Rx Note

Introduction Insomnia can be broken down into difficulty in getting to sleep, difficulty staying sleep, early waking or feeling unsatisfied by sleep , despite adequate time and opportunity to sleep. Often a mixture of these can occur. These are associated with complaints of impaired daytime functioning, such as poor concentration and memory, mood disturbances and daytime tiredness. Etiology Insomnia may be caused by any factor that increases activity in arousal systems or decreases activity in sleep systems. NOTE: In older people, the total duration of sleep is shorter and there is less deep (stage 4) sleep. Moreover, older people may nap during the day and this reduces their sleep need at night even further. Referral to Doctor Cases of chronic insomnia (>4 weeks) are best referred to the doctor, as there is usually an underlying cause. NOTE: People with chronic insomnia are at higher risk of medical conditions (e.g. cardiovascular disease, diabetes , psychiatric disorders (e.g. d...

Introduction Benzodiazepines are indicated for Short-term relief (2-4 weeks only) of anxiety or insomnia that is severe, disabling or causing the patient unacceptable distress. Rapid tranquillisation Treatment of some forms of epilepsy and severe muscle spasm Long-Term Use In most developed countries, the use of benzodiazepines is restricted to a maximum of 2-4 weeks. Most guidelines recommend that people on long-term benzodiazepines should be advised to stop because Tolerance to these drugs (which can develop after 2-4 weeks) means that they are not effective for insomnia or anxiety over the long term, and Dependence is likely to develop, meaning that treatment is continued only to prevent withdrawal symptoms. Long-term use of benzodiazepines is associated with several problems, which patients may be unaware and only appreciate after stopping. Withdrawal Symptoms Stopping these medications is often difficult. One study found that 90% of patients experience withdrawal symptoms...