Sleep deprivation recommendations

The usual starting dose for the treatment of ADHD in children over 5 years of age is 37.5 mg/ day, increased gradually by 18.75 mg/week until the desired response is reached. The usual therapeutic dose range is from 56.25 to 75 mg/day, with a maximum dose of 112 mg/day (57). Since pemoline is not approved for the treatment of narcolepsy, dosage recommendations for this indication are not readily available however, in the subsequent section, dosage information can be extrapolated from a small number of sleep deprivation studies. 

A recent report by the Committee on Military Nutrition Research (81) recommended using caffeine doses of 100-600 mg to sustain the cognitive performance and physical endurance of military personnel, especially during periods of sleep deprivation. The Committee noted the fact that caffeine s effects appear particularly consistent in fatigued individuals. 

The recommended dose of modafinil is 200 mg/day for the treatment of excessive daytime sleepiness associated with narcolepsy however, doses of 400 mg/day are FDA-approved. While there is evidence that the higher dose is well tolerated, it has not been established that it confers additional therapeutic benefit (196). In sleep-deprived subjects, doses of 600 mg/day have been administered, but the preponderance of evidence suggests that 300M00 mg/day is probably sufficient and less likely to produce unwanted side effects. 

Whatever the reason for insufficient sleep, the sleepiness and neurobehav-ioral consequences seem inevitable. Prevention of sleep deprivation through lifestyle management, and perhaps with hypnotics, would be first- and second-line recommendations for most situations. However, there are instances in which sleepiness cannot be managed with those approaches. Wake-promoting agents would seem very appropriate for use in some of these situations. It should be noted that the use of medications to modulate the effects of lifestyle is not unique to sleep medicine. The use of artificial sweeteners or lipid-lowering agents, often to correct the effect of inappropriate nutritional choices, has become an acceptable part of daily food selection as well as medical practice. 

Melatonin has been used to regulate the sleep-wake cycle and is used often to treat insomnia. It is not recommended during pregnancy and breast-feeding becanse of a lack of information abont its safety. Lower doses of melatonin (e.g., 0.1-1 mg at bedtime) are effective in initiating sleep higher doses may not improve the hypnotic effect. The rednction in daytime snnUght, which increases melatonin secretion, may exacerbate PMS in the winter this type of seasonal mood disorder may respond to phototherapy. Early sleep deprivation also may help to correct circadian rhythm disturbances in PMDD. ... 

Natural sleep is the safest. Sleep deprivation during the hours preceding CT (or MR) is often successful. However, except in rare instances in children under 6 months old, natural sleep is rarely obtained in a busy noisy CT room. Immobilization is strongly recommended even in sedated children (the venous access needs to be maintained visible). Immobilization avoids undesirable movement by the patient and keeps him or her warm. Sedation is rarely useful to examine the urinary tract by MDCT. Any sedation protocol should be discussed and written with anesthesiologists. In our institution, we occasionally use rectal midazolam (Hypnovel , 0.3mg/kg body weight), but heart rate and pulse oxymetry have to be monitored during the procedure and later. Hydroxyzine (Atarax ) decreases anxiety and is fairly sedative. 

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