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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...
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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...
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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...
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Pharmacotherapy for sleep bruxism.

Cristiane R Macedo1, Elizeu C Macedo, Maria R Torloni

  • 1Brazilian Cochrane Centre, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, Rua Borges Lagoa, 564 cj 63, São Paulo, SP, Brazil, CEP 04038-000.

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Pharmacological treatments for sleep bruxism show insufficient evidence of effectiveness. More high-quality randomized controlled trials (RCTs) are needed to determine safety and efficacy for this common sleep disorder.

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Pharmacology

Background:

  • Sleep bruxism, characterized by involuntary teeth grinding or clenching during sleep, is a common disorder.
  • Existing treatment strategies include behavioral, dental, and pharmacological approaches.

Purpose of the Study:

  • To systematically evaluate the effectiveness and safety of pharmacological interventions for sleep bruxism.
  • To compare drug treatments against placebo, no treatment, or other pharmacological agents.

Main Methods:

  • A comprehensive search of multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS) was conducted.
  • Included randomized controlled trials (RCTs) or quasi-RCTs comparing drugs with controls in individuals with sleep bruxism.
  • Data extraction and quality assessment were performed independently by multiple reviewers.

Main Results:

  • Seven small, cross-over design RCTs with 7-16 participants met inclusion criteria; three were low risk of bias, four uncertain.
  • Drugs evaluated included amitriptyline, bromocriptine, clonidine, propranolol, levodopa, and tryptophan, compared with placebo.
  • Results for primary outcomes (bruxism motor activity indices) were imprecise, showing no clear benefit or harm; adverse effects were noted for amitriptyline and propranolol.

Conclusions:

  • Insufficient evidence exists regarding the effectiveness of pharmacotherapy for sleep bruxism.
  • Well-designed RCTs with larger sample sizes, parallel designs, and standardized outcomes are necessary.
  • Future research should focus on robust methodologies to clarify treatment efficacy and safety.