Acute insomnia

Insomnia Due to a Medical Illness. Medically ill patients often have trouble with insomnia. Acute insomnia is frequently precipitated by anxiety regarding the prognosis of the illness, pending test resnlts, or the anticipation of unpleasant treatments or diagnostic procednres. These sitnations can at times be the trigger that nltimately prodnces a chronic conrse of insomnia independent of the medical illness. 

Acute benzene poisoning results in CNS depression and is characterized by an initial euphoria followed by staggered gait, stupor, coma, and convulsions. Exposure to approximately 4000 ppm benzene results in complete loss of consciousness. Insomnia, agitation, headache, nausea, and drowsiness may persist for weeks after exposure (126). Continued inhalation of benzene to the point of euphoria has caused irreversible encephalopathy with tremulousness, emotional lability, and diffuse cerebral atrophy (125). In deaths arising from acute exposure, respiratory tract infection, hypo- and hyperplasia of sternal bone marrow, congested kidneys, and cerebral edema have been found at autopsy. 

Benzodiazepines and other anxiolytics. Although benzodiazepines are widely used in the treatment of acute alcohol withdrawal, most nonmedical personnel involved in the treatment of alcoholism are opposed to the use of medications that can induce any variety of dependence to treat the anxiety, depression, and sleep disturbances that can persist for months following withdrawal. Researchers have debated the pros and cons of the use of benzodiazepines for the management of anxiety or insomnia in alcoholic patients and other substance abuse patients during the postwithdrawal period (Ciraulo and Nace 2000 Posternak and Mueller 2001). 

Despite the risks of benzodiazepine dependence and overdose among alcoholic patients beyond the period of acute withdrawal, there may be a role for the judicious use of benzodiazepines in treating these patients. To the degree that early relapse, which commonly disrupts alcoholism treatment, is a result of continued withdrawal-related symptoms (e.g., anxiety, depression, insomnia) that can be suppressed by low doses of benzodiazepines, retention in treatment could be enhanced by the use of benzodiazepines (Kissin 1977). Moreover, for some patients, benzodiazepine dependence, if it does occur, may be more benign than alcoholism. 

Antidepressants are commonly used to treat both acute withdrawal and persistent anxiety or insomnia. There is evidence to suggest that they are effective in relieving some acute abstinence symptoms, but it has been more difficult to establish their effectiveness in long-term discontinuation. Antidepressants with sedative and antianxiety effects are the preferred drugs. 

Nausea Vomiting Insomnia Headache Acute hepatic failure ... 

High-potency benzodiazepines (e.g., clonazepam and lorazepam) are common alternatives to or in combination with antipsychotics for acute mania, agitation, anxiety, panic, and insomnia or in those who cannot take mood stabilizers. Lorazepam IM may be used for acute agitation. A relative contraindication for long-term benzodiazepines is a history of drug or alcohol abuse or dependency. 

As would be expected, khat overuse produces symptoms similar to those of other monoamine stimulants, such as cocaine or amphetamine, including signs of sympathetic overarousal. In the extreme this can involve a toxic psychosis. Disorders more frequently associated with chronic khat use in males are headaches, anorexia, insomnia, constipation, and respiratory illnesses (Kennedy et al. 1983). Females report higher incidences of acute gastritis, jaundice, bronchitis and hepatic diseases. Also, cathinone has toxic reproductive effects in humans and experimental animals (Islam et al. 1990). It decreases sperm count and motility, and increases the number of abnormal sperm cells. It also decreases plasma testosterone in rats. 

No health hazards are known with the proper use of kava (Gruenwald et al. 1998). Kava has been approved by the German Commission E for treatment of anxiety and insomnia. In clinical studies of kava for anxiety, adverse effects were uncommon and did not differ across placebo and kava groups. There do not appear to be any studies published on the effects of acute overdosage with kava. Given its CNS depressant effects, it should not be taken with other similar drugs, including benzodiazepines, barbiturates. 

Benzodiazepines. The benzodiazepines were developed in the 1950s and introduced into the U.S. market in the 1960s. They have found a variety of uses including the treatment of several anxiety disorders, insomnia, seizure disorders, alcohol withdrawal, surgical anesthesia, and others. The benzodiazepines have also been used to calm agitated patients and are therefore useful during the acute treatment phase of bipolar mania. 

Aripiprazole (Abilify). Aripiprazole is indicated for the treatment of acute mania and for maintenance therapy. It is dosed at 5-30mg/day. Aripiprazole is well tolerated with the most common side effects being headache, agitation, anxiety, insomnia, and nausea. 

In this chapter, we will not attempt to provide an exhaustive description of every sleep disorder. Medication therapy plays a minimal role in the treatment of many sleep disorders. In fact, we contend that medication, apart from being an integral component of a comprehensive multimodal treatment program, is seldom an effective treatment for any sleep problem with the possible exception of acute insomnia due to an identifiable and short-lived stressor. Nevertheless, medications do play a part in the treatment of some sleep disorders. 

Acute Phase Treatment. Hypnotic medications are useful for short-term treatment of insomnia, but they should always be accompanied by behavioral and psychoeducational treatments, including a review of good sleep hygiene practices. It may also include more aggressive measures such as relaxation training, sleep restriction therapy, and stimulus control therapy. 

Diazepam is used for the control of anxiety and tension, the relief of muscle spasms, and the management of acute agitation during alcohol withdrawal, but it itself may be habit-forming. Chlordiazepoxide has similar uses and its synthesis is somewhat analogous to diazepam. Flurazepam is a hypnotic, useful for insomnia treatment. It is reported to provide 7-8 hr of restful sleep. 

Insomnia Insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, or early morning awakening. Can be used for recurring insomnia or poor sleeping habits and in acute or chronic medical situations requiring restful sleep. 

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