efficacy.

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Area of Science:

  • Neuroscience
  • Sleep Medicine

Background:

  • Sleep and wakefulness are active processes regulated by complex neural networks.
  • Insomnia, especially primary insomnia, is often linked to hyperarousal.
  • Current treatment guidelines for insomnia include behavioral and pharmacologic therapies.

Purpose of the Study:

  • To review the current landscape of insomnia treatments.
  • To evaluate the efficacy and durability of behavioral and pharmacologic therapies for insomnia.
  • To identify gaps in knowledge regarding long-term hypnotic use.

Main Methods:

  • Literature review of existing practice parameters and clinical investigations.
  • Analysis of efficacy and safety data for approved and investigational hypnotic agents.
  • Examination of the durability of treatment effects after cessation.

Main Results:

  • Behavioral therapy provides durable relief from insomnia symptoms.
  • Approved hypnotic agents have short-term use limitations (4 weeks) due to variable efficacy and safety concerns.
  • Eszopiclone is the only investigational hypnotic studied for prolonged efficacy (6 months) without significant tolerance.

Conclusions:

  • There is a need for updated practice parameters for pharmacologic insomnia treatment.
  • Physicians often prescribe sedating agents off-label due to limitations of approved hypnotics.
  • Further research is required to establish optimal long-term treatment durations for chronic insomnia.