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Related Concept Videos

Management of Insomnia01:19

Management of Insomnia

244
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...
244
Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

168
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...
168
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

336
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...
336
CNS Depressants: Barbiturates and Benzodiazepines01:14

CNS Depressants: Barbiturates and Benzodiazepines

249
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...
249
Sedatives and Hypnotics Drugs: Barbiturates01:20

Sedatives and Hypnotics Drugs: Barbiturates

245
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...
245
Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

236
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...
236

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Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review.

Gaurav Singh1,2, Christopher Nguyen1,2, Ware Kuschner1,2

  • 1Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.

Journal of Intensive Care Medicine
|June 17, 2024
PubMed
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Dexmedetomidine effectively improved sleep in intensive care unit (ICU) patients, enhancing sleep quantity and quality. While other sleep aids showed limited evidence, dexmedetomidine

Keywords:
ICUcritical carecritically illdexmedetomidineintensive caremelatoninorexin receptor antagonistpolysomnographypropofolramelteonsleepsleep efficiencysleep qualitysuvorexant

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Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Sleep Medicine

Background:

  • Intensive care unit (ICU) patients frequently suffer from poor sleep quality.
  • Pharmacologic sleep aids are commonly used, but their efficacy in the ICU is uncertain.
  • This review assesses the objective and subjective effects and adverse events of ICU sleep medications.

Approach:

  • Systematic literature search of major databases (PubMed, Scopus, etc.) until June 2023.
  • Included 34 comparative studies with 3498 participants, focusing on randomized controlled trials.
  • Evaluated melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine for sleep improvement.

Key Points:

  • Evidence for melatonin, ramelteon, suvorexant, and propofol was limited or mixed.
  • Dexmedetomidine demonstrated significant improvements in objective sleep metrics (duration, efficiency) and subjective quality.
  • Polysomnography/electroencephalography showed increased stage N2 sleep and decreased stage N1 sleep with dexmedetomidine.

Conclusions:

  • Dexmedetomidine is supported by objective and subjective data as an effective ICU sleep aid.
  • Potential hemodynamic side effects (bradycardia, hypotension) require consideration.
  • Further research is ongoing, particularly for melatonin and dexmedetomidine.