Clinical Pharmacology of Sleep (eBook)

Contents 4
List of contributors 6
Foreword 9
Preface 11
Credits and acknowledgements 12
Dedication 13
Primary and secondary insomnia 15
Introduction 15
Primary insomnia 15
Secondary insomnia 19
References 21
Primary insomnia: diagnosis and treatment 24
Introduction 24
Diagnosis of insomnia 25
Treatment of insomnia 27
References 29
Neuropharmacology of obstructive sleep apnea and central apnea 33
Introduction 33
Obstructive sleep apnea 33
Pro-in.ammatory cytokines and anti-cytokine therapy 39
Other drug therapies 40
Pharmacological treatments of OSA risk factors and morbidities 41
Central sleep apnea 44
Summary and future directions 45
References 45
Narcolepsy syndrome: a new view at the beginning of the second millennium 54
Introduction and history 54
Prevalence, genetics, and environmental factors 54
Clinical features 56
The secondary narcolepsy-cataplexy 59
Pharmacological studies 60
Shortcomings of current therapy 63
Conclusion 64
References 64
Sleep disturbances in restless legs syndrome (RLS) and periodic limb movements ( PLM) 71
De.nition and historical notes 71
Epidemiology and clinical features 72
Pathogenic hypotheses 77
Sleep disturbances and periodic leg movements in RLS 78
Non-pharmacological and pharmacological treatment of RLS and PLM 81
References 84
Sleep disturbances in anxiety disorders 90
Sleep disturbances in anxiety disorders 90
Sleep and sleep disturbances in anxiety disorders 91
Treatment of sleep disturbance in anxiety disorders 95
References 100
Sleep disturbances in affective disorders 110
Introduction 110
Sleep EEG .ndings in affective disorders 111
Depression and sleep-wake regulation mechanisms 114
Antidepressive therapies and sleep 121
Conclusion 124
References 124
Sleep disturbance in schizophrenia 134
Introduction 134
Subjective reports and questionnaire studies 135
Laboratory studies of sleep 136
Conclusions 139
References 139
Clinical pharmacology of sleep disturbances in children and adolescents 141
Introduction 141
Epidemiology of pediatric sleep disorders and medication use 141
Screening for sleep problems and evaluation of sleep complaints 142
General medication guidelines 143
Pediatric insomnia 143
Guidelines for treating pediatric insomnia 144
Medication use in pediatric insomnia 144
Special considerations for pharmacological treatment of pediatric insomnia in children with children with special needs 144
Pharmacological agents for pediatric insomnia 145
Pharmacological treatment for other pediatric sleep disorders 152
Management of parasomnias 152
Narcolepsy 153
Management of narcolepsy 153
RLS/PLMD 154
Management of RLS and PLMD 155
Conclusions 156
References 157
Assessment and treatment of sleep disturbances in aged population 161
Sleep 161
Sleep stages 161
Sleep in the elderly population 162
Circadian rhythm disturbances 164
Sleep disordered breathing 165
Insomnia 168
Restless legs syndrome and periodic limb movement disorder 175
References 177
Sleep disturbances in Alzheimer’s disease 181
Introduction 181
The biological bases of sleep disturbances in AD 182
Diagnosis of sleep disturbance in AD 183
Interactions between biological changes and environmental situations 183
Other causes of sleep disturbance in AD 184
Symptomatic treatment of insomnia in AD patients 186
The need for controlled clinical trials for improving sleep quality in AD 187
Nonpharmacological approaches to treating sleep disturbance in AD patients 188
Conclusions and a view to the future 188
References 189
Sleep disturbance during menopause 191
Introduction 191
Characteristics of climacterium 192
The effect of female sex hormone on the brain 193
Sleep and climacteric symptoms 193
The effect of hormone therapy on sleep quality 194
Sleep-disordered breathing during menopause 196
Other sleep-disorders during menopause 199
Treatment of sleep disturbances during menopause 199
Conclusion 200
References 200
Chronopharmacology and its implications to the pharmacology of sleep 205
The biological clock 205
Circadian rhythm disorders 206
The basis of chronopharmacology 207
Applied chronopharmacology 207
Chronobiotics 210
References 211
Overview of currently available benzodiazepine and nonbenzodiazepine hypnotics 215
Introduction 215
Insomnia: diagnostic criteria 216
The GABAA receptor and the mechanism of action of benzodiazepine and nonbenzodiazepine hypnotics 219
Pharmacokinetics of benzodiazepine and nonbenzodiazepine hypnotics 219
Metabolic clearance of benzodiazepine and nonbenzodiazepine hypnotics in populations at risk 221
The effect of benzodiazepine and nonbenzodiazepine hypnotics on sleep variables in patients with insomnia 222
Adverse effects of benzodiazepine and nonbenzodiazepine hypnotics 225
Long-term nightly 226
non-nightly administration of 226
hypnotic drugs in the treatment of chronic insomnia 226
References 227
Rebound and withdrawal with benzodiazepine and non- benzodiazepine hypnotic medication 232
Introduction 232
Definition of terms 232
Methodology 233
Benzodiazepines 234
Zopiclone 235
Zolpidem 236
Zaleplon 237
Clinical implications 238
Conclusion 238
References 239
Index 242