Difference between revisions of "Insomnia"
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* 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). | ||
=Melatonin= | =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. | ||
+ | |||
+ | * Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I, Ben-Shushan A, Ford I. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005 Feb;9(1):41-50. doi: 10.1016/j.smrv.2004.06.004. PMID: 15649737. | ||
+ | ** In a meta analysis of 17 randomized, double-blind, placebo controlled studies with objective sleep eval including 284 patients, melatonin decreased sleep latency by 2-5 minutes, improved sleep efficiency by 2-3%, and increased sleep length by 13 min. Melatonin doses ranged from 0.1 to 80 mg PO, or 50 mg IV in one study. | ||
+ | |||
+ | * 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. | ||
+ | ** | ||
+ | |||
+ | * 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. | ||
+ | ** | ||
+ | |||
* MOA: chronohypnotic that decreases firing rate of neurons in SCN via MT1 receptor, but only when endogenous levels are low (daytime) | * 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. | * In older adults, the amount of melatonin synthesized and the number and affinity of MT1 receptors all decrease. | ||
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* The body makes 1 mg per day, at higher doses exogenous melatonin might decrease your body's ability to synthesize it on its own. | * 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. | * Higher doses in the short term show a dose dependent effect, but this wears off quickly and then melatonin stops working at all. | ||
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Revision as of 13:42, 23 September 2024
- 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.
- Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I, Ben-Shushan A, Ford I. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005 Feb;9(1):41-50. doi: 10.1016/j.smrv.2004.06.004. PMID: 15649737.
- In a meta analysis of 17 randomized, double-blind, placebo controlled studies with objective sleep eval including 284 patients, melatonin decreased sleep latency by 2-5 minutes, improved sleep efficiency by 2-3%, and increased sleep length by 13 min. Melatonin doses ranged from 0.1 to 80 mg PO, or 50 mg IV in one study.
- 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.
- 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.
- 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.
- Higher doses might increase total sleep time.
- 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.