Sleep difficulty

Caffeine is considered by pharmacologists to be a mild stimulant of the central nervous system. It has been shown to promote feelings of well being and increased abiUty to perform certain mental tasks efficiently. There are people who are oversensitive to the effects of caffeine overindulgence by these individuals, eg, intake of more than 600 mg caffeine/d, can bring unwanted effects such as anxiety, restlessness, sleeping difficulties, headache, or palpitations of the heart (54). 

However, these side effects can be experienced with reboxetine or atomoxetine. Although they are seldom severe, one may need to take steps to remedy the side effects. The first step is to use the smallest effective dose. When this fails, using a second medication such as a benzodiazepine to counteract sleep difficulties or anxiety can be tried. However, without compelling reasons to stay with one of these medications, the best remedy is often to change to a different antidepressant. 

U.S. Food and Drug Administration for the treatment of insomnia, almost all benzodiazepines may be used for this purpose. Benzodiazepines are most clearly valuable as hypnotics in the hospital setting, where high levels of sensory stimulation, pain, and acute stress may interfere with sleep. The safe, effective, and time-limited use of benzodiazepine hypnotics may, in fact, prevent chronic sleep difficulties (NIMH/NIH Consensus Development Conference Statement 1985). Benzodiazepines are also used to treat akathisia and catatonia and as adjuncts in the treatment of acute mania. 

Momss RK, Wearden AJ, Battersby L. The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome. J Psychosom Res 1997 42 597-605. 

Sleep disorders such as sleep apnea, narcolepsy, delayed sleep-phase syndrome (DSPS), and insomnia can cause problem sleepiness and difficulty functioning during the day for adolescents (103). Over the course of several studies, Roberts and colleagues have shown that insomnia and related sleep problems have adverse consequences for the future functioning of adolescents (107,108). In particular, insomnia symptoms such as nonrestorative sleep, difficulty initiating sleep, and daytime sleepiness predicted self-esteem difficulties, interpersonal relationship problems, and symptoms of depression, along with somatic complaints (108). 

Subsequently, several authors have tested SRT, either alone or as one component in multifactorial interventions. The majority of the studies evaluating SRT alone have focused on elderly populations. As sleep becomes fragmented, daytime alertness is reduced, and insomnia vulnerability increases with aging. Older adults often spend more time in bed to cope with these changes. Although this response is adaptive in the short term, it may also perpetuate/exacerbate sleep difficulties. The use of SRT is, therefore, very relevant for this segment of the pop-... 

Common, non-prescription substances such as caffeine, nicotine, and alcohol often cause sleeping difficulties [41]. In addition, a number of prescribed medications and illegal substances can cause insomnia, depending on factors such as amount used, time of usage, and individual response. Types of drugs that can cause insomnia include energizing antidepressants, anti-hypertensives, bronchodilators, diuretics, beta-blockers, and corticosteroids. 

As mentioned previously, the causal connection between sleep difficulties and anxiety disorders are often impossible to determine in the clinical domain. The evaluation and treatment of sleep-specific pathologies may be as important as the evaluation and treatment of the anxiety disorders in these cases. Since hyperarousal is a common factor associated with both anxiety and sleep disturbances, the treatments for sleep problems are often similar to those targeting the reduction of worry, tension, and other manifestations of anxiety [73,74], However, treatments have also been developed to target specific aspects of certain anxiety disorders or sleep pathologies. 

Types of anxiety disorders Difficulty in initiation of sleep Difficulty in maintenance of sleep Early morning awakening Nightmares ... 

Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM (2003) Sleep difficulty in women at midlife. Menopause 10 19-28... 

Secondly, the sedative and calming effects of ECT may produce improvement especially in people with agitated depressions. As discussed in more detail later, depression-rating scales contain many items that would respond to sedative effects of drugs or ECT such as sleep difficulties, agitation and various manifestations of anxiety. Some older accounts suggest that it was indeed people with agitated depression who responded best to ECT (Paterson 1963 p. 87). 

Depression rating scales contain items that are not specific to depression, including sleeping difficulties, anxiety, agitation and somatic complaints. These symptoms are likely to respond to the non-specific sedative effects that occur with most tricyclics and many other antidepressants. Hence changes in rating scale scores may merely reflect drug-induced effects. 

Transient situational insomnia—sleep difficulty that is acute in onset and directly related to a stressor. 

Hypertension is most typically silent in adults, with no symptoms, but that s not always true for children. More than half of children with untreated elevations in blood pressure experience frequent headaches, sleeping difficulties, daytime tiredness, and chest or other pains. 

In an open study of tizanidine for neuropathic pain, several adverse effects were noted, such as dizziness, drowsiness, fatigue/weakness, dry mouth, gastrointestinal upset, and sleep difficulty (10). 

Lorazepam (la) in 2 or 4 mg doses showed hypnotic activity in insomniacs and good sedation in surgical premedication.41 Flurazepam (2h) is useful in the long term treatment of insomnia42 and shows no rebound effect after withdrawal.43 Flunitrazepam (2 ) has hypnotic activity in man at 2.5 mg, but does not induce physiological sleep.44 Fosazepam (2j) at 60-80 mg decreased sleep onset and awakening in healthy subjects.45 Quazepam (Sch 16134 2k) has been entered in the USAN listing as a sedative, hypnotic.46 Clobazam (9a) at 10—20 mg, but not triflubazam (9b) was useful for limited sleep difficulties in healthy males.47... 

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