Sleep disorders adverse effects

Treatment goals vary between different sleep disorders but generally include restoration of normal sleep patterns, elimination of daytime sequelae, improvement in quality of life, and prevention of complications and adverse effects from therapy. 

To determine the success of treatment, evaluate whether the treatment plan restored normal sleep patterns, reduced daytime sequelae, and improved quality of life without causing adverse effects. Schedule patients for follow-up within 3 weeks for insomnia and within 3 months for other sleep disorders. Perform a detailed clinical history to determine the patient s perception of treatment progress and symptoms along with medication effectiveness and side effects. 

The most commonly used therapies for anxiety and depression are selective serotonin reuptake inhibitors (SSRIs) and the more recently developed serotonin noradrenaline reuptake inhibitors (SNRIs). SSRIs, which constitute 60% of the worldwide antidepressant and antianxiety market, are frequently associated with sexual dysfunction, appetite disturbances and sleep disorders. Because SSRIs and SNRIs increase 5-HT levels in the brain, they can indirectly stimulate all 14 serotonergic receptor subtypes [2,3], some of which are believed to lead to adverse side effects associated with these drugs. Common drugs for short-term relief of GAD are benzodiazepines. These sedating agents are controlled substances with addictive properties and can be lethal when used in combination with alcohol. The use of benzodiazepines is associated with addiction, dependency and cognitive impairment. 

Psychiatric/Physical disorder Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, initiate symptomatic treatment of insomnia only after careful evaluation of the patient. Because some of the important adverse effects of eszopiclone appear to be dose-related, it is important to use the lowest possible effective dose, especially in the elderly. 

Prescription medications such as pain relievers, central nervous system (CNS) depressants (tranquilizers and sedatives), and stimulants are highly beneficial treatments for a variety of health conditions. Pain relievers enable individuals with chronic pain to lead productive lives tranquilizers can reduce anxiety and help patients with sleep disorders and stimulants help people with attention-deficit hyperactivity disorder (ADHD) focus their attention. Most people who take prescription medications use them responsibly. But when abused—that is, taken by someone other than the patient for whom the medication was prescribed or taken in a manner or dosage other than what was prescribed—prescription medications can produce serious adverse health effects, including addiction. 

Melatonin appears to be well tolerated and is often used in preference to over-the-counter "sleep-aid" drugs. Although melatonin is associated with few adverse effects, some next-day drowsiness has been reported as well as tachycardia, depression, vivid dreams, and headache. Sporadic case reports of movement disorders and psychoses have also appeared. 

Adverse effects of ACE inhibitors include hypotension, dizziness, headache, fatigue, GI disturbances, bad taste in the mouth, persistent dry cough, skin rashes, renal impairment, hypokalemia, and blood disorders. ACE inhibitors also can cause chest pain, palpitation, tachycardia, abdominal pain, cholestatic jaundice, alopecia, mood and sleep disturbances, and impotence. 

Adverse effects Diarrhea is the most common side effect of tolcapone. As expected, /evocfopa-related adverse effects increase when tolcapone is added. These include postural hypotension, nausea, sleep disorders, anorexia, dyskinesias, and hallucinations. Most seriously, fulminating hepatic necrosis is associated with tolcapone use. Baseline and frequent, regular determinations of hepatic serum enzymes are suggested by the manufacturer. Any elevations above normal are cause for discontinuation. Because of the hepatotoxicity, tolcapone should only be used as an adjunct in patients on levodopa/carbidopa who are experiencing symptom fluctuations. 

Clonazepam is widely used for the treatment of sleep disturbances related to post-traumatic stress disorder, despite very limited published data supporting its use for this indication. In a randomized, single-blind, placebo-controlled, crossover trial of clonazepam 1 mg at bedtime for 1 week followed by 2 mg at bedtime for 1 week in six patients with combat-related post-traumatic stress disorder there were no statistically significant differences between clonazepam and placebo (4). Adverse effects of clonazepam were generally mild and essentially indiscernible from those attributed to placebo. Only one patient elected to continue taking clonazepam at the end of the trial. The small sample size was a significant limitation of the study. 

Neurological adverse effects of ciclosporin have been reported in up to 39% of all transplant patients. Most are mild. The most frequent is a fine tremor, the mechanism of which is not known. From many case reports or studies in transplant patients, the pattern of ciclosporin neurotoxicity ranges from common and mild to moderate symptoms, such as headaches, tremors, paresthesia, restlessness, mood changes, sleep disturbances, confusion, agitation, and visual hallucinations, to rare but severe or hfe-threatening disorders, including acute psychotic episodes, cerebellar disorders, cortical blindness (permanent in one report), spasticity or paralysis of the limbs, catatonia, speech disorders or mutism, chorea, seizures, leukoencephalopathy, and coma (SED-13,1124) (SEDA-16, 516) (SEDA-17, 520) (SEDA-20, 343) (SEDA-21, 383) (17-19). 

Lumefantrine was inferior to artesunate + mefloquine in an open, randomized comparison in 617 patients in Thailand with uncomplicated multidrug-resistant malaria tropica, but produced two to four times fewer adverse effects, such as nausea, vomiting, dizziness, sleep disorders, or other neurological symptoms (4). 

Skin tolerability in patients with a history of eczema, psoriasis, or other skin disorders has been studied in 1481 participants (33). The adverse effects reported were erythema, rash, pruritus, irritation, edema at the site of application, musculoskeletal pain related to the application site, dreaming, and other sleep disturbances. 

In an open, 48-week, single-arm, multicenter phase II study in 99 patients abacavir 300 mg bd, amprenavir 1200 mg bd, and efavirenz 600 mg/day were associated with rashes in 50 patients, possibly because of abacavir hjrpersensitivity 17 permanently discontinued one or more drugs as a result (5). Other adverse effects included nausea (n = 41), diarrhea (n = 27), sleep disorders (n = 27), dizziness (n = 25), fatigue (n = 23), hypertriglyceridemia (n = 18), neutropenia (n = 8), hyperamylasemia (n = 4), leukopenia (n = 3), hypercholesterolemia (n = 2), raised alkaline phosphatase (n = 1), and raised aspartate transaminase (n = 1). 

In early studies the most frequent adverse effects of tolcapone were dyskinesias, nausea, sleep disorders, dystonia, orthostatic hypotension, diarrhea, dizziness, and hallucinations (1). However, very soon tolcapone was withdrawn in most countries, because of reports of severe hepatotoxicity. The background to these events has been briefly reviewed (2). 

Adverse Effects. Typical antidepressant doses of SSRIs can cause side effects of insomnia, jitteriness, restlessness, and agitation, and lead to drug discontinuation in patients with panic disorder. Transient gastrointestinal disturbances occur more frequently with SSRIs than with TCAs. Thus low initial SSRI doses should be prescribed. Sleep disturbances, headaches, and sexual dysfunction often are problematic. ... 

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