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Colorado Neurological Institute (CNI)
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Sleep Disorders Center
ArticlesThe following articles appeared in our quarterly newsletter, In Touch with CNI, in the Summer 2003 issue. New Sleep Medicines and TreatmentsAmong the numerous disorders that do affect sleep, patients generally have two complaints with regard to these disorders; excessive sleepiness and insomnia. Despite a number of conditions that can cause these two basic symptoms, many of the treatments are targeted at the symptoms of sleepiness and insomnia, and not necessarily at any specific disorder. There are a number of new medications that are improving the lives of people who suffer from disorders that result in excessive sleepiness and/or insomnia. With regard to insomnia, we are now entering the "third generation" of sleep medications, or so called sleeping pills. The first generation of sleeping pills were basically older anesthetic agents that could be given in a pill form. These medications were very good at the time, but were exceedingly sedating and could cause problems if too high a dose was given. The next big breakthrough in sleeping pills was the second generation of medications beginning with flurazepam (Dalmane). These medicines were an important discovery because they did not pose the dangers of the anesthetic medications nor did they have the side effects of the older medications. However, all of these sleeping pills were derivatives and "distant cousins" of Valium. They are still on the market and may be very effective for certain populations. The second generation gave way to the most modern and new third generation of sleeping pills. Presently there are two that fit this category: Ambien and Sonata. These are improvements on the Valium derivatives, because they are effective without having the sedating or addicting qualities of the older sleeping pills. There should be another generation of medications coming to market soon that have many of the same advantages of these non-Valium derivatives. In addition to these new medications for sleepiness, there have also been some scientific advances for people who are too sleepy. The first generation of medicines to treat sleepiness were the stimulants. The stimulants include very good medications that are still commonly used: methylphenidate (Ritalin), dextroamphetamine (Dexedrine, Adderall), and methamphetamine. This first generation of stimulants was very altering. Many of these older stimulants cause nervousness, tremor, and increased blood pressure. A second generation of medications is now available. These new medications promote normal awakening without those side effects. The prototype for these agents came out in the mid-1990's. That drug was modafinil (Provigil). More recently there are other non-stimulant alerting medications available that may prove useful in the treatment of excessive sleepiness. The newest one is Strattera. Another new agent that has been proven to help both nocturnal sleep and insomnia is sodium oxybate (Xyrem). This medicine, also an alerting agent, is presently on the market. It is a sleeping medication in a liquid form. It is used to treat sleepiness associated with narcolepsy, but may prove useful in other disorders that result in insomnia, as well as excessive sleepiness. A new class of chemicals that is responsible for regulating sleep has
been discovered in the brain. These chemicals are called orexins. They
are located in the very center of the brain in the area known as the hypothalamus.
These molecules appear to be important in regulating both sleep and alertness.
Hopefully, with the discovery of these chemicals in the brain, new medications
can be developed that will more directly help promote sleep or help people
wake up when they are suffering from these sleep problems. Basic Sleep HygieneSleep is part of the daily rhythm of life. Your sleep-wake cycle can be improved if you understand how your body responds to normal daily activities. Coffee/colas: Caffeine interrupts sleep and makes it harder to settle down into sleep. You should avoid caffeine. Do not drink any caffeinated beverage after 12:00 noon and only with your doctor's permission. Alcohol: Although it seems that alcoholic beverages will help you relax and sleep, they actually have a disruptive effect. Alcohol may make you feel relaxed at first, but then, even if you drop off to sleep, it will fragment your sleep. You should never use alcohol as a "sleeping pill." Naps: Daytime or evening sleep disrupts the length of nighttime sleep. You want to have long uninterrupted sleep at night. Therefore, take no naps, unless you discuss this with your doctor. Regular bedtime/wakeup time: Your body needs to have a consistent message each night. Decide on a time to go to bed and to awaken. Stick to it, even on weekends. Exercise: Exercise helps a person to cope with the mental and physical stress encountered during life. Exercise can help a person feel more relaxed in the evening, but it is not a good idea to begin exercise near sleep time. Exercise tends to wake people up for several hours rather than making them sleepy. What to do when sleep does not come: Your bed is the place where you should be doing your sleeping. When you lie down in bed at night, you should turn off the light and prepare yourself for sleep. If a half-hour goes by without being able to sleep, then get up and go into another room and listen to some quiet music or read a book and try to go back to bed when you feel sleep may come on. Meditating or doing relaxation could also be helpful. What to do if you wake up in the middle of the night: If you are lying in bed for more than 15 to 20 minutes without being able to go back to sleep, get up and go out into another room of the house, listen to some quiet music or do another quiet activity, then return to bed only when you feel ready to sleep. Sleeping medication: Your doctor may prescribe a sleeping medicine to be used during periods of troubled sleep. What will really improve your sleep, however, is to follow the general guidelines contained herein. Long term use of sleeping medications is discouraged, unless discussed with your doctor. Sleep can be affected by how you feel mentally: Almost everyone has felt the frustration and worry when sleep will not come. Certain relaxation techniques may be helpful, and you may wish to discuss these with your doctor. |
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