Sleep

Clinical Update

Tools to Help Kids and Teens to Sleep Better

Topics: Assessment | CBTi | circadian system | Cognitive Behavioral Therapy for Insomnia | Sleep | treatment

  Sasha is a 13-year-old whose grades are slipping. She reports trouble concentrating in school, and her parents are worried she might have ADHD. On taking a history, you learn that Sasha stays up late and gets up early, obtaining about six hours of sleep per night. Adolescents have been reporting less sleep over the past 20 years in what’s

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Research Update

Melatonin for Sleep-Onset Insomnia

Topics: Dosage Timing | Melatonin | Sleep | Sleep Onset Insomnia

REVIEW OF: Wei S et al, Sleep Medicine 2020;68:1–8 Sleep-onset insomnia, characterized by difficulty falling asleep and daytime fatigue, is a common problem among youth. While sleep hygiene is the first step, families often have trouble implementing such measures, which include regular wake-up times, daily exercise, shutting down screens in the eve

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Research Update

Adolescents and Sleep: Parents Can Make a Difference

Topics: adolescents | Sleep | teens

Review of: Peltz JS et al, Sleep 2019;zsz287 We know that sleep deprivation is an important contributor to mental health problems in teenagers. Studies show that adolescents need around 9.25 hours of sleep for optimal functioning, but most do not get adequate sleep for several reasons. Teens have a developmental drive to stay up later and sleep in lo

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Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

Topics: Anxiety | Clinical practice | Deprescribing | Free Articles | Pharmacology | polypharmacy | prescribing patterns | Risk Management | Sleep | Sleep Disorders

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

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Clinical Update

Light Therapy: Good for What Ails You?

Topics: ADHD | Alternative treatments | Antidepressant Augmentation | Bipolar Depression | Bulimia Nervosa | Complementary treatments | Complimentary Medicine | Depression | Depressive Disorder | Light and Dark Therapy | Light therapy | Lightbox | PTSD | Seasonal Affective Disorder | Sexual Dysfunction | Sleep | Sleep Disorders | Traumatic Brain Injury (TBI)

There are several lifestyle changes with broad health benefits that we often encourage in our patients. Exercise, a healthy diet, sleep hygiene, and supportive social connections are near the top of the list, and bright daytime light might be worth adding. Light therapy is a standard treatment for seasonal affective disorder, and in this article we’ll

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Research Update

Lemborexant and Sleep Architecture in the Elderly

Topics: Free Articles | Geriatric Psychiatry | Hypnotics | Lemborexant | Sleep | Sleep Disorders

REVIEW OF: Moline M et al, J Clin Sleep Med 2021. Epub ahead of print. TYPE OF STUDY: Randomized, double-blind, parallel-group study As we age, sleep architecture worsens in ways that reduce sleep quality, particularly after age 55. Unfortunately, most hypnotics either do not improve sleep quality (eg, the z-hypnotics) or slightly worsen it (eg, t

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Expert Q&A

Mood, Cognition, and Metabolic Health

Topics: Eszopiclone | Hypnotics | PTSD | Sleep

TCPR: Your research has explored how metabolic disorders can impair mood and cognition. Can you give us an overview of that topic? Dr. Mansur: Yes. There is a direct association between metabolic health and both mood and cognitive outcomes. All of the components of the metabolic syndrome—obesity, type II diabetes, dyslipidemia, and hypertension—inc

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Clinical Update

Is Ramelteon an Effective Hypnotic?

Topics: Belsomra | Benzodiazepines | Geriatric Psychiatry | Hypnotics | Lemborexant | Melatonin | Sleep | Suvorexant

Ramelteon (Rozerem) stands out from other hypnotics in several ways: It is not a controlled substance and has no risk of addiction or ­withdrawal. It is relatively safe in the elderly. It has a low risk of falls and complex sleep behaviors. However, ramelteon’s use has been limited by its high cost and modest efficacy. Now that it’s gone ge

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Article

A New Contraindication for Ambien and the Z-Hypnotics

Topics: FDA Warnings | Hypnotics | Insomnia | News of Note | Practice Tools and Tips | Psychopharmacology | Psychopharmacology Tips | Sleep

“Complex sleep behavior” is a euphemism for various problems that can happen after ingesting a sleeping pill. They range from cooking and emailing to driving a car or even sexual assault, all done in an amnestic state that is not recalled upon awakening. In 2007 the FDA placed warnings about these behaviors on all medications approved for insomnia,

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Research Update

Another Black Eye for Prazosin in PTSD?

Topics: Hypnotics | Insomnia | Nightmares | Prazosin | PTSD | Research | Research Update | Sleep | Suicidality

Review of: McCall W et al, J Clin Psychopharmacol 2018;38(6):618–621 Study Type: Randomized single-blind controlled trial (pilot study) Prazosin has become a mainstay in the pharmacologic treatment of PTSD. A selective antagonist of the noradrenergic alpha-1 receptor, it has modest benefits in sleep and nightmares that are supported by around ha

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