Short-term insomnia

It is important to evaluate insomnia based on its duration. A sleep complaint lasting two or three nights is considered to be transient insomnia. Short-term insomnia usually resolves in less than 3 weeks, and is typically due to illness, jet lag, or stress. According to the Diagnostic and Statistical Manual, insomnia lasting longer than 1 month is considered chronic. 

This medication allows the client to fall asleep and stay asleep, which is why it is prescribed for clients with insomnia. Short-term nse does not result in an addiction to this medication. 

Short-term use of corticosteroids is not associated with most of the adverse effects of chronic steroid use. The most common adverse effects encountered are gastrointestinal upset, insomnia, and mood swings.28... 

Second, if response is inadequate, consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Third, if response is inadequate, consider a two-drug combination ... 

Transient (two to three nights) and short-term (less than 3 weeks) insomnia is common and is usually related to a precipitating factor. Chronic insomnia (greater than 1 month) may be related to medical or psychiatric disorders or medication, or it may be psychophysiologic. 

Transient and short-term insomnia should be treated with good sleep hygiene and careful use of sedative-hypnotics if necessary. 

Patients with short-term or chronic insomnia should be evaluated after 1 week of therapy to assess for drug effectiveness, adverse events, and compliance with nonpharmacologic recommendations. Patients should be instructed to maintain a sleep diary, including a daily recording of awakenings, medications taken, naps, and an index of sleep quality. 

The cause for short-term insomnia is usually clear and requires little diagnostic assessment. As we previously noted, these brief disturbances of sleep seldom come... 

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. 

Buspar containing buspirone is indicated in short-term anxiety. Diazepam, Stilnoct containing zolpidem, Heminevrin containing clomethiazole, and Phenergan containing promethazine are all indicated in insomnia. 

Circadin is the proprietary preparation of melatonin, which is used for the short-term management of insomnia. 

Pentobarbital is basically considered an isomer of amobarbital. They are similar in terms of action, and the difference lies in the fact that pentobarbital is shorter lasting and easier to tolerate. It is used as a relaxant as well as a soporific for short-term insomnia. The most frequently used synonym of this drug is nembutal. 

Hypnotic Short-term treatment of insomnia, because barbiturates appear to lose their effectiveness in sleep induction and maintenance after 2 weeks. If insomnia persists, seek alternative therapy (including nondrug) for chronic insomnia. Preanesthetic Used as preanesthetic sedatives. 

Estazolam (Prosom) [C-IV] [Hypnotic/Benzodiazepine] Uses Short-term management of insomnia Action Benzodiazepine Dose 1-2 mg PO qhs PRN -1- in hqjatic impair/elderly/debilitated Caution [X, -] t Effects w/ CNS d ressants Contra PRG Disp Tabs SE Somnolence, weakness, palpitations, anaphylaxis, angioedema, amnesia Interactions t Effects W7 amoxicillin, clarithromycin T effects OF diaz am, phen5rtoin, warfarin X effects W7 food X effects OF azole antifungals, digoxin EMS Use caution w/ other benzodiazepines, may need a reduced dose concurrent EtOH and caffeine use can t CNS effects OD May cause alt ed reflexes, drowsiness, CNS depression, slurred speech, and Szs flumazenU can be used as an antidote... 

Zolpidem (1) is an effective hypnotic agent indicated for the short-term treatment of insomnia. Zolpidem interacts with the GABAa receptor, and its pharmacological effect is blocked by the benzodiazepine-receptor antagonist fiumazenil (Sanger and Depoortere, 1998). Zolpidem displaces benzodiazepines more selectively from the cerebellum than the hippocampus or spinal cord, consistent with preferential interaction with the ajGABAA receptor subtype (sometimes referred to as the benzodiazepine coi receptor). Studies... 

Benzodiazepines are effective as monotherapy (Rickels et al. 1993) but are rarely used as first-line in this context because of their side-effect profile. They have a useful short-term role for the rapid control of anxiety symptoms or for the control of somatic symptoms such as muscle tension and insomnia, particularly in the early stages of antidepressant therapy. Hydroxyzine has a limited role but can be considered if other treatments are unsuitable (Lader and Scotto 1998). 

Indicated only for short-term treatment of insomnia probably ineffective after 2 wk physical dependency may result when used for extended time (45-90 days depending on dose)... 

Withdrawal insomnia may occur after short-term use do not start using drug again, insomnia will improve in 1-3 nights... 

Some patients may experience jitteriness, restlessness, muscle tension, and disturbed sleep. These side effects typically occur early in treatment, before the antidepressant effect. All patients should be informed of the possibility of these side effects and be reassured that if they develop, they tend to be transient. In patients with preexisting anxiety, therapy should be started at low doses, with subsequent titration as tolerated. If overstimulation occurs with this approach, it will be less likely to be severe enough to result in nonadherence with therapy. The short-term use of a benzodiazepine also may help the patient cope with overstimulation in the early stages of treatment until tolerance to this side effect occurs. Despite these common transient stimulating effects, SSRIs are clearly effective in patients with anxiety or agitated depression. Similarly, insomnia that commonly occurs early in treatment may be tolerable if the patient is reassured that the side effect will be transient. Symptomatic, short-term treatment with a hypnotic at bedtime is reasonable. 

BZDs may offer temporary symptomatic relief for transient and short-term insomnia. They generally are not recommended as a long-term primary treatment for chronic insomnia or in patients with sleep apnea. Several of these agents are currently marketed in the United States or elsewhere for use as hypnotics ( Table 12-5), but other BZDs can also serve the same purpose. 

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