Chronic insomnia diagnosis
symptoms at least 3 times per week for at least 3 months
What drugs can worsen insomnia?
Acetylcholinesterase inhibitors
Alcohol
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants
Diuretics
Fluoxetine
Nicotine
INSTIs
Steroids
Stimulants
Varenicline
What sleep agents help falling asleep? Staying asleep? Both?
fall asleep: ramelteon, zaleplon
stay asleep: doxepin, suvorexant
both: eszopiclone, zoldipem
Lunesta
eszopiclone (C-IV)
Ambien
zoldipem (C-IV)
Edluar
zoldipem SL tablet
Zoldipem dosing for females, males, and older adults
male: 5-10 mg
female: 5 mg
older: 5 mg
Non-BZD hypnotics, MoA
eszopiclone, zolpidem, zaleplon
act selectively at BZD receptors to increase GABA
Non-BZD hypnotics safety
potential for abuse
Beers criteria
Orexin receptor antagonists
daridorexant
lemborexant
suvorexant
all C-IV
Melatonin receptor agonists
ramelteon
tasimelteon
not controlled
Which tricyclic antidepressant can be used for insomnia
doxepin
Restoril
temazepam
C-IV
Which antidepressants can be used for insomnia
diphenhydramine
doxylamine
Unisom SleepTabs
doxylamine
Antihistamine safety
anticholinergic effects (urinary retention, dry mouth, dry eyes/blurry vision, constipation)
avoid use in BPH and glaucoma
Treatment for restless leg syndrome
dopamine agonists: pramipexole, ropinirole, rotigotine patch
gabapentin
Treatment for narcolepsy
modafinil, armodafinil
sodium oxybate
pitolisant, solriamfetol
dexmethylphenidate, Adderall, methylphenidates
sodium oxybate safety
derived from GABA
C-III
REMS only (used illicitly and for sexual assault)
Silenor
doxepin