Sunday, June 19, 2011

How chronic insomnia is treated with sedative hypnotics–New guidelines

According to the stahl’s essentials of psychopharmacology 3rd edition, There is a place for long term use of sedative hypnotics in chronic insomnia. Sedative hypnotic is a drug that causes depression of central nervous system activity which causes sleep.

The old guidelines recommend short term use of sedative hypnotics, improve sleep hygiene and treat the underlying cause for insomnia. It does not appreciate chronic insomnia as a disease entity on its own.

In addition, most of the older sedative hypnotics such as benzodiazepines (Vallium, Dalmane) and barbiturates are comparatively long acting. These long acting compounds tend to cause sleepiness in the following day and falls/hip fractures in the elderly. In addition, they tend to cause withdrawal symptoms and dependence.

New thinking on insomnia and sedative hypnotic use

Now most experts think chronic insomnia is a disorder by itself and there is a need for long term treatment. In addition, hypnotics such as Zaleplon, Zolpidem and Zopiclone extremely short acting. Therefore they do not show any sleepiness in the following day.

In addition, long term studies conducted on eszopiclone shows little or no tolerance (need to take increasing amount of drug to get the same effect) and withdrawal symptoms (Stahl, 3rd).

Following hypnotics have shown marked promise and have no restrictions in the long term use. However, some of them may cause sleepiness in the next day morning.

1. Zolpidem CR (Ambien continuous release)
2. Trazadone (Desyrel)
3. Quatiapine (Seroquel)

This drug related blog post is for information only. YOU MUST CONSULT YOUR DOCTOR BEFORE TAKING THESE DRUGS.

Essential psychopharmacology Stahl, 3rd edition

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