The Use and Misuse of Sleeping Pills: A Clinical Guide

ISBN-13: 9781468436495 / Angielski / Miękka / 2012 / 220 str.

Wallace B. Mendelson; Wallace B. Mendelson

Opis

Hypnos (the Greek god of sleep) and Thanatos (death) were the twin sons of Nyx, the goddess of night (Fox, 1964). Hypnos lived in a dusky valley in the land of the Cimerians, watered by Lethe, the river of forgetfulness. He brought sleep to both men and gods, and sometimes sent his sons Morpheus, Icelus, and Phantasus to appear in dreams. At the door of his abode grew poppies and other herbs which induce sleep (Hamilton, 1961). This book deals with these herbs and their subsequent imitations. Before launching into an examination of hypnotics, it might be well to comment briefly on the manner in which this was written, and to acknowledge the help of a number of individuals. My intention was that this be useful not only for the physician or scientist, but also for the student. Thus each chapter contains an introductory section which pro vides background material. Chapter 3, for instance, describes the general principles of drug absorption, distribution, and metabolism before dis cussing the pharmacologic properties of each hypnotic. In addition, each chapter concludes with a section which summarizes the main issues."

Spis treści

1 Basic Concepts about Sleep and Insomnia.- History.- The Sleep Stages.- Waking.- NonREM Sleep.- Stage 1.- Stage 2.- Stages 3 and 4.- REM Sleep.- Influences on the Appearance of Sleep Stages.- Physiologic Regulation of Sleep.- Passive versus Active Model.- The Neurotransmitters.- Circulating Humors.- Hypnotics and Sleep Regulation.- Sleep Deprivation.- The Need for Sleep.- Insomnia.- Summary and Conclusions.- 2 The Prevalence of Sleep Disturbance and Hypnotic Use.- Surveys of Reported Sleep Disturbance.- Types of Sleep Complaints.- Surveys of Hypnotic Use.- Patient-Physician Interaction.- Prescriptions for Outpatients.- Prescribing Hypnotics in Hospital Practice.- Summary and Conclusions.- 3 Pharmacology of Prescription Hypnotics.- Pharmacologic Considerations.- Barbiturates.- History.- Actions.- Structure and Classification.- Alterations in Metabolism and Excretion: Illness, Old Age, Enzyme Induction.- Chronic Administration.- Benzodiazepines.- History.- Flurazepam.- Nitrazepam.- Temazepam.- Other Properties of Benzodiazepines.- Nonbarbiturate, Nonbenzodiazepine Hypnotics.- Chloral Hydrate and Derivatives.- Methaqualone.- Piperidinedione Derivatives.- Glutethimide.- Methyprylonz.- Ethchlorvynol.- Ethinamate.- Summary and Conclusions.- 4 The Efficacy of Hypnotics.- Methodologic Considerations.- Possible Measures of Efficacy.- Subject Selection.- Other Methodological Issues.- Efficacy Studies in Specific Disorders.- Reference Section: Efficacy Studies in Normal Volunteers and “Insomniacs”.- Barbiturates.- Benzodiazepines.- Flurazepam.- Nitrazepam.- Temazepam.- Nonbarbiturate, Nonbenzodiazepine Hypnotics.- Chloral Hydrate.- Methaqualone.- Glutethimide.- Methyprylon.- Ethchlorvynol.- Summary and Conclusions.- 5 Suicide and Hypnotics.- Incidence.- Traits of the Victim.- Clinical Toxicity.- Barbiturates.- Benzodiazepines.- Nonbarbiturate, Nonbenzodiazepine Hypnotics.- ChloralHydrate.- Methaqualone.- Glutethimide.- Ethchlorvynol.- Treatment.- Prevention.- Summary and Conclusions.- 6 Residual Daytime Effects of Hypnotics.- Electrophysiologic Residual Effects.- Psychomotor Measures of Residual Effects.- Subjective Evaluation of Daytime Performance.- Hypnotics and Driving.- Summary and Conclusions.- 7 Interactions with Ethanol.- General Considerations.- Barbiturates.- Benzodiazepines.- Nonbarbiturate, Nonbenzodiazepine Hypnotics.- Chloral Hydrate.- Methaqualone.- Glutethimide.- Summary and Conclusions.- 8 Hypnotic Dependence.- Classical Drug Abuse.- Dependence in Medical Practice.- Dependence on Extremely Large Doses.- Prolonged Use of Recommended Doses.- Incidence and Contributing Factors.- Drug Qualities Related to Prolonged Use.- Summary and Conclusions.- 9 Hypnotics and the Elderly.- Pharmacology in the Elderly.- Efficacy Studies.- Toxicity.- Summary and Conclusions.- 10 Other Pharmacologic Approaches.- Over-the-Counter Hypnotics.- Compounds Used in OTC Hypnotics.- Methapyrilene.- Scopolamine.- Bromides.- Efficacy.- Federal Regulation.- l-Tryptophan.- Ethanol.- Summary and Conclusions.- 11 Nonpharmacologic Treatment of Insomnia.- Counseling and Psychotherapy.- Behavioral Therapies.- General Considerations.- Relaxation Procedures.- Conditioning-Derived Therapies.- Attributional Therapy.- Behavioral Self-Management.- Summary and Conclusions.- 12 Conclusion: Implications for Medical Practice.- Summary.- Approach to the Insomniac Patient.- Evaluation.- The Decision Whether to Give Hypnotics.- Acute or Intermittent Insomnia.- Chronic Insomnia.- When Hypnotics Are Prescribed.- References.