Difference between revisions of "Insomnia"
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* 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. [35436355] | * 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. | + | * 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. | * 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. | ||
| − | * Refs: 15649737, 11600532, 24802882, 35436355 | + | * Refs: 15649737, 11600532, 24802882, 35436355, 33417003 |
Revision as of 19:09, 29 April 2023
- 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
- 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.
- 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, 33417003