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.