Introduction

Article Abstract:

Treatment of insomnia, or inability to sleep, should be based on careful consideration of the patient's characteristics and the medication effects. The origin of the insomnia complaint and the age of the patient should be considered. Transient, short-term insomnia is characterized by sleeplessness lasting several days to a few weeks, which may require the use of hypnotic drug therapy. This type of insomnia may be caused by emotional problems, medical illness, or a change in the patient's sleep-wake schedule or environment. Symptoms may include difficulty falling asleep, frequent wakings during the night, or waking up in the early morning. Hypnotic drugs can be combined with recommendations for improving sleep habits. Drugs should be given at the lowest effective dose and for periods lasting no longer than two to three weeks. Chronic or long-term insomnia may be associated with disorders of breathing, and the use of hypnotic agents is not recommended. The prevalence of insomnia increases with age and is more often related to medical disorders in the elderly. However, hypnotics must be used with caution in the elderly, because of increased risk of apnea (cessation of breathing), decreased daytime alertness, and changes in the elimination of hypnotic agents in the elderly. An ideal hypnotic drug is absorbed into the body rapidly and induces and maintains sleep for the normal sleep period of eight hours. Some adverse effects of hypnotic agents include impairment of performance the morning after drug ingestion, amnesia or loss of memory, and deterioration of sleep after drug discontinuation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment

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Hypnotics and behavior

Article Abstract:

Hypnotic drugs are used to treat insomnia or the inability to sleep. Hypnotics may cause adverse effects on memory processes and daytime performance of various tasks, particularly in the morning after a nightly dose. The dose of the hypnotic is the major factor influencing the development of morning effects, and all hypnotics given in high doses will cause decreased morning performance. Hypnotic agents that have a long duration of action will also cause impairments in morning performance. In addition, some results indicate that patients develop a tolerance or decreased sensitivity to the adverse effects of hypnotics on morning performance. Benzodiazepines are the hypnotic drugs of choice for treating insomnia, and have reportedly caused amnesia or memory loss when used as medications before surgery. The magnitude of benzodiazepine effects on memory processes depends on the method of administering the drug, the dose, and the pharmacokinetics of the drug. The pharmacokinetics of a drug are features that describe the drug's absorption, distribution, metabolism, and elimination from the body. In summary, the decision to use a particular hypnotic drug should consider the trade-off between its effectiveness in producing and maintaining sleep and its tendency to decrease daytime performance and cause amnesia. Choice of the appropriate drug and dosage can in some cases prevent the development of these adverse side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Human behavior, Dosage and administration, Amnesia

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Rebound insomnia: its determinants and significance

Article Abstract:

Rebound insomnia occurs after discontinuing hypnotic drugs which are used to treat insomnia, and is characterized by worsening of sleep as compared with previous sleep levels. Rebound insomnia was first reported in studies examining the effectiveness and safety of benzodiazepines, the drugs of choice for treating insomnia. The causes, mechanisms, and clinical significance of rebound insomnia are discussed, and approaches for studying rebound insomnia are also described. Rebound insomnia occurs in both healthy, normal subjects and patients with sleep disorders, and may be defined as a disturbance of one or two nights' duration following discontinuation of benzodiazepines with short or intermediate durations of action. This sleep disorder develops after taking high doses of a hypnotic, beyond which there is no additional hypnotic effectiveness. The incidence and extent of rebound insomnia is not affected by the duration of drug therapy. The findings show that there are individual differences in the experience of this sleep disorder. Rebound insomnia may be avoided by starting hypnotic therapy with the lowest effective dose and tapering the dose upon discontinuation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Benzodiazepines

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