insomnia(redirected from Insomnious)
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Causes and symptoms
- A medical condition or its treatment, including sleep apnea
- Use of substances such as caffeine, alcohol, and nicotine
- Psychiatric conditions such as mood or anxiety disorders
- Stress, such as sadness caused by the loss of a loved one or a job
- Disturbed sleep cycles caused by a change in work shift
- Sleep-disordered breathing, such as snoring
- Periodic jerky leg movements (nocturnal myoclonus), which happen just as the individual is falling asleep
- Repeated nightmares or panic attacks during sleep.
Symptoms of insomnia
Changes in behavior
The American Academy of Sleep Medicine recommends that health care practitioners should screen all patients for symptoms of insomnia during health examinations. Fatigue, irritability, reduction in memory, and loss of ability to concentrate are among the daytime manifestations of insomnia.
The treatment of insomnia must be individualized, based on the underlying cause. Physical and mental health problems must be addressed, although they cannot always be successfully treated. Specific medications for sleep, such as sedatives, hypnotics, and other agents are frequently used but are often asociated with development of tolerance, or with rebound insomnia when they are discontinued. Nonpharmacologic treatments that have strong research support include the following: stimulus control to retrain the person who is unable to sleep so that he or she re-associates the bed and bedroom with sleep; progressive muscle relaxation; paradoxical intention therapy where the patient stays awake to eliminate performance anxiety related to sleep; biofeedback; and multi-component (cognitive) therapy.
Numerous papers and guidelines to support evidence-based practice in the management of insomnia are available by writing to the American Academy of Sleep Medicine, 6301 Bendel Road NW, Suite 101, Rochester, MN 55901 or looking at their web site at http://www.aasmnet.org/practiceparameters.htm.
cyclosporine ophthalmic emulsion
Restasis, Sandimmun (UK)CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness
Pharmacologic class: Polypeptide antibiotic
Therapeutic class: Immunosuppressant
Pregnancy risk category C
Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm
FDA Box Warning
• Drug should be prescribed only by physicians experienced in managing systemic immunosuppressive therapy for indicated disease. At doses used for solid-organ transplantation, it should be prescribed only by physicians experienced in immunosuppressive therapy and management of organ transplant recipients. Patient should be managed in facility with adequate laboratory and medical resources. Physician responsible for maintenance therapy should have complete information needed for patient follow-up.
• Neoral may increase susceptibility to infection and neoplasia. In kidney, liver, and heart transplant patients, drug may be given with other immunosuppressants.
• Sandimmune should be given with adrenal corticosteroids but not other immunosuppressants. In transplant patients, increased susceptibility to infection and development of lymphoma and other neoplasms may result from increased immunosuppression.
• Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably without physician supervision.
• In patients receiving Sandimmune soft-gelatin capsules and oral solution, monitor at repeated intervals (due to erratic absorption).
Unclear. Thought to act by specific, reversible inhibition of immunocompetent lymphocytes in G0-G1 phase of cell cycle. Preferentially inhibits T lymphocytes; also inhibits lymphokine production. Ophthalmic action is unknown.
Capsules: 25 mg, 100 mg
Injection: 50 mg/ml
Oral solution: 100 mg/ml
Solution (ophthalmic): 0.05% (0.4 ml in 0.9 ml single-use vial)
⊘Indications and dosages
Adults:Neoral only-1.25 mg/kg P.O. b.i.d. for 4 weeks. Based on patient response, may increase by 0.5 mg/kg/day once q 2 weeks, to a maximum dosage of 4 mg/kg/day.
➣ Severe active rheumatoid arthritis
Adults:Neoral only-1.25 mg/kg P.O. b.i.d. May adjust dosage by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks, to a maximum dosage of 4 mg/kg/day. If no response occurs after 16 weeks, discontinue therapy. Gengraf only-2.5 mg/kg P.O. daily given in two divided doses; after 8 weeks, may increase to a maximum dosage of 4 mg/kg/day.
➣ To prevent organ rejection in kidney, liver, or heart transplantation
Adults and children:Sandimmune only-Initially, 15 mg/kg P.O. 4 to 12 hours before transplantation, then daily for 1 to 2 weeks postoperatively. Reduce dosage by 5% weekly to a maintenance level of 5 to 10 mg/kg/day. Or 5 to 6 mg/kg I.V. as a continuous infusion 4 to 12 hours before transplantation.
➣ To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca
Adults: 1 drop in each eye b.i.d. given 12 hours apart
• Aplastic anemia
• Atopic dermatitis
• Hypersensitivity to drug and any ophthalmic components
• Rheumatoid arthritis, psoriasis in patients with abnormal renal function, uncontrolled hypertension, cancer (Gengraf, Neoral)
• Active ocular infections (ophthalmic use)
Use cautiously in:
• hepatic impairment, renal dysfunction, active infection, hypertension
• herpes keratitis (ophthalmic use)
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established for ophthalmic use).
• For I.V. infusion, dilute as ordered with dextrose 5% in water or 0.9% normal saline solution. Administer over 2 to 6 hours.
• Mix Neoral solution with orange juice or apple juice to improve its taste.
• Dilute Sandimmune oral solution with milk, chocolate milk, or orange juice. Be aware that grapefruit and grapefruit juice affect drug metabolism.
• In postoperative patients, switch to P.O. dosage as tolerance allows.
• Be aware that Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably.
• Before administering eyedrops, invert unit-dose vial a few times to obtain a uniform, white, opaque emulsion.
• Know that eyedrops can be used concomitantly with artificial tears, allowing a 15-minute interval between products.
CV: hypertension, chest pain, myocardial infarction
EENT: visual disturbances, hearing loss, tinnitus, rhinitis; (with ophthalmic use) ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, itching, stinging, blurring
GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, gastritis, peptic ulcer, mouth sores, difficulty swallowing, anorexia, upper GI bleeding, pancreatitis
GU: gynecomastia, hematuria, nephrotoxicity, renal dysfunction, glomerular capillary thrombosis Hematologic: anemia, leukopenia, thrombocytopenia
Metabolic: hyperglycemia, hypomagnesemia, hyperuricemia, hyperkalemia, metabolic acidosis
Musculoskeletal: muscle and joint pain
Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm
Skin: acne, hirsutism, brittle fingernails, hair breakage, night sweats
Other: gum hyperplasia, flulike symptoms, edema, fever, weight loss, hiccups, anaphylaxis
The following interactions pertain to oral and I.V. routes only.
Drug-drug.Acyclovir, aminoglycosides, amphotericin B, cimetidine, diclofenac, gentamicin, ketoconazole, melphalan, naproxen, ranitidine, sulindac, sulfamethoxazole, tacrolimus, tobramycin, trimethoprim, vancomycin: increased risk of nephrotoxicity
Allopurinol, amiodarone, bromocriptine, clarithromycin, colchicine, danazol, diltiazem, erythromycin, fluconazole, imipenem and cilastatin, itraconazole, ketoconazole, methylprednisolone, nicardipine, prednisolone, quinupristin/dalfopristin, verapamil: increased cyclosporine blood level
Azathioprine, corticosteroids, cyclophosphamide: increased immunosuppression Carbamazepine, isoniazid, nafcillin, octreotide, orlistat, phenobarbital, phenytoin, rifabutin, rifampin, ticlopidine: decreased cyclosporine blood level
Digoxin: decreased digoxin clearance
Live-virus vaccines: decreased antibody response to vaccine
Lovastatin: decreased lovastatin clearance, increased risk of myopathy and rhabdomyolysis
Potassium-sparing diuretics: increased risk of hyperkalemia
Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, glucose, low-density lipoproteins: increased levels
Hemoglobin, platelets, white blood cells: decreased values
Drug-food.Grapefruit, grapefruit juice: decreased cyclosporine metabolism, increased cyclosporine blood level
High-fat diet: decreased drug absorption (Neoral)
Drug-herbs.Alfalfa sprouts, astragalus, echinacea, licorice: interference with immunosuppressant action St. John's wort: reduced cyclosporine blood level, possibly leading to organ rejection
• Observe patient for first 30 to 60 minutes of infusion. Monitor frequently thereafter.
• Monitor cyclosporine blood level, electrolyte levels, and liver and kidney function test results.
• Assess for signs and symptoms of hyperkalemia in patients receiving concurrent potassium-sparing diuretic.
• Advise patient to dilute Neoral oral solution with orange or apple juice (preferably at room temperature) to improve its flavor.
• Instruct patient to use glass container when taking oral solution. Tell him not to let solution stand before drinking, to stir solution well and then drink all at once, and to rinse glass with same liquid and then drink again to ensure that he takes entire dose.
• Tell patient taking Neoral to avoid high-fat meals, grapefruit, and grapefruit juice.
• Advise patient to dilute Sandimmune oral solution with milk, chocolate milk, or orange juice to improve its flavor.
• Instruct patient to invert vial a few times to obtain a uniform, white, opaque emulsion before using eyedrops and to discard vial immediately after use.
• Inform patient that eyedrops can be used with artificial tears but to allow 15-minute interval between products.
• Caution patient not to wear contact lenses because of decreased tear production; however, if contact lenses are used, advise patient to remove them before administering eyedrops and to reinsert 15 minutes after administration.
• Inform patient that he's at increased risk for infection. Caution him to avoid crowds and exposure to illness.
• Instruct patient not to take potassium supplements, herbal products, or dietary supplements without consulting prescriber.
• Tell patient he'll need to undergo repeated laboratory testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
insomnia/in·som·nia/ (-som´ne-ah) inability to sleep; abnormal wakefulness.insom´niacinsom´nic
insomniaSleep disorders The perceived or actual inability to sleep one's usual amount of time; a condition characterized by any combination of difficulty with falling asleep, staying asleep, intermittent wakefulness, and early-morning awakening; episodes may be transient, short-term–lasting 2 to 3 wks, or chronic Triggers Illness, depression, anxiety, stress, poor sleep environment, caffeine, abuse of alcohol, heavy smoking, physical discomfort, daytime napping, medical conditions, poor sleep habits–eg, early bedtime, excessive time awake in bed Examples Psychophysiologic–learned insomnia, delayed sleep phase syndrome, hypnotic dependent sleep disorder, stimulant dependent sleep disorder. See Circadian rhythm, Conditioned insomnia, Familial fatal insomnia, Jet lag, Pseudoinsomnia, Rebound insomnia, REM sleep, Sleep disorder, Sleep-onset insomnia.
insomniaDifficulty in falling asleep or in remaining asleep for an acceptable period. Insomnia is very common and is often caused by worry, tension, depression, pain or old age. Sleep requirements vary widely from person to person and those who sleep for apparently short periods seldom, if ever, suffer any harmful effects.
Patient discussion about insomnia
Q. Is this a kind of Insomnia...? It's hard to explain my situation. I've always had a horrible sleeping pattern ever since I was really little. In fact, I've never really had a bed time. I always go to bed really early in the mornings, like 7, 8, 9 am. If I want to put myself on a normal sleeping schedule, I stay up all day and I manage to conk out around 10 pm...sometimes even later. But then, the next couple of days, I'm doing the same exact thing again. I was wondering, is this a type of insomnia? And if it is, should I see a doctor about it?
Q. Any other treatment for sleeplessness problem than Melatonin??? 33 years male having acute sleeping problem awake until 08:00-09:00am. Taking Melatonin failed.
The sleepless conditions calling for Belladonna are due to congestion; sleep is extremely restless, as a rule it is interrupted by talking, startings, muscular jerkings and spasmodic motions; frightful images appear on closing the eyes and the patient therefore dreads sleep. Children awake from sleep frightened. The dreams found under Belladonna are frightful ones, and they constantly awaken the patient. It is probably our best remedy for insomnia due to cerebral hyperaemia; that is, it will be most often indicated, also after morphine which produces cerebral hyperaemia of a passive variety. Aconite comes in here, too, but with Aconite there is intense anxiety and restlessness, fear of disaster or death. Cuprum, Stramonium and Zincum have the symptom that the patient is aroused from sleep frightened. For the complete list: http://www.hpathy.com/diseases/insomnia-sleeplessness-treatment-cure.asp Hope this helps.
Q. On stopping the medicines his insomnia like condition starts hi all………………my dad is bipolar II and he was on lithium and clonazepam which had put his mania under control, but he sleeps a lot, as he finds his sleep refreshing him; which is due to medicine. On stopping the medicines his insomnia like condition starts and so now he takes his doses in excess to sleep…..we were told not to stop on these medicines……is it all right?
The insomnia syptoms are signs of mania which will happen when he stops taking his medications. If you stop taking medications that are controlling bipolar symptoms the only logical outcome is the return of the bipolar symptoms. I would have him visit his doctor and discuss changing or increasing his doseages if he is finding they are not working effectivly anymore.