Insomnia drug treatment
A. Valium drugs (benzodiazepines).
This type of drug is familiar sleeping pills, but also the fear of addiction drugs, its advantages are good sedative-hypnotic effect, cheap, the disadvantage is that the side effects are large, such as waking up in the morning dizziness, muscle weakness, but also easy to cause a decrease in alertness during the day, can not be engaged in driving such work, long-term use of a large number of drugs easy to produce drug dependence.
Little common sense.
1, where the drug is followed by a certain diazepam or a certain zolam, are Valium-type drugs.
2, drug dependence: including psychological dependence: deep inside the desire to take drugs, even if not, as long as the body has drugs will be very solid. Somatic dependence: Once you don’t take the medication, the original symptoms such as insomnia and irritability will appear again, as well as panic, nausea, sweating and other somatic symptoms.
If drug dependence occurs, generally speaking, patients will be taking larger and larger doses of medication, but the effectiveness of the medication is getting worse and worse, which is a sign of dependence. I often see patients who have been taking a certain kind of Valium for a long time, but the dose is not too high and the effect is very good, so I do not recommend that patients change their medication.
According to the duration of action of the Valium class of drugs can be divided into.
1, short-acting drugs: the drug takes effect quickly, and the effect disappears quickly.
The advantage is that it is effective in solving the difficulty in falling asleep and waking up the next day with few side effects, the disadvantage is that it is easy to produce drug dependence.
(1) Midazolam: commonly used dose 7.5-15mg, 15-30 minutes before bedtime, recommended for short-term temporary use.
(2) triazolam: commonly used dose 2.5-5mg, 15-30 minutes before bedtime, this drug can no longer be bought, discontinued.
2, medium-acting drugs: sedative-hypnotic effect is certain, the next day wake up side effects on the side, the advantages of anti-anxiety effect is good.
(1) Eszopiclone (Scholastin): commonly used dose 1-3mg, 15-30 minutes before bedtime.
(2) Oxazepam: commonly used dose 15mg-30mg, 15-30 minutes before bedtime, can also 7.5-15mg temporary dose of anti-anxiety.
(3) alprazolam: (Jiajing Valium) commonly used dose 0.4-0.8mg, 15-30 minutes before bedtime. Can also 0.4mg temporary dose of anti-anxiety.
(4) Lorazepam: (lorazepam) commonly used dose 1-2mg, 15-30 minutes before bedtime. Can also 0.5-1mg temporary dose of anti-anxiety.
3, long-acting drugs: the advantage is the strongest sedative-hypnotic effect in the Valium class of drugs, the disadvantage is that the side effects are large.
(1) clonazepam (clonidine): commonly used dose 2-4mg, taken 15-30 minutes before bedtime. Dizziness and body weakness are easy to occur during the day. The strongest drug effect and the greatest side effects.
(2) Nitrazepam (nitroprusside): commonly used dose 5mg-15mg, taken 15-30 minutes before bedtime.
(3) Diazepam: (Valium) commonly used dose 5-10mg, 15-30 minutes before bedtime.
The principles of the use of tranquilizers.
1, the principle of intermittent dosing: 2-4 times a week with medication, can not be used without medication, not long-term large amounts.
2, the principle of the minimum effective amount: a small dose works without a large dose
3, the principle of regular change of medication: If the condition requires long-term use of Valium drugs, it is recommended that 3-4 weeks to change another Valium drugs or third-generation sleeping pills, can effectively avoid dependence on the generation. Note that when changing medications, the original medication should be slowly reduced, and the new medication should be slowly added, usually once every 3-5 days, and half the amount of medication should be reduced at a time. After a period of cross-taking the two drugs, withdraw the original drug and add the new drug to the treatment amount. If the patient is taking a short-acting Valium, the reduction process will be extended accordingly.
If the patient is older, the dose of medication is not large, and the efficacy is better, you can also not change the medication, as long as the dose of Valium drugs taken does not increase, within the normal range, and the efficacy does not diminish, it is considered that the patient is in need and not dependent.
Second, the third generation of hypnotic drugs
With hypnotic effect, no sedative, anticonvulsant effect, can improve the sleep structure, but does not affect the normal physiological sleep structure, the first-line drugs for the treatment of insomnia. It has a short half-life, does not produce accumulation, has few after-effects, and has a mild effect on daytime. Generally does not produce rebound insomnia, drug resistance and dependence.
1, zolpidem: commonly used dose of 5-10mg, 15-30 minutes before bedtime.
2, Zopiclone: commonly used dose 7.5mg-15mg, 15-30 minutes before bedtime.
3, Zaleplon: commonly used dose 5-10mg, 15-30 minutes before bedtime.
4, eszopiclone: commonly used dose of 3mg-6mg
Third, other drugs to improve insomnia.
1, antipsychotic drugs: olanzapine 5-10mg, quetiapine 50-200mg, suitable for schizophrenia or depression patients, simple insomnia patients are not recommended to take.
2, antidepressants: mirtazapine 15-30mg, trazodone 50-100mg, and amitriptyline 25-50mg, doxepin 50-75mg, etc., suitable for depression patients, insomnia patients can also take, no dependence, but amitriptyline tablets, doxepin side effects.
3, antihistamines: itself is an anti-allergy drugs, side effects are hypnotic, basically no dependence, commonly used is promethazine 25-75mg.
4, melatonin: is a kind of hormone, is considered a health product, sold very hot brain platinum is this thing in effect, only suitable for mild insomnia.
5, proprietary Chinese medicine: suitable for mild insomnia, there are Wu Ling capsule, Xin Shen Ning, seven leaves of Shen An tablets, Jujube Ren An Shen Liquid, Lu You Tai, Sweet Dreams capsule, An Shen Tonic Heart Pill, septic tablets, cypress heart pill, Zhu Sha An Shen Pill and so on.
Fourth, the choice of drugs for different types of insomnia
1.Difficulty in falling asleep: choose drugs with fast sleep-inducing effects, most of which are drugs with short half-life, such as zaleplon, zopiclone, zolpidem, etc.
2, the presence of obvious anxiety; choose lorazepam, oxazepam, alprazolam and other drugs.
3, easy to wake up at night: choose drugs that can prolong NREM sleep stage 3 and 4 and REM sleep time, such as zopiclone, nitrazepam, clonazepam, etc.
4, early awakening: Mostly seen in depression, while treating the primary disease, you can choose medium and long-acting drugs, such as clonazepam, nitrazepam, diazepam, etc., isoprostanes can also be used.
If the patient’s insomnia is secondary to depression, schizophrenia and other diseases, you can consider antipsychotic drugs, antidepressants to take.
Among the classifications of insomnia, intractable insomnia is a common condition and it is more difficult to treat with than secondary insomnia. Persistent insomnia is often caused by psychological factors, the main clinical manifestations are difficulty in falling asleep and maintaining sleep, daytime fatigue, the more you want to fall asleep as soon as possible at night, the more difficult it is to fall asleep, aggravating the psychological conflict, generating tension and anxiety, emotional instability, excessive worry, self-consciousness pain leads to insomnia, forming a vicious circle.
Insomnia as a symptom is quite common, and scholars in China speculate that the prevalence rate in the population is about 10% to 20%. In fact, insomnia is not an isolated symptom, if it is a persistent, long-term insomnia, 80% of it may be caused by anxiety disorders. Some psychological studies have found that persistent insomnia is mainly caused by the insomniac’s allergic emotional reaction to the phenomenon of falling asleep, sleep quality, sound disturbance during sleep, early awakening, and excessive anxiety and tension before falling asleep. According to clinical data, 97% of persistent insomnia is anxiety insomnia and depressive insomnia. Anxiety is often the first cause of insomnia in men; and depression is often the first cause of insomnia in women. Men’s anxiety mainly comes from career, responsibility and competitive pressure; women’s depression tends to develop during adolescence, maternity and menopause.
Insomnia patients with anxiety and depression tendencies must see insomnia as a symptom of anxiety and depression, systematic anti-anxiety and antidepressant drug treatment, anxiety and depression symptoms a reduction, sleep will naturally improve. Relying solely on sleeping pills to control insomnia not only fails to effectively eliminate insomnia, but also makes the patient’s own not-so-serious anxiety and depression tendency develop into a painful anxiety disorder.
The effective way to eliminate persistent insomnia is not control but treatment; the proper way to treat insomnia is not only to treat the symptoms but also to remove the causes. Today, you receive anti-anxiety and antidepressant medication, you can completely get rid of decades or even a lifetime of insomnia pain and save decades or even a lifetime of sleeping pills. Why wouldn’t we be happy about that?
As for which medication is appropriate for each patient, we have to consider the patient’s condition, previous medication experience and the effect after taking the medication, the patient’s tolerance of the medication, the side effects, and also the patient’s economic situation, and make a decision after comprehensive consideration, and then follow up with the patient to adjust the treatment plan at any time, so that the patient can gradually move towards recovery and let the smile bloom on the face of every family member.