Sleep Disorders

• Psychiatric disorders - This refers to a broad range of problems that disturb a person’s thoughts, feelings, behavior or mood.
• Insomnia

  • Being unable to fall asleep and stay asleep.
  • Most common sleeping disorder.
• Sleep apnea

  • Breathing disorder in which you stop breathing for 10 seconds or more during sleep.
• Restless leg syndrome

  • Tingling/prickly sensation in your legs, along with a powerful urge to move them.
• Hypersomnia

  • Being unable to stay awake during the day.
  • Includes narcolepsy, which causes extreme daytime sleepiness
• Circadian rhythm disorders

  • Problems with the sleep-wake cycle.
  • Makes you unable to sleep and wake at right times.
• Parasomnia

  • Acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating
• Sleep loss can also adversely affect life by contributing to the development of obesity, diabetes and heart disease.
• Primary insomnia - sleep problems are not linked to any other health condition/problem.
• Secondary insomnia - you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication; or substance use (like alcohol).
• INSOMNIA SYMPTOMS

  1. Sleepiness during the day
  2. Fatigue
  3. Grumpiness
  4. Problems with concentration or memory
• BENZODIAZEPINE SEDATIVES (INSOMNIA)

  1. Triazolam
  2. Estazolam
  3. Lorazepam
  4. Temazepam
  5. Flurazepam
  6. Quazepam
• BENZODIAZEPINE SEDATIVES

  • Assist the patient in going to the bathroom/toilet especially the older people who are prone to accidents and falls.
  • Bathroom should have grab bars for support, have anti-slip mats, have a shower chair.
• NON-BENZODIAZEPINE HYPNOTICS (INSOMNIA)

  1. Zolpidem
  2. Zaleplon
  3. Eszopiclon
• NON-BENZODIAZEPINE HYPNOTICS

  1. Metallic taste in the mouth
  2. Sleepy at daytime
• 1 hour before bedtime - when non-benzodiazepine hypnotics are taken
• RAMELTEON SIDE EFFECTS(INSOMNIA)

  1. Dizziness
  2. Tiredness
  3. Daytime drowsiness
• RAMELTEON SERIOUS SIDE EFFECTS (INSOMNIA)

  1. May sleep walk, sleep talk or eat while not fully awake
  2. Mental and mood changes
  3. Depression
  4. Thoughts of suicide
  5. Decreased sexual desire
  6. Missed menstrual periods
  7. Nipple discharge
  8. Difficulty becoming pregnant
• 30 minutes before bedtime - when RAMELTEON is taken
• RAMELTEON should not be taken with or immediately after a high fat meal because it can affect how well this drug works
• Before giving RAMELTEON to a patient, assess breathing
• Opioid, cough relievers - drugs in which RAMELTEON should not be taken with
• Suvorexant - CNS depressant that helps you sleep faster
• SUVOREXANT SIDE EFFECTS (INSOMNIA)

  1. Unusual dreams
  2. Daytime drowsiness
• SUVOREXANT SERIOUS SIDE EFFECTS (INSOMNIA)

  1. Mental/mood changes (depression or suicidal thoughts)
  2. Temporary weakness of the legs
  3. Sleep paralysis
  4. Rare: sleep walk, sleep talk, eating and having sex while not fully awake
• 30 minutes before bedtime - when SUVOREXANT is taken
• Suvorexant - a drug for insomnia that may be taken with or without food, but it may take longer to work if you take it with or right after a meal
• Suvorexant - a drug for insomnia that needs a full night's sleep of at least 7 hours (prevent memory loss & loss of alertness)
• Suvorexant - a drug for insomnia that if used for a long time, it may not work as well.
• Suvorexant can cause sleep paralysis for several minutes
• Lemborexant - a drug for insomnia that is a SCHEDULE IV substance with sedative properties. It belongs to CNS depressants.
• Lemborexant - a drug for insomnia that will slow down the nervous system. It will help you get to sleep faster and sleep throughout the night.
• LEMBOREXANT SIDE EFFECTS (INSOMNIA)

  1. Nightmares/unusual dreams
  2. Tiredness
  3. Daytime drowsiness
• LEMBOREXANT SERIOUS SIDE EFFECTS (INSOMNIA)

  1. Mental/mood changes (depression, hallucinations, thoughts of suicide)
  2. Temporary weakness of the legs
  3. May cause sleep paralysis
  4. May cause “sleep-driving”. People have gotten out of bed and driven vehicles while not fully awake.
  5. May sleepwalked, prepared/eaten food/made phone calls or had sex while not fully awake.
• Bedtime - when LEMBOREXANT is taken
• Grapefruit/Grapefruit juice - should be avoided when taking LEMBOREXANT as it can increase the chance of side effects
• Doxepin - a tricyclic antidepressant used to treat anxiety or depression. Used to treat insomnia.
• DOXEPIN SIDE EFFECTS (INSOMNIA)

  1. Drowsiness
  2. Dry mouth
  3. Dizziness
  4. Headache
  5. Tiredness
  6. Blurred vision
  7. Constipation
  8. Trouble urinating
• DOXEPIN SERIOUS SIDE EFFECTS (INSOMNIA)

  1. Heartburn that doesn’t go away
  2. Mental/mood changes ( anxiety, agitation, confusion)
  3. Shaking
  4. Severe stomach/abdominal pain
  5. Severe dizziness
  6. Fast/irregular heartbeat
  7. Fainting
  8. Seizures
  9. Eye pain/swelling/redness/widened pupils/vision changes (seeing rainbows around lights at night)
• 1-3 - how many times DOXEPIN should be taken