Sleep Carlat Reports | Carlat Publishing

Clinical Update

Tools to Help Kids and Teens to Sleep Better

From The Carlat Child Psychiatry Report, Overarousal in Children and Adolescents

Sasha is a 13-year-old whose grades are slipping. She reports trouble concentrating in school, and her parents are worried she might have ADHD. On taking a history, you learn that Sasha stays up late and gets up early, obtaining about six hours of sleep per night. Adolescents have been reporting less sleep over the past 20 years in what’s

Research Update

Melatonin for Sleep-Onset Insomnia

From The Carlat Child Psychiatry Report, Clinical Complexity With Children and Adolescents

Topics: Dosage Timing | Melatonin | Sleep | Sleep Onset Insomnia

REVIEW OF: Wei S et al, Sleep Medicine 2020;68:1–8 Sleep-onset insomnia, characterized by difficulty falling asleep and daytime fatigue, is a common problem among youth. While sleep hygiene is the first step, families often have trouble implementing such measures, which include regular wake-up times, daily exercise, shutting down screens in the eve

Research Update

Adolescents and Sleep: Parents Can Make a Difference

From The Carlat Child Psychiatry Report, Psychosis in Children and Adolescents

Topics: adolescents | Sleep | teens

Review of: Peltz JS et al, Sleep 2019;zsz287 We know that sleep deprivation is an important contributor to mental health problems in teenagers. Studies show that adolescents need around 9.25 hours of sleep for optimal functioning, but most do not get adequate sleep for several reasons. Teens have a developmental drive to stay up later and sleep in lo

Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

In-Brief

A Longer Acting Lorazepam

From The Carlat Psychiatry Report, Living With Mental Illness

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | extended-release | Sleep

Lorazepam (Ativan) received a new coating this year as Loreev XR, which promises a 24-hour duration for this benzodiazepine that is otherwise divided in two or three daily doses. It joins alprazolam (Xanax) as the only benzos with extended-release (XR) formulations (clorazepate ventured into this territory as Tranxene SD in 2002, but that medication is

Research Update

Sleepwalking on Antipsychotics and Lithium

From The Carlat Psychiatry Report, Bipolar Disorder

REVIEW OF: Gouverneur A et al, Br J Clin Pharmacol 2021;87:3971–3977 STUDY TYPE: Retrospective analysis Sleepwalking and sleep-eating are common parasomnias, also known as somnambulism and sleep-related eating disorder. Both can be side effects of benzos, z-hypnotics, and—rarely—antidepressants. This review looked at parasomnias’ association w

Clinical Update

Light Therapy: Good for What Ails You?

From The Carlat Psychiatry Report, Mood Disorders

Topics: | | | | | | | | | | | | | | | | | ADHD Alternative treatments Antidepressant Augmentation Bipolar Depression Bulimia Nervosa Complementary treatments Complimentary Medicine Depression Depressive Disorder Light and Dark Therapy Light therapy Lightbox PTSD Seasonal Affective Disorder Sexual Dysfunction Sleep Sleep Disorders Traumatic Brain Injury (TBI)

There are several lifestyle changes with broad health benefits that we often encourage in our patients. Exercise, a healthy diet, sleep hygiene, and supportive social connections are near the top of the list, and bright daytime light might be worth adding. Light therapy is a standard treatment for seasonal affective disorder, and in this article we’ll

Research Update

Lemborexant and Sleep Architecture in the Elderly

From The Carlat Psychiatry Report, Therapy

REVIEW OF: Moline M et al, J Clin Sleep Med 2021. Epub ahead of print. TYPE OF STUDY: Randomized, double-blind, parallel-group study As we age, sleep architecture worsens in ways that reduce sleep quality, particularly after age 55. Unfortunately, most hypnotics either do not improve sleep quality (eg, the z-hypnotics) or slightly worsen it (eg, t

Expert Q&A

Mood, Cognition, and Metabolic Health

From The Carlat Psychiatry Report, Metabolism and Mental Health

Topics: Eszopiclone | Hypnotics | PTSD | Sleep

TCPR: Your research has explored how metabolic disorders can impair mood and cognition. Can you give us an overview of that topic? Dr. Mansur: Yes. There is a direct association between metabolic health and both mood and cognitive outcomes. All of the components of the metabolic syndrome—obesity, type II diabetes, dyslipidemia, and hypertension—inc

Clinical Update

Is Ramelteon an Effective Hypnotic?

From The Carlat Psychiatry Report, Practical Psychotherapy

Ramelteon (Rozerem) stands out from other hypnotics in several ways: It is not a controlled substance and has no risk of addiction or withdrawal. It is relatively safe in the elderly. It has a low risk of falls and complex sleep behaviors. However, ramelteon’s use has been limited by its high cost and modest efficacy. Now that it’s gone ge

Article

A New Contraindication for Ambien and the Z-Hypnotics

From The Carlat Psychiatry Report, How to Talk about Medication

“Complex sleep behavior” is a euphemism for various problems that can happen after ingesting a sleeping pill. They range from cooking and emailing to driving a car or even sexual assault, all done in an amnestic state that is not recalled upon awakening. In 2007 the FDA placed warnings about these behaviors on all medications approved for insomnia,

Research Update

Another Black Eye for Prazosin in PTSD?

From The Carlat Psychiatry Report, Side Effects Part II

Review of: McCall W et al, J Clin Psychopharmacol 2018;38(6):618–621 Study Type: Randomized single-blind controlled trial (pilot study) Prazosin has become a mainstay in the pharmacologic treatment of PTSD. A selective antagonist of the noradrenergic alpha-1 receptor, it has modest benefits in sleep and nightmares that are supported by around ha