Insomnia complications

Side effects include dyskinesias, orthostatic hypotension, dizziness, nausea, insomnia, sleep attacks, pathologic gambling, discoloration of urine/sweat, and psychiatric effects (confusion, hallucinations, nightmares, and altered behavior). Dyskinesias caused by adding other PD drugs to levodopa may be improved by decreasing the levodopa dose. Motor complications occur in about 40% of patients within 4 to 6 years of starting levodopa.1,8,24,25,37... 

O Insomnia is most frequently a symptom or manifestation of an underlying disorder (secondary insomnia) but may occur in the absence of contributing factors (primary insomnia). Early treatment of insomnia may prevent the development of psychopathologic complications. 

The answer is b. (Hardmanr p 1158.) Isoniazid inhibits cell-wall synthesis in mycobacteria. Increasing vitamin B6 levels prevents complications associated with this inhibition, including peripheral neuritis, insomnia, restlessness, muscle twitching, urinary retention, convulsions, and psychosis, without affecting the antimycobacterial activity of INH. 

The newest appetite suppressant, sibutramine (Meridia), works by blocking the reuptake of both serotonin and norepinephrine. It does not stimulate nerve cells to release serotonin, as do fenfluramine and dexfenfluramine. Administered at 20 mg/ day, sibutramine effectively reduces weight in obese patients, but its use has not been assessed in eating disorder patients. The most common side effects of this medication are insomnia, dry mouth, and constipation. It has not been associated with the more serious heart and lung complications observed with fenfluramine and dexfenfluramine. Because sibutramine acts in part through modulation of norepinephrine, there is no rational basis for coadministering phentermine, which acts via this same mechanism. 

Although we are focusing on the primary sleep disorders, sleep disturbance quite often occurs as a symptom of another illness. Depression, anxiety, and substance abuse can impair the quality of sleep, though in the setting of chronic insomnia, other psychiatric disorders account for less than 50% of cases. Nightmares are a frequent complication of post-traumatic stress disorder (PTSD), and pain, endocrine conditions, and a host of medical illnesses can produce sleep problems. Thus, when discussing insomnia or hypersomnia, we are well advised to remember that these can be either a symptom of a psychiatric syndrome, a medical illness, or a sleep disorder. 

What to do with the patient who is a long-time user of sedative-hypnotics is often a difficult clinical decision. The most successful treatment approaches seem to be those that are gradual and address the insomnia from a multimodal perspective. Many of the sedative-hypnotics with moderate or longer half-lives will display rebound insomnia on discontinuation and this only complicates the treatment picture. At some point, one has to ask if discontinuing the chronic use of a sedative-hypnotic, in the absence of any harmful effects, is treating the patient or the prescriber. 

Delirium and depression may exist as separate illnesses that need to be distinguished from dementia or as complications superimposed on dementia. In addition to these four complications that are listed in DSM-IV, demented patients are also frequently troubled by insomnia and anxiety. 

Insomnia. The medicines used to treat insomnia are the same as those used to treat insomnia in other patients. As with other complications of dementia, the crucial task is to relieve the insomnia without worsening the dementia. 

Range of flu-like S5miptoms, e.g. fever, headache, chills Anorexia Strong fatigue Insomnia Cardiovascular complications Autoimmune reactions Hepatic decompression... 

The presentation is complicated by continued marked agitation, insomnia, and anxiety. 

Typical complications include insomnia and excessive daytime sleepiness due to frequent nighttime awakenings. Sleep electroencephalogram (EEG) reveals absent or decreased slow-wave sleep, and, in some patients, early-onset REM sleep. If untreated, long-term effects of sleep apnea include increased incidence of hypertension vascular events (e.g., myocardial infarction, stroke) poor work performance increased risk of traffic accidents and stress in personal relationships ( 22, 23). 

Withdrawal delirium (delirium tremens), which usually appears 1 to 4 days after abstinence and peaks at about 72 to 96 hours. The mortality rate may be as high as 15% if serious complicating medical problems are also present. Clinical signs and symptoms include profound confusion, illusions, delusions, vivid hallucinations, agitation, insomnia, and autonomic hyperactivity. Death results from infection, cardiac arrhythmias, fluid and electrolyte abnormalities, or suicide (e.g., in response to hallucinations, illusions, or delusions). 

Contraindications to the use of 3 blockers are asthma and other bronchospastic conditions, severe bradycardia, atrioventricular blockade, bradycardia-tachycardia syndrome, and severe unstable left ventricular failure. Potential complications include fatigue, impaired exercise tolerance, insomnia, unpleasant dreams, worsening of claudication, and erectile dysfunction. 

Adverse effects have been reported with a frequency comparable to that of placebo. These include nausea, headache, stomach upset, diarrhea, allergy, anxiety, and insomnia. A few case reports noted bleeding complications in patients using ginkgo. In a few of these cases, the patients were also using either aspirin or warfarin. 

Zidovudine is a nucleoside analogue reverse transcriptase inhibitor. Its adverse effects include hematological complications, severe headache, insomnia, confusion, nausea, vomiting, abdominal discomfort, myalgia (myopathy), and nail pigmentation (1). 

High doses of sulfur mustards can cause hyperexcitability, convulsions, and insomnia. Systemic absorption of sulfur mustard may induce bone marrow suppression and an increased risk for fatal complicating infections, hemorrhage, and anemia. 

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