Sleep initiation and maintenance disorders: Difference between revisions
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==Treatment== | ==Treatment== | ||
===GABA agonists=== | ===GABA agonists=== | ||
These medications are agonists of the [[GABA-A receptor]]s. | |||
====BZ<sub>1</sub> selective agonists ==== | ====BZ<sub>1</sub> selective agonists ==== | ||
In treating persistent [[insomnia]] in adults, 6 weeks of zolpidem 10 mg nightly along with weekly sessions of [[cognitive behavioral therapy]] followed by 6 months of monthly sessions and no medications yielded the most remission of insomnia in a [[randomized controlled trial]].<ref name="pmid19454639">{{cite journal| author=Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al.| title=Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 19 | pages= 2005-15 | pmid=19454639 | In treating persistent [[insomnia]] in adults, 6 weeks of zolpidem 10 mg nightly along with weekly sessions of [[cognitive behavioral therapy]] followed by 6 months of monthly sessions and no medications yielded the most remission of insomnia in a [[randomized controlled trial]].<ref name="pmid19454639">{{cite journal| author=Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al.| title=Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. | journal=JAMA | year= 2009 | volume= 301 | issue= 19 | pages= 2005-15 | pmid=19454639 | ||
Revision as of 21:14, 8 December 2009
In medicine, sleep initiation and maintenance disorders, including insomnia, are "disorders characterized by impairment of the ability to initiate or maintain sleep. This may occur as a primary disorder or in association with another medical or psychiatric condition."[1][2]
Treatment
GABA agonists
These medications are agonists of the GABA-A receptors.
BZ1 selective agonists
In treating persistent insomnia in adults, 6 weeks of zolpidem 10 mg nightly along with weekly sessions of cognitive behavioral therapy followed by 6 months of monthly sessions and no medications yielded the most remission of insomnia in a randomized controlled trial.[3]
In geriatrics, the benefits of zolpidem for insomnia to not clearly exceed the drug toxicity.[4][5]
Melatonin agonists
Ramelteon is one available agonist.
Tasimelteon can help transient insomnia due to shift changes related to employment..[6]
References
- ↑ Anonymous (2024), Sleep initiation and maintenance disorders (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Kupfer DJ, Reynolds CF (1997). "Management of insomnia.". N Engl J Med 336 (5): 341-6. PMID 9011788.
- ↑ Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C et al. (2009). "Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial.". JAMA 301 (19): 2005-15. DOI:10.1001/jama.2009.682. PMID 19454639. Research Blogging.
- ↑ Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE (2005). "Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits.". BMJ 331 (7526): 1169. DOI:10.1136/bmj.38623.768588.47. PMID 16284208. PMC PMC1285093. Research Blogging. Review in: ACP J Club. 2006 Jul-Aug;145(1):14 Review in: Evid Based Med. 2006 Aug;11(4):110 Review in: Evid Based Nurs. 2006 Jul;9(3):87
- ↑ Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF, Kupfer DJ (1997 Dec 24-31). "Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy.". JAMA 278 (24): 2170-7. PMID 9417012.
- ↑ Rajaratnam SM, Polymeropoulos MH, Fisher DM, Roth T, Scott C, Birznieks G et al. (2009). "Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials.". Lancet 373 (9662): 482-91. DOI:10.1016/S0140-6736(08)61812-7. PMID 19054552. Research Blogging.