Sleep Disorders - United States Navy：睡眠障碍-美国海军.ppt

* * * * * * * * * * * * * * * * * Sleep Hygiene Attempt to maintain regularity in the sleep–wake cycle timing. Exercise regularly, but not within a few hours of bedtime. Develop a relaxing evening routine. Reserve the bedroom and bed for sleep and sexual activities. Avoid caffeine after lunchtime. Avoid alcohol, especially within a few hours of bedtime. Avoid late heavy meals, but consider a small bedtime snack. Avoid bedroom temperature extremes. Avoid disruptive noises and consider a white noise machine. Avoid excessive wakeful time in bed. Medications used to aid sleep Benzodiazepines Benzodiazepine analogs (Non benzodiazepine GABA A receptor agonists) Antihistamines Antidepressants Herbals Antipsychotics Mood stabilizers Blood pressure medications Class Agent Dose (mg) Half life (h) Receptor Year approved Side effects Comments Benzodiazepine ? Flurazepam 15–30 50–100 GABA-BZD 1970 Dizziness, drowsiness, ataxia, amnesia, falls, gastrointestinal upset FDA approved for insomnia; abuse potential; rebound insomnia; tolerance and dependence; hangover effect; increased fall risk; cytochrome P450 metabolism ? Estazolam 0.5–2 10–24 GABA-BZD 1980 ? Temazepam 7.5–30 8–25 GABA-BZD 1981 ? Triazolam 0.125–0.25 1.5–5.5 GABA-BZD 1982 ? Quazepam 7.5–15 39–73 GABA-BZD 1985 Sedative-Hypnotics ? Zolpidem 5–20 2.5–2.8 GABA-A: alpha-1 1993 Dizziness, drowsiness, amnesia, headache, gastrointestinal upset For sleep-onset insomnia; risk of dependence rebound; abuse potential ? Zaleplon 5–10 1.0 GABA-A: omega 1 1997 Headache, dizziness, myalgia, amnesia For sleep-onset insomnia; no tolerance or hangover ? Eszopiclone 1–3 5–7 GABA-A 2004 Dry mouth, unpleasant taste, dizziness, amnesia, gastrointestinal upset Studied in elderly; favorable side-effect profile;FDA approved for long-term use Melatonin receptor agonist Ramelteon 8 1.5 MT1, MT2 2005 Fatigue, dizziness, headache, nausea Studied in elderly; favorable side-effect profile Antidepressants ? Trazodone 50–150 Ear