Question

Sleep Case Study:

Sheena, a 42-year-old woman, is referred to the sleep disorders center with a complaint of chronic, severe insomnia affecting her daytime functioning. The single mother of three teenage boys, she first experienced insomnia eight years ago when bankruptcy threatened her small business. Although the business recovered a year later, her insomnia has remained almost unchanged over the next eight years.

Medication History: She has unsuccessfully taken Ativan (lorazepam), Restoril (temazepam), and Ambien (zolpidem tartrate).  Although an initial benefit was derived from each of these medications, she gave up on each of them after a few weeks because of their side effects and/or lack of efficacy.  She is currently trying Melatonin, an over-the-counter sleep aid.

1. What is the action of sedative-hypnotics?  What are the considerations for initial dosing, regular use, and cessation?  
2. Which of the above medications would most likely cause the most daytime sleepiness?

Answer 1

1. Sedative hypnotics acts on the brain centres and induce sleep

Avoid overdose of drugs, continue regular use as per doctor's order

Follow nonpharmacological management

Cessation of taking drug leads to higher experience of symptoms.