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Management of Insomnia

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...

Insomnia

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...

Sedatives and Hypnotics Drugs: Miscellaneous Agents

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...

CNS Depressants: Barbiturates and Benzodiazepines

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: Overview

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: Benzodiazepines

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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Meta-Analysis of the Effectiveness and Safety of Shugan Jieyu Capsules for the Treatment of Insomnia

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[Complementary and alternative medicine for insomnia].

Hidehisa Yamashita, Akihiko Machino, Kazuhiro Shishida

Nihon Rinsho. Japanese Journal of Clinical Medicine

|June 13, 2015

Summary

Insomnia prevalence rises with age. Elderly Japanese patients show low adherence to sleeping pills due to stigma, leading to increased use of complementary therapies with insufficient evidence.

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Area of Science:

Gerontology
Sleep Medicine
Pharmacology

Context:

Insomnia is a growing concern in the elderly population.
Traditional treatments like benzodiazepine receptor agonists may be insufficient for some elderly patients.
Elderly Japanese individuals exhibit low adherence to sleeping pills owing to significant social stigma.

Purpose:

To review the current landscape of insomnia treatments in the elderly.
To evaluate the efficacy and safety of complementary and alternative medicine (CAM) for geriatric insomnia.
To discuss the advantages and disadvantages of various pharmacological and non-pharmacological interventions.

Summary:

Benzodiazepine receptor agonists are commonly prescribed but often yield insufficient effects in the elderly.
Complementary and alternative medicine, including sedative antidepressants, antipsychotics, antihistamines, and supplements, are frequently used by elderly Japanese for insomnia.
Evidence supporting the effectiveness and safety of these CAM options for insomnia in the elderly is limited.

Impact:

Highlights the need for more robust evidence regarding CAM treatments for geriatric insomnia.
Informs clinical practice by outlining the pros and cons of current insomnia management strategies in older adults.
Addresses the critical issue of treatment adherence and stigma associated with sleep medications in the elderly population.