SLEEP-INSOMNIA MGM (PHARMACOLOGIC)

SUMMARY

1. Benzodiazepines.
2. Non-benzodiazepine (zolpidem, zaleplon): facilitate GABAA transmission by preferential binding at the 1a receptor subunits (corresponding to benzodiazepine receptor subtype 1), and therefore are devoid of the significant muscle relaxant, anxiolytic, and anticonvulsant activity of traditional full-agonist benzodiazepines.
3. Patients with trouble initiating sleep would require short acting medications, whereas those with fragmented sleep would benefit from medications with an intermediate to long half-life.
4. Melatonin: naturally occurring hormone.

AVOID
5. Opiates tend to produce sedation and have the effect of increasing sleep fragmentation and decreasing REM and stage 2 sleep.
6. Nicotine delays sleep onset.
7. Alcohol sedates by increasing slow-wave and reducing REM sleep, but also causes rebound increase in sleep fragmentation later in the sleep cycle.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.