Akademik Veri Yönetim Sistemi
Therapeutische Umschau, cilt.39, sa.11, ss.868-874, 1982 (Scopus)
Patients with sleep problems require a therapeutic approach which takes the presumed origin of their problems into account. Among the primary sleep-disorders, the chronically poor sleepers should be advised to adhere to the rules of sleep hygiene and to stay away from drugs. In contrast, patients suffering from abnormal sleepiness as a result of narcolepsy or of the Klein-Levine syndrome, may be managed successfully with stimulant or antidepressant compounds. In secondary sleep-disorders, treatment should be aimed at the underlying cause and not at the sleep disturbance itself. Patients with loss of sleep because of pain should receive analgetic rather than hypnotic drugs. In cases of drug abuse, abstinence will be the decisive therapeutic measure. In view of the development of tolerance, hypnotics are purposeful only for short-term therapy, and their long-term efficacy remains to demonstrated. Barbiturates have now largely been replaced by benzodiazepines. Since the various benzodiazepines have very similar pharmacodynamic properties, the choice of a specific drug should primarily be based on pharmacokinetic considerations. A half-life of 2 to 3 hours is optimal for a sleep-inducing agent, whereas longer half-lives may lead to daytime sedation. Since this latter effect is desirable only in a few specific situations, such as chronic anxiety-states interfering with sleep, there is little indication for prescribing long-acting drugs. Despite the relative safety of the benzodiazepines, all pharmacological effects of these drugs should be kept in mind for optimal prescribing. (Review article with 12 references).