Meds
What TCAs are used for insomnia?
Doxepin/Sinequan
Amitriptyline/Elavil
Delayed onset of sleep?
1. take med earlier
2. take on empty stomach
3. raise dose
The PMHNP knows there are 3 primary consequences of circuitry issues regarding hypersomnia (increased sleep) which are?
1. Idiopathic (unknown cause)
2. Narcolepsy
3. Circadian rhythm disorders
What causes the Circadian Rhythm Disorder: Non 24?
Individuals with visual impairment unable to entrain the internal circadian clock regulated by light acting on the suprachiasmatic nucleus
What is special about Doxepin/Sinequan dosages?
3-6 mg highly selective for H1 without anticholinergic properties (can use with elderly)
Doses 10-150 have anticholinergic properties
Waking up on the middle of the night?
1. change to extended release version
2. raise the dose
3. switch to an agent with a longer 1/2 life
The PMHNP knows to look for underlying (2nd hypersomnia) causes such as:
1. OSA
2. Psychiatric Illness
3. Medication side effects
Non 24 Sleep Wake disorder is d/t ?
Free running internal clock
Anticonvulsants off label used for anxiety & insomnia
Gabapentin/Neurontin
Pregabalin/Lyrica(mostly fibromyalgia pain -controlled substance)
Too drowsy in the morning?
1. take earlier in the evening
2. lower the dose
3. switch to an agent with a shorter 1/2 life
The PMHNP knows the following classes of medications can be used for sleep wake disorders:
BZDs (including Z Drugs)
DORAs
Antidepressant (including TCAs-2)
Antipsychotics (low doses-2)
Antihistamines
Anticonvulsants
FDA approved medication for Non: 24 Sleep wake disorder?
MOA?
When can the med be found?
Tasimelteon/Hetlioz
Binds to Melatonin 1 &2 receptors(melatonin receptor agonist
20mg capsules
special pharmacy
What antipsychotics at low doses are used as hypnotics?
Chlorpromazine/Thorazine
Quetiapine/Seroquel