Insomnia - Revision history

Aesetholephews: /* Melatonin */

2024-09-23T18:00:34Z

Melatonin

Aesetholephews: /* Melatonin */

2024-09-23T17:51:09Z

Melatonin

Aesetholephews: /* Melatonin */

2024-09-23T17:41:10Z

Melatonin

Aesetholephews: /* Melatonin */

2024-09-23T17:16:08Z

Melatonin

Aesetholephews: /* Melatonin */

2024-09-23T15:18:16Z

Melatonin

Aesetholephews at 14:44, 23 September 2024

2024-09-23T14:44:20Z

Aesetholephews at 13:44, 23 September 2024

2024-09-23T13:44:34Z

Aesetholephews: /* Melatonin */

2024-09-23T13:42:59Z

Melatonin

Aesetholephews at 19:19, 29 April 2023

2023-04-29T19:19:09Z

Aesetholephews: /* Melatonin */

2023-04-29T19:09:57Z

Melatonin

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 =Melatonin=
-Melatonin is a chronohypnotic that decreases firing rate of neurons in SCN via MT1 receptor, but only when endogenous levels are low (i.e. daytime). In older adults, the amount of MT synthesized and the number and affinity of MT1 receptors all decrease. Does not make you feel drowsy. It enhances natural sleep wake cycle. Must be paired with good sleep hygiene. Only need very small amounts (1 mg). Give 1 hr before bedtime. The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own. Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all.
+Melatonin is a chronohypnotic that is secreted by the pineal gland and decreases firing rate of neurons in SCN via MT1 receptor. Normal peak serum concentrations are 60 pg/ml. Less than 1 mg is synthesized per day. In older adults, the amount of MT synthesized and the number and affinity of MT1 receptors all decrease. Does not make you feel drowsy. It enhances natural sleep wake cycle. Must be paired with good sleep hygiene. Only need very small amounts (1 mg). Give 1 hr before bedtime. The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own. Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all.
 * Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30. doi: 10.1210/jcem.86.10.7901. PMID: 11600532.

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 * Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol. 2022 Jan;269(1):205-216. doi: 10.1007/s00415-020-10381-w. Epub 2021 Jan 8. PMID: 33417003.
-**
+** Systematic review and meta-analysis of 23 RCTs that used sleep quality as assessed by PSQI as an outcome. They found a significant improvement in sleep quality amongst patients with respiratory, metabolic, or sleep disorders, but not other comorbidities. Effects were seen for both low dose and high dose (>3 mg).
 * Duffy JF, Wang W, Ronda JM, Czeisler CA. High dose melatonin increases sleep duration during nighttime and daytime sleep episodes in older adults. J Pineal Res. 2022 Aug;73(1):e12801. doi: 10.1111/jpi.12801. Epub 2022 May 13. PMID: 35436355; PMCID: PMC9288519.
 **

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 * Vural EM, van Munster BC, de Rooij SE. Optimal dosages for melatonin supplementation therapy in older adults: a systematic review of current literature. Drugs Aging. 2014 Jun;31(6):441-51. doi: 10.1007/s40266-014-0178-0. PMID: 24802882.
-** Meta analysis of 16 studies (9 RCTs), in older patients.
+** Meta analysis of 16 studies (9 RCTs), in patients aged 55-73 receiving oral melatonin in doses ranging from 0.1 to 50 mg/kg. Melatonin at higher doses led to a prolonged supraphysiologic plasma concentration, with some studies showing that this decreased the effectiveness of melatonin compared to lower doses.
 * Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol. 2022 Jan;269(1):205-216. doi: 10.1007/s00415-020-10381-w. Epub 2021 Jan 8. PMID: 33417003.

@@ Line 16: / Line 16: @@
 ** Meta analysis of 16 studies (9 RCTs), in older patients.
-* Duffy JF, Wang W, Ronda JM, Czeisler CA. High dose melatonin increases sleep duration during nighttime and daytime sleep episodes in older adults. J Pineal Res. 2022 Aug;73(1):e12801. doi: 10.1111/jpi.12801. Epub 2022 May 13. PMID: 35436355; PMCID: PMC9288519.
+* Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol. 2022 Jan;269(1):205-216. doi: 10.1007/s00415-020-10381-w. Epub 2021 Jan 8. PMID: 33417003.
 **
-* Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol. 2022 Jan;269(1):205-216. doi: 10.1007/s00415-020-10381-w. Epub 2021 Jan 8. PMID: 33417003.
+* Duffy JF, Wang W, Ronda JM, Czeisler CA. High dose melatonin increases sleep duration during nighttime and daytime sleep episodes in older adults. J Pineal Res. 2022 Aug;73(1):e12801. doi: 10.1111/jpi.12801. Epub 2022 May 13. PMID: 35436355; PMCID: PMC9288519.
 **

@@ Line 14: / Line 14: @@
 * Vural EM, van Munster BC, de Rooij SE. Optimal dosages for melatonin supplementation therapy in older adults: a systematic review of current literature. Drugs Aging. 2014 Jun;31(6):441-51. doi: 10.1007/s40266-014-0178-0. PMID: 24802882.
-**
+** Meta analysis of 16 studies (9 RCTs), in older patients.
 * Duffy JF, Wang W, Ronda JM, Czeisler CA. High dose melatonin increases sleep duration during nighttime and daytime sleep episodes in older adults. J Pineal Res. 2022 Aug;73(1):e12801. doi: 10.1111/jpi.12801. Epub 2022 May 13. PMID: 35436355; PMCID: PMC9288519.

← Older revision		Revision as of 14:44, 23 September 2024
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−	* Trazodone ~~has~~ low rates of side effects with low doses used PRN for sleep.	+	=Trazodone=
		+	* Jaffer KY, Chang T, Vanle B, Dang J, Steiner AJ, Loera N, Abdelmesseh M, Danovitch I, Ishak WW. Trazodone for Insomnia: A Systematic Review. Innov Clin Neurosci. 2017 Aug 1;14(7-8):24-34. PMID: 29552421; PMCID: PMC5842888.
		+	** Has low rates of side effects with low doses used PRN for sleep.
	* Olanzapine and Quetiapine 2nd gen antipsychotics used for sleep and delirium. Avoid in older patients with dementia (black box warning).		* Olanzapine and Quetiapine 2nd gen antipsychotics used for sleep and delirium. Avoid in older patients with dementia (black box warning).

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 * Trazodone has low rates of side effects with low doses used PRN for sleep.
 * Olanzapine and Quetiapine 2nd gen antipsychotics used for sleep and delirium. Avoid in older patients with dementia (black box warning).
 =Melatonin=
 * Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30. doi: 10.1210/jcem.86.10.7901. PMID: 11600532.
 ** Double-blind, placebo-controlled study, subjects who slept normally (n = 15) or were insomniacs, i.e. exhibited actigraphically confirmed decreases in sleep efficiency (n = 15) received, in randomized order, a placebo and three melatonin doses (0.1, 0.3, and 3.0 mg) orally 30 min before bedtime for a week. There was a non-dose dependent increase in sleep efficiency in insomniacs but not in controls. The 3 mg dose caused transient hypothermia and supraphysiologic plasma melatonin levels that persisted for much of the following day.
@@ Line 16: / Line 19: @@
 * Fatemeh G, Sajjad M, Niloufar R, Neda S, Leila S, Khadijeh M. Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol. 2022 Jan;269(1):205-216. doi: 10.1007/s00415-020-10381-w. Epub 2021 Jan 8. PMID: 33417003.
 **

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 * Olanzapine and Quetiapine 2nd gen antipsychotics used for sleep and delirium. Avoid in older patients with dementia (black box warning).
 =Melatonin=
 * MOA: chronohypnotic that decreases firing rate of neurons in SCN via MT1 receptor, but only when endogenous levels are low (daytime)
 * In older adults, the amount of melatonin synthesized and the number and affinity of MT1 receptors all decrease.
@@ Line 8: / Line 23: @@
 * The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own.
 * Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all.

@@ Line 4: / Line 4: @@
 * MOA: chronohypnotic that decreases firing rate of neurons in SCN via MT1 receptor, but only when endogenous levels are low (daytime)
 * In older adults, the amount of melatonin synthesized and the number and affinity of MT1 receptors all decrease. [35436355]
-* Does not make you feel drowsy. It enhances natural sleep wake cycle. Must be paired with good sleep hygiene. Only need very small amounts (1 mg). Give 1 hr before bedtime. [1|https://link.springer.com/article/10.1007/s00415-020-10381-w]
+* Does not make you feel drowsy. It enhances natural sleep wake cycle. Must be paired with good sleep hygiene. Only need very small amounts (1 mg). Give 1 hr before bedtime.
 * The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own.
 * Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all.
-* Refs: 15649737, 11600532, 24802882, 35436355
+* Refs: 15649737, 11600532, 24802882, 35436355, 33417003