Sleep and Sleep Aid Products (Mari - Sleep and Sleep Aid Products

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Sleep and Sleep Aid Products
M.Z. Wincor

What is Sleep?
A physiologic state of relative unconsciousness, and inaction of the voluntary muscle, the need
for which recurs periodically

Study of Sleep:
Apply electrodes & record muscle recording: 2 eye recordings, central EEG, & Brain recording.

Classical dreaming occurs during REM sleep; if we wake you up at the end of the REM sleep
pattern, you would have 90% chance you would obtain a typical dream report.

Hypnogram: chart out night of sleep

Hynpogram of Normal healthy young adult:
Start out awake, quickly descend Delta sleep; after about 90 min. reach first REM dream;
normal architecture of sleep goes through 90 min. cycles. Each cycle has a REM period. REM
sleep occurs later into the night. REM period gets longer and longer as night progresses, and
they become more intense, physiologically & psychologically.

T/F People need less sleep as they get older. ANSWER: F; Often get less sleep as one ages;
major differences: Very little delta sleep-loose ability to make delta waves after the age of 40;
many periods of wakefulness, some associated with specific sleep pathology; some natural
aging; therefore, disruptive night of sleep. Elderly make up periods of wakefulness by mapping.

Multiple Sleep Latency Test: assumptions, sleepier one is more likely to fall asleep. Individual
every 2 hours placed into dark quiet bedroom, allowing to relax and fall asleep. Idea: sleepier
you are, quicker you’ll fall asleep. If fall asleep, awaken so not to affect next testing session 2 hrs
later. If you don’t fall asleep after 20mins, not very sleepy.
         Results of test:
              Teenagers don’t fall asleep in 20min session, during summer free running.
              Average adult falls asleep within 15mins in a dark quiet room; deprived of sleep.
              Elderly fall asleep faster.
              College students, fall asleep within 10mins. Pharmacy students, somewhere
                 below ;)
              True disorders, fall asleep within a few min.



T/F Getting one hour sleep less then you need will impair next day function. ANSWER: T;
If someone requires 9 hours of sleep, if we deprive of 2 hrs, then sleeps more quickly in dark,
quiet room. If deprive 4 hrs, sleeps more quickly; if deprive half of the sleep, he will fall asleep,
almost out.
2

T/F You can make up for loss sleep by sleeping extra on the weekends. ANSWER: F;
Overall, one can’t. Short term, maybe yes. Chronically, higher risks for any long term chronic
disease state imaginable.

24 hours of continuous wakefulness, give you impairment of 0.10% blood alcohol concentration;
DUR: 0.08%; Maggie’s Law in New Jersey in 2003; college student killed by driver who fell
asleep at wheel after not sleeping for 30hrs; can be charged with vehicular homicide.

How does one get sleepy:
  1. Sleep depravation increases sleepiness.
  2. Biological clock, circadian rhythm; individual variability regarding biological clock.


Journal of Sleep: Diagnostic Classification of Sleep Disorders

ICSD2-international classification of sleep disorders, second edition, published by American
Academy of Sleep Medicine; just know that there are more then 80 sleep disorders described in
detail.

Divided into 7 major categories:
   1. Insomnia
   2. Sleep-related breathing disorders
   3. Hypersomnias of Central Origin
   4. Circadian Rhythm Sleep Disorders
   5. Parasomnias
   6. Sleep Related Movement Disorders
   7. Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues

*More discussed at later lecture.

Insomnia:
     Definition: Relative Lack of Sleep; one may require only 5 hours of sleep at night and
      function fine. Another may require 9 hours of sleep at night and only get 8 hours of sleep
      at night, and feel horrible during the next day—this is a problem.

     Prevalence: Up to 35% of people across the nation, at some point, have complains about
      their sleep; Of those 17% have severe complaints about sleep.

     Impact: Lack of sleep is associated of negative impact on any course of life.

     Dimensions: a)Mild or Severe, b) transient, chronic, intermittent, c) Difficulty falling
      and/or staying asleep (SEE CHART IN HANDOUT)


    Insomnia involves complaint:
          1. Difficulty falling asleep
3

           2. Difficulty staying asleep, multiple awakenings during the night
           3. Early morning awakening, often associated to major depressive disorder
           4. Non-restorive sleep

Any of these, need to have measurable next day consequences. One or more of the above
complaints, with daytime impairment defines insomnia.

People with Insomnia increase in: automobile accidents, falls, memory impairment, healthcare
cost.


Development of Insomnia
SEE HANDOUT OUTLINE Page, 4, C

If one has develops insomnia, by definition, the first few weeks, it is recognized as transient
insomnia; after which, if it progresses, then short term, and lastly chronic.

Assessing the Sleep Complaint: not significant; discussed more in detail later on in different
lectures.

Treatment of Transient or Short-Term Insomnia:
   1. Sleep Hygiene
   2. Techniques of Relaxation
   3. Judicious, short term use of hypnotics; if insomnia is short term, and mild; and, patient
      can tolerate potential side effects of non-Rx hypnotics, then maybe considered.

Good Sleep Hygiene: rules for people having problems sleeping
   1. regularity; biological clock needs to be reset every morning at the same time to know
      what is night time and what is wake up time; wake up time is more important!
   2. exercise, early in the day; exception, well-trained athletes
   3. avoid day time naps; exception: regularly have nap (siestas); usually afternoon dip in
      circadian cycle, if take a regular nap-improve health/function daily
   4. no heavy, spicy food
   5. use bedroom for activities only associated with sleep; exception: intimacy ;); stimulus
      control-associate bedroom with good sleep
   6. Alcohol, mild withdrawal- awakenings
   7. caffeine

Ideal hypnotic:
    1. take for immediate sleep
    2. lasts entire sleep period
    3. no hang-overs
    4. no tolerance over several weeks
    5. discontinue without withdrawal symptom
    6. normalize abnormal sleep pattern
    7. wide range of safety
4

    8. no drug-drug, drug-disease state interactions

Important Hypnotics:
Those that have sleep problems use OTC medications and/or alcohol 40% of the time.

IMPORTANT: KNOW THE ANTIHISTAMINES: Page, 5, IV
   1. use for sedative effects for mild insomnia, in those who can tolerate side effects.
           Problems: develop tolerance, don’t have data to support use

    2. Combination products: “PM” antihistamine, “aspirin free”-acetaminophen
    3. Side Effects: sedative; and serious anticholenergic side effects- GI tract involves
       constipation, dry mouth, blurred vision, urinary retention, particularly problematic
       for older people. 50 % of those using these drugs end up with morning hang-overs.


    Pineal gland in brain produces “hormone of darkness”, also known as melatonin. Melatonin
    secreted when it gets dark; light inhibits the production of melatonin. Tryptophan serotonin
    (important for regulation of sleep and wakefulness) melatonin

    El Tryptophan—used because precursor to serotonin; efficacy different for different people-
    major side effect, GI upset & nausea (similar to morning sickness); pulled of the product due
    to complications.

    2 Process Model of Sleep & Wakefulness
    Homeostatic drive- first processes
    Circadian process- 2nd processes

        Homeostatic: Begin at 9a.m. in the morning (with a goodnite sleep-very lil’ sleep
         drive); as day progresses, your drive for sleep increases. In bed, as you satisfy your
         sleep, homeostatic drive reduces.
        Circadian- suprachiasmatic nucleus: master biological clock in the brain in
         hypothalamus; generate alerting signal-gets stronger and stronger as the day goes on;
         counteracts drive for sleep. At night, circadian rhythm at peak; therefore, won’t let
         you sleep. Production and secretion of melatonin from pineal gland
         counteracts/suppresses circadian rhythm. Melatonin gets to melatonin 1 and 2
         receptors in superchiasmatic nucleus and as melatonin binds to receptors, it
         suppresses the alerting signal.

Melatonin may work for shift changes, such as jet lag.

Herbals:

        Valerian & Kava Kava: work within apavergic (?) systems; gama-aminodetergic acid;
         benzodiazapines work at same system too. Risk factors exist.
        Kava-risk of hepatotoxicity

				
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