- cause identification,
- causal treatment:
elimination of risk factors,
somatic diseases treatment,
mental disorders treatment
- symptomatic treatment:
rules of sleep hygiene,
- transient insomnia: hypnotics only for 1-2 nights a minimal dose ( diazepam [BZD] not higher than 2-5 mg)
- short-term: hypnotics no longer than 2 weeks every 2-3 nights (not higher than 10 mg of diazepam)
- chronic: causal treatment: e.g. in depressive disorder, pharmacotherapy like in short term.
- sleep onset insomnia (difficulty falling asleep).
- sleep maintenance insomnia: frequent walking, shallow sleep and daytime sleepiness
- influence of chronic insomnia on health:
risk of psychosomatic disorders: 2X,
risk of coronary disease: 2X,
immune system impairment,
increase level of accidents: 2-4X
higher death risk in subject sleeping less than 7 hours.
30% of society,
frequently in Females,
increases in elderly pat.
transient insomnia: lasts just couple nights (shift work, jet lag syndrome, sudden stress, waiting for surgery)
short-term: lasts no more than three weeks (sudden somatic disease, mourning)
chronic: lasts more than three weeks (primary sleep disorders, mental disorders, somatic disorders)
- rules of usage:
half an hour before going to sleep,
no longer than 2-3 weeks,
not every night: 2-3 per week,
half of the dose for elderly,
drug holiday (lower in weekends)
reduction of daily dose 1/8 -1/4 every 1-2 week
- effect of BZD:
shortening of falling asleep time,
extend the total sleep time,
delaying of REM sleep,
reduction of 3rd and 4th stage
reduction of REM sleep
- side effects of BZD:
excessive sleepiness the following day,
memory disturbances and rebound insomnia,
high risk of falls and femoral fracture in elderly pat.
tolerance and addiction.
acts selectively on omega-1 receptors,
half-life of about 5 hours
acts after 30 mins.
low addiction than BZD
does not reduce the slow-wave sleep (3rd -4th) and does not influence REM sleep.
does not upset psychomotor function in the morning after wake up.
classification by DSM-IV
- primary sleep disorders:
Dyssomnias: Insomnia, hypersomnia, narcolepsy, sleep apnea.
Parasomnias: nightmare disorders, sleep terror disorder, sleepwalking disorder, not other specified.
- sleep disorders due to a general medical condition not elsewhere classified.
- sleep disorders due to other mental disorders.
- substance-related sleep disorders.
go to sleep only when you feel sleepy,
use your bed only for sleeping,
don't sleep during the day,
don't lie in tour bed longer than 15 mins.
stand up on the same hours every day, independently on the total amount of sleep during the night
- roles of sleep:
noradrenergic receptors sensitivity regulation
- Dyssomnias: primary disorders of imitating or maintaining sleep or of excessive sleepiness and are characterised by a disturbance in the amount, quality, or timing of sleep.
- Parasomnias: characterised by undesirable motor, verbal, or experimental phenomena occurring in association with sleep, specific stage of sleep, or sleep-awake transition phase.
- chemicals causing sleep disorders: beta blockers, methyldopa, bronchodilators, diuretics, steroids, thyroid hormones, alcohol, caffeine, cocaine, hypnotic and sedative drugs, psychostimulants.
- melatonine: neurohormone produced by pineal gland, induction of sleep and synchronises the diurnal cycle and biological clock, prescribed in daily rhythm disorders in blind pat. and in jet lag disorder