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Management of Insomnia01:19

Management of 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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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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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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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.
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Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
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Insomnia01:27

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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.
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Hypnotic Discontinuation in Chronic Insomnia.

Jonathan P Hintze1, Jack D Edinger2

  • 1Division of Pediatric Sleep Medicine, University of South Carolina School of Medicine-Greenville, Greenville Health System, 200 Patewood Drive, Suite A330, Greenville, SC 29615, USA.

Sleep Medicine Clinics
|May 11, 2020
PubMed
Summary
This summary is machine-generated.

Discontinuing hypnotic medications for chronic insomnia is encouraged but challenging. Gradual tapering and behavioral therapies, like cognitive behavioral therapy, improve outcomes and reduce withdrawal symptoms.

Keywords:
BenzodiazepinesDeprescribingDiscontinuationHypnoticInsomniaSleep disorder

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Area of Science:

  • Sleep Medicine
  • Pharmacology

Background:

  • Chronic insomnia is frequently treated with hypnotic medications.
  • Long-term effects of these medications are largely unknown.
  • Discontinuation of hypnotics is recommended but often difficult.

Purpose of the Study:

  • To review strategies for effective hypnotic medication discontinuation in patients with chronic insomnia.
  • To evaluate the efficacy of different methods in managing withdrawal and rebound symptoms.

Main Methods:

  • Literature review of studies on hypnotic cessation.
  • Analysis of strategies including gradual tapering, patient education, and behavioral therapies.
  • Assessment of adjunctive pharmacological interventions.

Main Results:

  • Gradual tapering is superior to abrupt cessation for avoiding rebound insomnia and withdrawal.
  • Written patient information may support discontinuation efforts.
  • Cognitive behavioral therapy (CBT) and other behavioral therapies significantly improve discontinuation outcomes.

Conclusions:

  • Phased reduction of hypnotic medication is crucial for successful discontinuation.
  • Behavioral interventions, particularly CBT, are effective non-pharmacological aids.
  • Evidence for adjunct medications in hypnotic cessation remains limited.