Difference between revisions of "Sleep"

Revision as of 16:47, 19 June 2012

Sleep Disorders

Sleep disorders nosology is rather complex, but it is important to be aware of major categories.

• Insomnia
  • primary insomnia
  • insomnia due to mental condition, medical condition or substances
  • behavioral insomnia of childhood
• Sleep-related Breathing Disorders
  • central sleep apnea
  • obstructive sleep apnea
  • sleep-related hypoventilation/hypoxemic syndrome
• Hypersomnia of Central Origin
  • narcolepsy
  • Kleine–Levin syndrome
  • menstrual-related hypersomnia
• Circadian Rhythm Sleep Disorders
  • jet lag, shift work disorders
• Parasomnias
  • Disorders of arousal from NREM: sleepwalking, sleep terrors
  • REM: REM sleep behavior disorder, recurrent isolated sleep paralysis, nightmares
  • other: enuresis, sleep-related eating disorder
• Sleep-related Movement Disoders
  • restless leg syndrome
  • bruxism
  • periodic limb movement disorder

Sleep and Depression

Depression causes a number of sleep disturbances: increased sleep latency, increased nocturnal and early-morning awakenings, shortened latency to REM sleep, increased REM density, decreased slow-wave sleep in first NREM cycle.
REM sleep deprivation alleviates depression; also most antidepressants suppress REM sleep (exceptions: bupropion, nefazodone (Serzone)) (K&S, p.2154)

Activating antidepressants

These are believed to have activating effect and offer require co-prescribed sleeping aid [2]:

• imipramine, desipramine (TCAs),
• fluoxetine,
• paroxetine,
• venlafaxine,
• reboxetine (not effective for MDD in adults according to meta-analysis) [3]
• bupropion

Sedating antidepresants

These are believed to promote sleep through resynchronization of the circadian rhythm (not through sedating action)

• doxepin, trimipramine (TCAs),
• mirtazapine,
• trazodone,
• agomelatine (Valdoxan, Melitor) (great for improving sleep AND severe depression!) [4]

[2] Wichniak A., Sleep and Antidepressant Treatment. Curr Pharm Des. 2012
[3] Cipriani A., Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis, Lancet, 2009
[4] Montgomery, SA., Severe depression and antidepressants: focus on a pooled analysis of placebo-controlled studies on agomelatine.". Int Clin Psychopharmacol. 22 (5): 283–91.

Sleep High-Yield Pearls

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