Insomnia incidence

The occurrence of seizures with bupropion is dose related and may be increased by predisposing factors (e.g., history of head trauma or CNS tumor). At the ceiling dose (450 mg/day), the incidence of seizures is 0.4%. Other side effects include nausea, vomiting, tremor, insomnia, dry mouth, and skin reactions. It is contraindicated in patients with bulimia or anorexia nervosa. 

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

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. 

Insomnia and fatigue in many postmenopausal women may be related to reduced estrogen levels there is a correlation between the incidence of waking episodes and low levels of estrogen. Estrogen replacement therapy may be used to treat severe cases. 

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). 

Zopiclone is relatively well tolerated (137). The most common adverse reaction is taste alteration. A postmarketing analysis of 10,000 cases revealed that zopiclone has a relatively low incidence of side effects (about 8%) (138). Like BZDs, zopiclone has a dose-related hangover effect (139). Rebound insomnia has occurred after short-term use (5 to 14 days) but does not appear to be as severe, even after abrupt withdrawal (140, 141). Abuse, tolerance, and physical and psychological dependence have been reported with zopiclone (142). Zopiclone has been shown to be as effective a hypnotic as triazolam in the elderly ( 143). More comparisons with short to medium half-life BZDs for the treatment of insomnia are needed to show that zopiclone has an advantage over the BZDs. 

Even after relatively short periods of administration, discontinuation of short and intermediate half-life BZDs, such as triazolam and temazepam, may result in marked worsening of sleep, even worse than baseline levels (i.e., rebound insomnia), although this does not seem to occur with zolpidem (95, 102, 103, 109, 110, 113, 285, 297, 316, 325, 326, 327, 328, 329, 330, 331,332, 333, 334, 335, 336 and 337). Gradual dose reduction may attenuate the incidence of rebound, and with flurazepam and quazepam, little sleep disturbance occurs, even after abrupt drug withdrawal ( 99, 100, 101, 102, 103,104, 105 and 106, 280, 338, 339, 340 and 341). 

The averages of random samples of a population are normally distributed. Therefore, the standard deviation of the population of sample means is the standard deviation of the population from which the sample is drawn divided by the square root of sample size. If we standardize the data to have a mean of 0.0 and a standard deviation of 1.0, then the standard deviation of the sample mean is 1.0 divided by the square root of the sample size. To be 95 percent confident that the incidence of insomnia in one group is smaller than the incidence in another group, the incidence in the first must be at least 1.64 standard deviations smaller than the incidence in the second. The sample size required to detect any given difference in means is approximately the square of 1.64 divided by the difference—in this case, (1.64/0.05) or 1,075.84. 

The most common adverse effects of indinavir are indirect hyperbilirubinemia and nephrolithiasis due to crystallization of the drug. Nephrolithiasis can occur within days after initiating therapy, with an estimated incidence of approximately 10%. Consumption of at least 48 ounces of water daily is important to maintain adequate hydration. Thrombocytopenia, elevations of serum aminotransferase levels, nausea, diarrhea, insomnia, dry throat, dry skin, and indirect hyperbilirubinemia have also been reported. Insulin resistance may be more common with indinavir than with the other Pis, occurring in 3-5% of patients. There have also been rare cases of acute hemolytic anemia. 

Adverse Reactions Adverse events with a higher incidence in fiuvastatin-treated patients than placebo patients Arthropathy Exercise-related muscle pain Sinusitis Bronchitis Dyspepsia Diarrhea Abdominal pain Nausea Insomnia Fatigue Abdominal pain Asthenia Constipation Diarrhea Dyspepsia Flatulence Nausea Headache Upper respiratory tract infection Headache Constipation Flatulence Dyspepsia Abdominal pain Arthralgia Myalgia Bronchitis Pruritus Rhabdomyolysis Increases in serum transaminases and CPK... 

As indicated, raloxifene may also reduce the incidence of breast and uterine cancers.20,57 This drug may cause several bothersome side effects, including hot flashes, joint or muscle pain, depression, insomnia, and gastrointestinal disturbances. More serious problems with raloxifene may be indicated by symptoms... 

Although L-dopa can increase dopamine levels in the brain, its effectiveness decreases across time, such that larger and more frequent doses are required for it to be effective. In addition, after only 2-5 years of L-dopa treatment, its duration of effect is reduced. Chronic administration of L-dopa has been reported to produce psychiatric symptoms, such as paranoia, mania, anxiety, depression, hallucinations as well as increased incidence of insomnia and nightmares (92). It is not clear whether these symptoms are associated with chronic L-dopa therapy or disease course, since the two are temporally related (94). Chronic L-dopa therapy may also produce a state where patients response to administration fluctuates, such that they experience an on/off phenomena of L-dopa s effects. Additional symptoms of dyskinesias, e.g., involuntary twisting and writhing, are associated with this on/off phenomenon. Consequently, treatment with L-dopa is typically delayed until other treatments are no longer effective. 

Most patients tend to respond in a positive way to any therapeutic intervention by interested, caring, and enthusiastic medical personnel. The manifestation of this phenomenon in the subject is the placebo response (Latin "I shall please") and may involve objective physiologic and biochemical changes as well as changes in subjective complaints associated with the disease. The placebo response is usually quantitated by administration of an inert material, with exactly the same physical appearance, odor, consistency, etc, as the active dosage form. The magnitude of the response varies considerably from patient to patient. However, the incidence of the placebo response is fairly constant, being observed in 20-40% of patients in almost all studies. Placebo "toxicity" also occurs but usually involves subjective effects stomach upset, insomnia, sedation, etc. 

Foley DJ, Monjan A, Simonsick EM, Wallace RB, Blazer DG (1999) Incidence and remission of insomnia among elderly adults an epidemiologic study of 6,800 persons over three years. Sleep 22 Suppl 2 S366-S372... 

In human studies, there is some evidence that withdrawal signs such as nervousness, anxiety and vertigo occur following sub-chronic administration of zopiclone but the frequency and intensity of the withdrawal effects are greater after conventional 1,4-benzodiazepines. No rebound effects have been seen in patients with insomnia who received zolpidem daily for 7-180 days. By contrast, after 3 weeks of abercamil treatment of patients with generalized anxiety disorder possible signs of withdrawal resulted, the incidence of these withdrawal effects being related to doses of abercamil administered. 

From the published clinical studies, it would appear that the partial agonists bretazenil and abercamil are less likely to cause physiological dependence, have lower reinforcing effects and a lower incidence of subjective effects associated with abuse liability than the conventional 1,4-benzodiazepine sedative-hypnotics. It is presently unclear whether the full agonists for the GABA-A receptor, zolpidem and zopiclone, offer a real advance in the treatment of insomnia although their adverse effect profiles and abuse liability may be lower than that of the conventional benzodiazepines. 

Side effects. Piracetam is well tolerated and there is a low incidence of reported side effects. Those that do occur, at a frequency of less than 10%, include dizziness, insomnia, nausea, gastrointestinal discomfort, weight gain, drowsiness and agitation. Piracetam is indicated only for the treatment of myoclonus, particularly cortical myoclonus. It is used as a second-line drug for patients who are resistant to valproate or the benzodiazepines. 

There seems to be little difference between SSRIs with respect to frequency and severity of adverse effects. The most common adverse effects are gastrointestinal disturbances (nausea, diarrhea/loose stools, constipation incidence 6-37%), nervous system effects (insomnia, somnolence, tremor, dizziness and headache 11-26%), and effects on the autonomic nervous system (dryness of the mouth and sweating 9-30%) (2,10). Weight gain or weight loss have been documented relatively infrequently (2). A high frequency of sexual disturbances has been... 

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