Supplemental Reading

Yuan R, Flockhart DA, and Balian JD. Pharmaco-kinetic and pharmacodynamic consequences of metabolism-based drug interactions with alprazolam, midazolam and triazolam. J Clin Pharmacol 1999;39,1109-1125.

Dooley M and Plosker GL. Zaleplon: A review of its use in the treatment of insomnia. Drugs 2000;60,413-445.

Doghramji PP. Treatment of insomnia with zaleplon, a novel sleep medication. Int J Clin Pract 2001;55,329-334.

Zohar J and Westenberg HG. Anxiety disorders: A review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand Suppl 2000;403,39-49.

Case Study Nighttime Anxiety

M. W. is a 22-year-old woman who visits her doctor because she is extremely tired. She reports that although she is exhausted at bedtime, she typically cannot fall asleep for at least an hour or two. She moved to town 2 months ago and has her first full-time job. She likes her job but fears that her supervisors think she is "dumb" because she has made some careless mistakes. After falling to sleep, she sometimes wakes an hour or more before her alarm goes off, usually thinking about her dumb mistakes. Her problems with sleeping began approximately 5 months ago, when she was studying for final examinations in her senior year of college. Aside from a minor dermatological condition, she is in excellent health. What treatment would you recommend for her insomnia and fatigue?

Answer: Zolpidem is the best choice. M. W.'s inability to sleep well is probably the result of anxiety caused by several stresses in her life. She is a recent college graduate, has a new job, and has moved to a new town. These events constitute three stressors, which can induce anxiety and sleep loss. The sleep loss and anxiety are usually of relatively short duration. Zolpidem has a quick onset and a half-life of approximately 2.5 hours. If taken at bedtime, it should allow her to fall asleep quickly and sleep though most or all of the night. Its elimination is fast enough that it should not produce residual drowsiness during the day. A week-long trial of Zolpidem should help M. W. overcome her sleep disturbance.

Healthy Sleep

Healthy Sleep

A Guide to Natural Sleep Remedies. Many of us experience the occasional night of sleeplessness without any consequences. It is when the occasional night here and there becomes a pattern of several nights in arow that you are faced with a sleeping problem. Repeated loss of sleep affects all areas of your life The physical, the mental, and theemotional. Sleep deprivation can affect your overall daily performance and may even havean effecton your personality.

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