Insomnia
Insomnia is a common problem in the hospital.
Consider patient's MS prior to starting meds.
Underlying medical or psychiatric d/o
mood and anxiety d/o, substance abuse d/o, common medications (beta-blockers, steroids, bronchodilators, etc.), sleep apnea, hyperthyroidism, and nocturnal myoclonus, depression, complex partial seizures.
Makes sure delirium and dementia are not present as well as pain that may be keeping the patient awake.
Otherwise, consider use of the following agents:
Antihistamines such as diphenhydramine, 25 mg PO qhs prn. Be cognizant of the anti-cholinergic side effects, especially in the elderly.
Zolpidem (Ambien), 5 - 10 mg PO qhs prn.
Benzodiazepines such as Restoril, 15 - 30 mg PO qhs, prn
Lorazepam, oxazepam, temazepam, and triazolam undergo glucuronidation to inactive metabolites; therefore, these agents may be particularly useful in the elderly and in those with liver disease.
Benzodiazepine toxicity is enhanced by malnutrition, advance age, hepatic disease, and concomitant use of alcohol, other CNS depressants, INH, and cimetidine.
Benzo withdrawal syndrome consists of agitation, irritability, insomnia, tremor, palpitations, headache, GI distress, and perceptual disturbances, begins 1 to 10 days after a rapid decrease in dosage or abrupt cessation of therapy and may last several weeks.