Chapter 11: Sleep Disorders & ADHD Treatment

Chapter 11: Treatment of Sleep Disorders and Attention-Deficit Hyperactivity Disorder

• Sleep Disorders and Medications Used to Treat Them:
  • Learn terminology associated with sleep disorders and ADHD
  • Discuss why sleep is necessary
  • Describe the phases of a normal sleep cycle
  • Describe symptoms associated with sleep deprivation
  • Describe different types of sleep disorders
  • Describe the function of neurotransmitters related to sleep
  • Classify medications used to treat sleep disorders
  • Describe the mechanism of action for each class of drugs used to treat sleep disorders
  • Identify warning labels and precautionary messages associated with medications used to treat sleep disorders

Key Terms

• Hypnotic
• Insomnia
• Melatonin
• Non-REM sleep
• Rapid eye movement (REM) sleep
• Rebound hypersomnia
• Sedative
• Stimulant

Overview

• Sleep is vital for a healthy body and encompasses a variety of functions including immune system health, nervous system health, emotional and social functioning, physical and mental agility, and memory improvement

The Sleep Cycle

• The sleep cycle is influenced by circadian rhythms, which are biological changes influenced by daylight
• The pineal gland plays a critical role in releasing melatonin, which promotes drowsiness and regulates body temperature and hormone secretion

Five Stages of Sleep

• Stage 1: Easily awakened, limb movements may occur
• Stage 2: Eye movements stop, brain activity decreases
• Stage 3 & 4: Deep sleep, difficult to awaken, disorientation upon waking
• REM (Rapid Eye Movement): Dreaming occurs

Sufficient Sleep Varies

• Sleep needs vary between 5 and 16 hours per day depending on age
  • Infants may need up to 16 hours
  • Teenagers often need 9 hours
  • Adults need 5-8 hours
  • Seniors may sleep less than young adults

Sleep Deprivation

• Signs include daytime drowsiness, falling asleep quickly, and factors like sleep apnea, restless leg syndrome, caffeine consumption, prescriptions, and chronic illnesses

Sleep Disorders

• Common disorders include insomnia, restless legs syndrome, Ropinirole, , Pramipexole, sleep apnea, and narcolepsy

Insomnia

• Categorized by duration: transient (less than 7 days), short-term (up to 3 weeks), and long-term (more than 3 weeks)

Treatment of Sleep Disorders

• Prescription drugs, such as benzodiazepines and other sedative-hypnotics, are used to treat insomnia.

Benzodiazepines Used in The Treatment of Insomnia

• Common names end in "-epam" or "-olam"
• Reduce neuronal excitability by opening calcium channels
• More desirable safety profile than barbiturates

Miscellaneous Drugs Used for Insomnia

• Zaleplon, zolpidem, eszopiclone, zopiclone, diphenhydramine, and doxylamine are other common medications to treat insomnia

MOA of Imidazopyridines and Cyclopyrrolone Derivatives

• Act on benzodiazepine receptors subtype v-1
• Modulate GABA receptors, chloride channel, to reduce neuronal excitability

Imidazopyridines and Cyclopyrrolone Derivatives Adverse Effects

• Side effects include sedation, dizziness, tolerance/dependence, photosensitivity, and bitter/metallic taste

Herbal Treatments for Insomnia

• Herbal treatments such as melatonin and valerian root are used
• Melatonin: hormone produced by the pineal gland, sensitive to light changes
• Valerian root: dates back over 2000 years

Non-pharmacological Treatment of Insomnia

• Avoid stimulants close to bedtime (eg., caffeine, colas, tea, highly caffeinated beverages)
• Establish a regular sleep schedule
• Avoid daytime naps
• Create a comfortable sleep environment free of noise and light
• Reduce use of electronics before bed

Non-pharmacological Treatment of Insomnia (cont'd)

• Don't go to bed hungry
• Exercise 20-30 minutes daily (5-6 hours before sleep)
• If you can't fall asleep, get up and do something relaxing for 10-15 minutes before trying again.

Benzodiazepines: Warning Labels

• May cause drowsiness, impair driving ability
• Avoid alcohol consumption
• Can be habit-forming

Pharmacotherapy for Narcolepsy

• Stimulants are used to treat narcolepsy
• Modafinil: a non-amphetamine stimulant believed to stimulate alpha1-adrenergic receptor sites
• Modafinil can treat sleep apnea as well
• Amphetamine and methylphenidate are also used

MOA of Drugs Used to Treat Narcolepsy

• Modafinil and armodafinil stimulate alpha1-adrenergic receptor sites
• Amphetamine and methylphenidate are sympathomimetics

Modafinil: Adverse Effects

• Stimulation, insomnia, tolerance, and dependence

Modafinil: Warning Labels

• Avoid alcohol
• May decrease effect of oral contraceptives
• May be habit-forming

Attention-Deficit Hyperactivity Disorder and Medications Used to Treat It

• Describe etiology (cause) of ADHD
• Classify ADHD medications
• Discuss mechanism of action for each class of ADHD medications
• Identify warning labels and precautions
• Identify significant look-alike or sound-alike drug issues

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Most common childhood behavioral disorder
• Symptoms include hyperactivity, restlessness, impulsiveness, inattention, distractibility, forgetfulness, and inability to complete tasks
• Three subtypes of ADHD: hyperactive-impulsive, predominantly inattentive, and combined type

Environmental and Nutritional Risk Factors for ADHD

• Genetic component (up to 25% of children with ADHD have a relative affected by it too)
• Cigarette smoke and alcohol consumption during pregnancy
• High lead levels (from lead-based paint or gasoline)
• Food additives and sugar consumption might exacerbate ADHD symptoms

Look-Alike/Sound-Alike Drugs

• Adderall® and Inderal®
• Ritalin®, Ritalin® SR

Treatment of ADHD

• No cure, only treatment of symptoms with pharmacotherapy and behavioral therapy is possible
• Drug treatment can involve amphetamines and non-amphetamines.
• Amphetamines affect individuals with ADHD differently than people without ADHD. They decrease hyperactivity and improve focus

Drugs Used in the Treatment of ADHD

• Adderall (mixed salts of amphetamine)
• Dexedrine (dextroamphetamine)
• Focalin (dexmethylphenidate)
• Biphentin/Concerta/Ritalin (methylphenidate)
• Vyvanse (lisdexamfetamine)
• Atomoxetine (Strattera): non-amphetamines stimulant and inhibits the reuptake of norepinephrine

MOA of Amphetamines

• Stimulates the release of norepinephrine and dopamine
• Increases stimulation of adrenergic receptors (resulting in increased alertness and responsiveness, and wakefulness)
• Decreases feelings of tiredness or fatigue

Adverse Effects of Amphetamines

• Decreased appetite, nausea, stomach ache, anxiety, irritability, insomnia, increased heart rate, palpitations, arrhythmia, dizziness, tremor, and amphetamine syndrome (a drug-induced psychosis).

Warning Labels for Amphetamines

• Take with food
• Can be habit-forming
• Swallow whole; crushed/chewed formulations may be dangerous