Zolpidem reduces the sleep disturbance of jet lag.

OBJECTIVE: To determine the degree to which zolpidem 10 mg would reduce the sleep disruption associated with rapid, eastward transatlantic travel. BACKGROUND: Subsequent to rapid transmeridian travel, individuals often complain of jet lag which includes transient disturbances in sleep patterns, alertness, appetite and mood. Disturbed sleep and impaired alertness appear to be the most debilitating symptoms of jet lag. METHODS: This multi-center, double-blind randomized, placebo-controlled, parallel-groups study involved 138 adult (mean age 44.9 years) experienced travelers while on their regular eastward transatlantic assignments originating in the US and crossing 5-9 time zones. Subjects were normal sleepers when not traveling and had to have traveled overseas at least twice during the last 24 months. Subjects were randomized to zolpidem 10 mg or placebo for three (optionally four) consecutive nights starting with the first nighttime sleep after travel. Sleep was assessed with daily questionnaires. RESULTS: A total of 130 subjects completed the study. Compared to placebo, zolpidem was associated with significantly improved sleep (statistically significant differences at nights indicated) longer total sleep time (night 1), reduced number of awakenings (nights 1 and 2), and improved sleep quality (nights 1, 2 and 3). Zolpidem was not associated with improvement in sleep latency. No unexpected or serious adverse events were reported and the most common adverse event was headache in both groups (9.2 and 17.6% for placebo and zolpidem, respectively). CONCLUSION: In seasoned travelers, zolpidem 10 mg produced significant improvement in sleep following rapid transmeridian travel.

Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases.

Restless legs syndrome (RLS) is a common neurosensorimotor disorder that presents with paresthesias, sleep disturbances and, in most cases, periodic limb movements of sleep (PLMS). Although many treatments have been described, interest has recently been focused on dopaminergic mechanisms of etiology and treatment. The dopamine agonists L-dopa/carbidopa, bromocriptine mesylate or both were initiated in 49 patients with RLS/PLMS who sought consultation at a sleep disorders center. This retrospective study describes the symptoms, time course of response and complications in 36 men and 13 women with a mean age of 53.9 years. Only 47 of the patients were available for extended follow-up. The most common presenting complaints were the sensation of restless legs and sleep maintenance insomnia lasting over 20 years. In the extended follow-up group of 47, four failed to respond to L-dopa or bromocriptine, five discontinued treatment because of side effects and two reported loss of therapeutic effect within the first month. Between month one and six, only three additional subjects discontinued treatment. At a mean follow-up of 283 days (SD 316), 33 patients continued on L-dopa/carbidopa at a mean bedtime dose of 160 mg L-dopa (SD 300). Treatment-emergent morning leg restlessness developed in eight patients, seven of whom required daytime medication for relief. Other side effects, generally nausea, occurred in only eight of 43 patients. Psychiatric side effects of dyskinesia were not seen. The > 70% long-term response is comparable to other studies in the literature.

Insomnia. Use of a 'decision tree' to assess and treat.

Insomnia, a remarkably common disturbance in a basic biologic function, arises from multiple psychological, physiologic, and environmental factors. Transient insomnia usually resolves spontaneously. Short-term insomnia is usually normalized by coping with acute changes in a medical condition or a relationship. In patients with insomnia caused by stressful life events, a short (ie, 10 days or less) course of a short- or intermediate-acting benzodiazepine hypnotic may be indicated. Long-term insomnia deserves comprehensive evaluation. Psychiatric disorders are common in patients with long-term insomnia. In patients over age 50, intrinsic sleep disorders are more prevalent. Behavioral therapy, including improved sleep hygiene, stimulus-control techniques, and sleep-restriction therapy, is preferred in the management of long-term insomnia. Pharmacotherapy (eg, low-dose antidepressant or benzodiazepine) is best used as an adjunct.

Management of the 10 most common sleep disorders.

The most common sleep disturbance is an adjustment reaction to life events and physical illness. Snoring, without sleep apnea, is a problem frequently encountered by primary care physicians. Sleep disturbances caused by behaviors incompatible with sleep require counseling, while sleep disturbances due to psychiatric conditions require treatment of the underlying illness. Sleep disorders caused by alcohol and other drugs are prevalent. Chronic insomnia with no identifiable underlying psychiatric or medical condition is best managed with behavioral therapies. New pharmacotherapies for leg movements or restless legs sensations during sleep appear promising. New therapies are also dramatically effective for obstructive sleep apnea.

Common sleep disorders in the elderly: diagnosis and treatment.

Insomnia and daytime sleepiness in an elderly patient may be a normal consequence of aging, the result of a primary sleep disorder, or an adverse effect of medication or medical illness. Effective management requires a differential diagnosis. Adjustment sleep disorder, primary snoring, inadequate sleep hygiene, and mood disorders are common in the aged. The physician needs to review the patient history, including stressful events, medications, medical illness, and the possible presence of a psychiatric disorder. Treatment often involves behavioral changes and conservative use of medications, including antidepressants or benzodiazepines.