1 Sleep AIDS Presented : Dr. A. Al-Ahdal Clinical Pharmacy Department KAAU

2 Insomnia Incidence 15% sever insomnia 33% occasional problems in sleeping 2% of American receive a hypnotic annually 1% of patients with insomnia use OTC meds.

3 Insomnia Can't sleep – sleep latancy Night time a waking – early time a wakin Poor quality of sleep [↑ age]

4 Sleep physiology - 4 stages Stage 1 Transitional period of sleep (REM) Stage 2 50% of total time of sleep – light – sleep Stage 3+4 Deep sleep

5 Classification of insomnia Transient: Few days as new environment, final exams Wory – travel Short – term: < 3 weeks – time period – severe type of stress (e.g. – death) Chronic: Months – years – disease state, potential medication, psychological problem, substance abuse

6 Etiology: Disease induced: exacerbation of CHF (not sleep), Asthma (orthopnea), depression, Anxitey..... Drug induced: amphetamine – antidepressant [prozac] decongestiant caftine Withdrawal- Rebound insomnia – alcohol, (Benzodiazepine – XanaxR [alprazolam]) Note Benzodiazepine suppress REM – and withdrawal may cause rebound insomnia

7 Effect of insomnia Missed up – quality of life, Tired, law productivity, irritation.

8 Treatment ☺Tolerance may occur because of law efficacy of OTC meds. ☺Maintain good sleep hygiene. 1. Use standard hours of sleep time, including weekends. 2. Avoid caffeine, nicotine, stimulants. 3. Avoid alcohol. 4. Avoid large meals as well as hunger at bed time. 5. Don't exercise near bed time.

9 6. Optimize bedroom for temperature, darkness, silence. 7. Relax mentally before going to bed – Avoid long periods of wakefulness while being in bed. 8. Use the bed room for sleeping only. 9. Avoid napping during the day. 10.Avoid excessive fluid intake in the evening to prevent trips to the bathroom

10 Pharmacologic ☺ Rx hypnotic agents: benzodiazepine + zolpidem. ☺ OTC sleep aid products ☺ ADOL pm R[APAP Diphenhydiamine 25mg] ☺ Panadol night R[APAP 500mg + Diphenhydramie 25mg] ☺ Amydrnmine R 12.5mg ☺ Histop R[chlorpheniramie 4mg] AlleffinR, pheniramR Tab Liquid Alternative

11 Stimulant products – (Caffeine) ☺ Physiologic effects: A. CNS. ↑ alertness- ↓ fatigue, tremulousness, nervousness,.. B. CV- systemic relecne of NEPi, rennin …… C. Broneodilator, diuretic, pepsin seretion …. ☺ Dependence & withdrawal ☺ Product: Caffedrine R keep alert 100 – 200mg tab ☺ Pregnant women

12 Weight loss Aids ☺ Best – behavioral modification as diet, exercise. ☺ Phenylpropanolamine 37.5 – 75mg – short term.

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