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Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
The CRSWDs include advanced sleep–wake phase disorder (ASWPD), delayed sleep–wake phase disorder (DSWPD), non–24-hour sleep–wake rhythm disorder (N24SWD), irregular sleep–wake rhythm disorder (ISWRD), shift work disorder (SWD), and jet lag disorder (JLD).2
Classification of sleep disorders
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
Delayed sleep–wake phase disorder occurs when there is a significant delay in the phase of the major sleep episode in relation to the desired sleep and wake-up time. When allowed to sleep as desired, sleep duration and quality are age appropriate. Advanced sleep–wake phase disorder occurs when there is a significant advance in the phase of the major sleep episode in relation to the desired sleep and wake-up time. When allowed to sleep as desired, sleep duration and quality are age appropriate. Irregular sleep–wake rhythm disorder is a recurrent or chronic pattern of irregular sleep and wake episodes throughout the 24-hour period, with symptoms of insomnia and daytime sleepiness. Non-24-hour sleep–wake rhythm disorder is due to a progressively delayed sleep– wake pattern. Shift work disorder is insomnia or excessive sleepiness associated with a recurring work schedule that overlaps with the usual time for sleep. Sleep logs and actigraphy monitoring for at least 7 days is recommended for all of the above CRSWDs. Jet lag disorder is insomnia or sleepiness accompanied by transmeridian jet travel across at least two time zones.
Selecting a pharmacotherapy regimen for patients with chronic insomnia
Published in Expert Opinion on Pharmacotherapy, 2020
Amanda B. Hassinger, Nikolas Bletnisky, Rizwan Dudekula, Ali A. El-Solh
Because of the normal, age-related changes in the diurnal rhythm of several hormones that can affect sleep patterns in the elderly age group, total sleep time and sleep efficiency are decreased with a prominent tendency for early morning awakenings and increased napping during the day [69]. The multitude of medical conditions most notably chronic obstructive lung disease, congestive heart failure, neurologic conditions, and/or advanced arthritis exacerbates sleep disruption further worsening the severity of insomnia. Instituting pharmacotherapy in this population should rely on comprehensive risk-benefit analysis including assessment of age-related changes of pharmacokinetics and pharmacodynamics. Judicious use of hypnotics can ameliorate the quality of sleep in this age group but the adverse effects can be life threatening due to increased risk of falls, fractures, and worsening delirium [70]. The use of anticholinergics, antipsychotics, doxepin (>6 mg), and benzodiazepines are not recommended in this patient population [71]. However, low-dose doxepin appears to be a good alternative for elderly insomniacs with sleep-maintenance problem [39]. Eszopiclone at a low dose (1 mg) may assist in alleviating sleep onset and sleep-maintenance insomnia up to 12-weeks of use [72]. Alternatively, low-dose suvorexant (10 mg) may be considered. Trazodone produces transient improvement in sleep quality and sleep continuity in older patients with insomnia, but carries significant risks such as orthostatic hypotension and priapism [73,74]. For sleep-onset problem, melatonin, and synthetic melatonin agonists are the preferred therapeutic agents in older adults with insomnia [75,76]. Evidence suggests that prolonged release melatonin may result in significant improvements in sleep quality, sleep-onset latency, and quality of life for patients aged 55 years and older [38,77]. However, these agents should be used with caution in geriatric patients with dementia who exhibit irregular sleep-wake rhythm disorder due to detrimental effects on daytime mood functioning [78].
Lack of residual morning effects of lemborexant treatment for insomnia: summary of findings across 9 clinical trials
Published in Postgraduate Medicine, 2021
Margaret Moline, Gary Zammit, Jane Yardley, Kate Pinner, Dinesh Kumar, Carlos Perdomo, Jocelyn Y. Cheng
Lemborexant is a dual orexin receptor antagonist that has been approved by the US Food and Drug Administration (FDA) and the Japanese Pharmaceuticals and Medical Devices Agency (PMDA) for the treatment of insomnia in adults [10] and is under investigation for the treatment of irregular sleep-wake rhythm disorder [11].