SEDATIVES, hypnotics, & anxiolytics

"Drifting off" stage of sleep

recurring problems in falling or staying asleep

NREM

REM sleep

Non-pharmacological preferred

RX- intended only for short-term use. If taken nightly, most will become ineffective in 2-4 weeks and will cause sleep disturbances when stopped. NO REM's

CNS depression

-All can produce drug tolerance
-psychological and physiological dependence and thus potential withdrawal symptoms (CII-IV)

-not unusual to develop CNS stimulation in children ("paradoxical reaction")
- confusion in the elderly; fall risk

Respiratory depression to death

All end in "am", "zepan" or "zolam"

Diazepam

GABA agonist

-clonazepam (klonopin)
-diazepam (valium)
-chlordiazepoxide (librium)
-lorazepam (ativan)
-flurazepam (dalmane)

Amnesia effects

FLUMAZENIL

end with "tal"

Binds to the GABA receptor-chloride channel complex

Phenobarbital (Hyponitic)
pentobarbital (seizures)

-eszopiclone (Lunesta)
-zolpidem (Ambien & Ambien CR)

immsomnia, unusual dreams

Hormone regulating sleep-wake cycles. Can be bought OTC

melatonin agonist RX

turn off wake signaling (good for sleep maintenance)

-Diphenhydramine (Benadryl)
-Doxylamine (Unisom)
-hydroxyzine

1. Provide non-pharmacological treatment first
2. Assess vitals
3. safety
4. Monitor for rebound excitability, insomnia, and nightmares, especially after discontinuation.

-Will result in impaired mental and physical function; avoid use with activities that require alertness
- Do not mix with alcohol or other CNS depressants- Do not take sleeping pills nightly
- Some reported problems with sleepwalking & other such activities with amnesia for events.