Difference between revisions of "Insomnia"

From Seth's Wiki
Jump to navigation Jump to search
Line 2: Line 2:
 
* 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.
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.
 
* 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, 33417003
 

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.
Retrieved from "http://www.sethvogel.com/wiki/index.php?title=Insomnia&oldid=1010"