Transient insomnia

CNS Nystagmus ataxia dysarthria slurred speech mental confusion dizziness insomnia transient nervousness motor twitchings diplopia fatigue irritability drowsiness depression numbness tremor headache. 

Sallanon, M., Sakai, K, Denoyer, M., Jouvet, M. (1989) Long lasting insomnia induced by preoptic neuron lesions and its transient reversal by muscimol injections into the posterior hypothalamus. Neuroscience. 32, 669-83. 

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. 

Indeed, a pharmacological approach is the first line treatment in transient insomnia. Meanwhile, a behavioral or non-pharmacological approach is the recommended therapy for chronic insomnia, together with intermittent aid of pharmacological treatment [3]. 

HY-10275 (no structure reported), having such a dual mechanism, has been recently reported to meet the primary and secondary endpoints in the initial phase II trial at doses of 1 and 3 mg in adults with transient insomnia [93]. 

Arrhythmias palpitations tachycardia transient hypertension bradycardia headache lightheadedness dizziness drowsiness tremor insomnia nervousness restlessness giddiness psychological disturbances prolonged psychosis weakness nausea gastric irritation hypersensitivity reactions such as rash, urticaria, leukopenia, agranulocytosis, and thrombocytopenia orofacial dystonia sweating blepharospasm urinary retention may occur in patients with prostatic hypertrophy. 

Insomnia caused by anxiety or transient situational stress 2 to 4 mg at bedtime. 

Mild transient headache, difficulty concentrating, insomnia, light-headedness, vertigo, diarrhea, nausea, vomiting, visual disturbances, tinnitus Rare... 

Sedation, tremor, dry mouth, insomnia, agitation, hyperactivity, erectile dysfunction AE s mostly transient Insomnia, nausea, agitation and tremor... 

Mirtazapine is an antidepressant with a novel mechanism of action affecting both 5-HT and noradrenergic function. A recent systematic, open-label study found that 9 (34.6%) of 26 subjects (5 females, 21 males mean age, 10.1 +/— 4.8 years, age range 3.8-23.5 years) with autistic disorder and other PDDs were much improved or very much improved on the CGI after a mean duration of treatment of 5 months (Posey et al., 2001). The dosage range for mirtazapine was 7.5 to 45 mg/day with a mean daily dose of 30.29 mg +/— 12.64 mg. Target symptoms of aggression, self-injury, irritability, hyperactivity, anxiety, depression, and insomnia showed improvement. Adverse effects were transient and minimal and included increased appetite, irritability, and sedation. Based upon these preliminary data, a double-blind, placebo-controlled trial appears warranted. 

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. 

Patients describe symptoms as flu-like these symptoms include nausea, diarrhea, insomnia, malaise, muscle aches, anxiety, irritability, dizziness, vertigo, and vivid dreams (Coupland et al. 1996). Often, and for unknown reasons, patients who experience this constellation of symptoms have transient electric shock sensations. This unique symptom is diagnostically useful and strongly suggests to the clinician that the patient is in fact experiencing withdrawal because the symptom rarely occurs in other conditions, such as viral infections, or as a side effect of a new medication. 

A partial list of stimulant side effects is outlined in Table 6-2. Common side effects (such as insomnia, nervousness, nausea, decreased appetite, stomachaches, and headaches) tend to be transient and diminish with time or medication discontinuation. Using the lowest effective dose, taking the medications with meals, and avoiding doses late in the day help minimize these side effects as well. 

Some of the adverse effects associated with the use of psychostimulants include anorexia, nausea, weight loss, insomnia, nightmares, dizziness, irritability, dysphoria, agitation, tachycardia, cardiac arrhythmias, increase in tics and dyskinesias (Sadock and Sadock. 2001). Use of psychostimulants in children with ADHD may cause transient retardation of body growth... 

It is indicated in treatment of transient, situational and chronic insomnia, insomnia secondary to psychiatric disorders. 

Transient disturbances may occur as a result of rapid time zone changes (as in transoceanic flights) or staying up late for a few days. Diagnosis of a sleep— wake schedule disorder, however, is made only if complaints meet criteria for an insomnia or a hypersomnia disorder. These disorders often improve when the person is able to resume a normal sleep—wake pattern. 

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. 

Because insomnia is often transient and intermittent, the prolonged administration of estazolam is generally neither necessary nor recommended. Caution should be exercised in prescribing this hypnotic for elderly or debilitated patients, as well as for those with impaired renal or hepatic function, because of increased sensitivity or reduced capacity to metabolize and eliminate the drug. The recommended initial dose is 1 mg, but some may need a 2 mg dose. For the elderly, a 0.5 or 1 mg dose is appropriate. 

Several psychotic reactions to zolpidem have been reported-two cases of amnestic psychotic reaction and a psychotic reaction with hallucinations in an anorectic patient (151). Zolpidem 5 mg was prescribed for a 34-year-old woman with chronic insomnia. Twenty minutes after taking the recommended adult dose (10 mg), she experienced feelings of objects in her environment. She then slept uneventfully and recalled the unusual experience in the morning. Zolpidem may also cause transient cognitive and behavioral problems similar to those of BZDs (152). 

O Donnell VM, Balkin TJ, Andrade JR, et al. Effects of triazolam on performance and sleep in a model of transient insomnia. Hum Perform 1988 1 145-160. 

Rosenberg R et al An assessment of the efficacy and safety of eszopiclone in the treatment of transient insomnia in healthy adults. Sleep Med 2005 6 15. [PMID 15680290]... 

When used for 1-3 days, albendazole is nearly free of significant adverse effects. Mild and transient epigastric distress, diarrhea, headache, nausea, dizziness, lassitude, and insomnia can occur. In long-term use for hydatid disease, albendazole is well tolerated, but it can cause abdominal distress, headaches, fever, fatigue, alopecia, increases in liver enzymes, and pancytopenia. 

Adverse effects are infrequent, mild, and transient. They include nausea, vomiting, diarrhea, abdominal cramps, dizziness, drowsiness, headache, insomnia, rash, fever, and weakness. Pyrantel should be used with caution in patients with liver dysfunction, because low, transient aminotransferase elevations have been noted in a small number of patients. 

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