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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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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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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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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).
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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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Medications Used for Pediatric Insomnia.

Vijayabharathi Ekambaram1, Judith Owens2

  • 1Department of Psychiatry, Touro University, Touro University Medical Group, 1805 North California Street, Suite 201, Stockton, CA 95204, USA.

Child and Adolescent Psychiatric Clinics of North America
|November 23, 2020
PubMed
Summary
This summary is machine-generated.

Pediatric insomnia negatively impacts children's health and development. This review examines FDA-approved and off-label medications for pediatric insomnia, emphasizing combination with behavioral therapy for lasting results.

Keywords:
ChildrenInsomniaMedicationsPediatricsPharmacotherapySleep disorders

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Area of Science:

  • Pediatric Sleep Medicine
  • Pharmacology

Background:

  • Pediatric insomnia presents significant challenges to children's physical, mental, and cognitive well-being.
  • Current treatment options lack specific Food and Drug Administration (FDA) approval for pediatric insomnia.
  • Existing pharmacologic interventions are largely based on adult data or case reports.

Purpose of the Study:

  • To review FDA-approved (in adults), over-the-counter, and off-label medications for pediatric insomnia.
  • To provide clinicians with general principles, practice guidelines, and considerations for selecting medications in pediatric patients.
  • To highlight the importance of integrating pharmacologic management with behavioral therapy.

Main Methods:

  • Comprehensive review of existing literature on pediatric insomnia pharmacotherapy.
  • Analysis of FDA-approved medications in adults, over-the-counter options, and commonly used off-label drugs in children.
  • Synthesis of current practice guidelines and clinical considerations.

Main Results:

  • No medications are specifically FDA-approved for pediatric insomnia.
  • Pharmacologic strategies often extrapolate from adult data or rely on case reports.
  • Behavioral therapy demonstrates long-lasting positive outcomes.

Conclusions:

  • Clinicians require guidance on selecting appropriate pharmacologic agents for pediatric insomnia.
  • A combined approach of medication and behavioral therapy is recommended for optimal management.
  • Further research into FDA-approved treatments for pediatric insomnia is warranted.