Recommendations on use of pharmacological interventions for sleep disturbance.14,15
| Management of sleep disturbance should focus on treatment of perpetuating factors, sleep hygiene and non-pharmacological interventions.
Medication should be restricted to patients with distressing sleep disturbance. The choice of medication depends on a variety of factors, including patient-related factors (eg age, co-morbidities), clinical features (eg sleep pattern, associated symptoms) and drug-related factors (eg duration of action, side effect profile). Medication should be prescribed for short periods (generally 1 week, maximum 3 weeks). a Medication should be prescribed for intermittent usage (not continuous usage). a Patients with difficulty initiating sleep (and in whom daytime sedation is undesirable) should be prescribed drugs with a short duration of action eg temazepam, zopiclone. Patients with difficulty maintaining sleep (and in whom daytime sedation is acceptable) should be prescribed drugs with a long duration of action eg flurazepam, nitrazepam. Benzodiazepines and the Z-drugs b should be avoided in the elderly due to potential side effects (eg confusion, falls). Benzodiazepines and other hypnotics should be used with caution in patients receiving opioid analgesics due to potential side effects (eg sedation, respiratory depression). Benzodiazepines (and the Z-drugs) cause physical/psychological dependence, and are associated with clinically significant withdrawal reactions (which can occur up to 3 weeks later). |