Sleep Hygiene
Natural Insomnia Program
1. Encourage patient to keep a consistent pattern of waking, and sleeping at the same time each day.
2. Avoid large meals before bedtime.
3. Discontinue stimulant caffeine, alcohol, or nicotine.
4. Avoid daytime naps
5. Engage in regular exercise, but avoid exercise before sleeping.
6. Allow for a period of relaxation before bedtime (hot bath)
|
Agents Used for Insomnia | ||||||
|
Agent |
Dosage |
Ave Half-life of Metabolites |
Comments | |||
|
Zolpidem (Ambien) |
5-10 mg qhs |
3 hours |
Non-benzodiazepine; no daytime hangover | |||
|
Zaleplon (Sonata) |
5 -10 mg |
1 hour |
Non-benzodiazepine; no daytime hangover | |||
|
Triazolam (Halcion) |
0.125-0.25 mg qhs |
2 hours |
Short acting, some patients can experience perceptual disturbances | |||
|
Estazolam (ProSom) |
1-2 mg qhs |
17 hours |
Short acting | |||
|
Flurazepam (Dalmane) |
15-30 mg qhs |
100 hours, active metabolites long t V |
Hangover is common. Can accumulate in elderly. | |||
|
Temazepam (Restoril) |
7.5-30 mg qhs |
11 hours |
(Doxepin) |
50-100 mg |
long |
Anticholinergic side effects |
|
Antihistamines Diphenhydramine (Benadryl) |
50 mg |
NA |
Limited efficacy for mild initial insomnia. | |||
|
Chloral Hydrate |
500 - 1000 mg |
metabolite: 8-11 hours |
Tolerance after 2 weeks, GI side effects common. | |||
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