Melatonin for Insomnia in Patients With Autism

Topics: Autism | Child Psychiatry | Research Update | Sleep Disorders

Review of: Maras A et al, J Child Adolesc Psychopharmacol 2018;28(10):699–710 Treating sleep problems in youth with autism spectrum disorder (ASD) is tricky at best. One promising treatment is pediatric prolonged-release melatonin ­(PedPRM) sold under the name Slenyto. In 2017, a randomized controlled trial (funded by the manufacturer) assigned 11

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

Topics: Anxiety | Clinical practice | Deprescribing | Free Articles | Pharmacology | polypharmacy | prescribing patterns | Risk Management | Sleep | Sleep Disorders

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

A Prescription App for Insomnia

Topics: Cognitive Behavioral Therapy | Cognitive Behavioral Therapy for Insomnia (CBTi) | Health Apps | Sleep Disorders

You may recommend smartphone apps for mindfulness, symptom tracking, or medication reminders, but do you prescribe apps? FDA-authorized “prescription digital therapeutics” are already available for ADHD (EndeavorRx), traumatic nightmares (Nightware), and opioid use disorder (reSET-O). Now Somryst, a prescription app for insomnia, joins them. It is d

Sleepwalking on Antipsychotics and Lithium

Topics: Antipsychotics | Lithium | Second Generation Antipsychotics (SGAs) | Side Effects | Sleep | Sleep Disorders | Somnambulism

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

Light Therapy: Good for What Ails You?

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

Turning Nightmares Into Dreams

Topics: Behavior therapy | Behavioral therapy | Brief psychotherapy | Nightmares | Psychotherapy | PTSD | Sleep Disorders | Therapy during medication appointment | Therapy with Med Management

TCPR: What is nightmare disorder? Dr. Krakow: This is a sleep disorder in DSM-5 characterized by repeated, distressing nightmares. Some patients awaken from the dreams and others do not, but either way they usually remember the dreams, sometimes vividly. These nightmares often involve themes of threat, fear, and other distressing emotions. An important

Lemborexant and Sleep Architecture in the Elderly

Topics: Free Articles | Geriatric Psychiatry | Hypnotics | Lemborexant | Sleep | Sleep Disorders

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

A New Dopamine and Norepinephrine Reuptake Inhibitor for Excessive Sleepiness

Topics: Novel Medications | Pharmacology | Sleep Apnea | Sleep Disorders

Solriamfetol (Sunosi), a new dopamine and norepinephrine reuptake inhibitor (DNRI), has been approved by the FDA “to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea.” The medication has never been studied in psychiatry, but is likely to have important psychiatric ­effects

Sleep and PTSD

Topics: PTSD | Sleep Disorders

TCPR: A lot of patients with PTSD have trouble sleeping. How does this differ from the insomnia we see in other disorders? Dr. McCarthy: Insomnia is different in PTSD. Some of that is explained by the symptoms of PTSD, such as nightmares, hyperarousal, anxiety, and physical restlessness. But there’s another thing we’re seeing that isn’t as obviou

Ask the Editor - Jet Lag and Psychiatric Disorders: Plan for Prevention

Topics: Light and Dark Therapy | Sleep Disorders

Dear Dr. Aiken: I enjoyed Dr. Phelps’ discussion of blue-light blockers as a treatment for mania in the February issue. I’m wondering: Could these work for jet lag? Dr. Aiken: Jet lag happens when people fly across multiple time zones. The body’s internal clock gets out of sync with the outside signals of sunrise and sunset. The result is inso

Insomnia and Substance Use Disorders

Topics: Sleep Disorders | Substance Abuse

TCPR: Why is sleep so important in addictions? Dr. Rosenlicht: Sleep problems are common in recovery, and they have many causes such as withdrawal states, circadian rhythm disruptions, and a host of psychiatric and medical comorbidities. It’s a two-way street: Insomnia raises the risk of substance misuse, and addiction can cause or worsen sleep probl

Jornay PM Nighttime Stimulant for Next-Morning Effect

Topics: ADHD | News of Note | Sleep Disorders

Prescribing bedtime stimulants sounds like a recipe for a bad night’s sleep. But the FDA recently approved Jornay PM, which is an extended release (ER) formulation of methylphenidate that is, in fact, dosed at night. Approved for kids age 6 and older, Jornay PM has an extremely delayed onset of effect of 10 hours. This means kids can take it at aro

Sleep Apnea in Patients With Substance Use Disorders: A Primer

Topics: Addiction | Sleep Disorders | Substance Abuse

A 55-year-old male patient you have been treating for alcohol use disorder has been struggling with withdrawal following detox. He tells you his spouse is complaining about his severe and disruptive snoring, and he says he feels “wiped out” all day, even falling asleep at work. He then admits that, to stay alert, he has been regularly taking Adderal

Treating Insomnia With Addiction

Topics: Addiction | Sleep Disorders | Substance Abuse

CATR: With substance use disorders (SUDs) that are comorbid with chronic insomnia, what would you say are some of the main treatment challenges? Dr. Hermes: The first thing I’d say is that chronic insomnia has a high comorbidity rate with SUDs as well as general psychiatric conditions and medical conditions, including chronic pain, COPD, heart diseas

Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

Cognitive Behavior Therapy for Insomnia

Topics: Practice Tools and Tips | Psychotherapy | Sleep Disorders

TCPR: Dr. Perlis, you are one of the major researchers of cognitive behavior therapy for insomnia. Why are you so interested in the topic of insomnia? Dr. Perlis: Because insomnia is so ubiquitous and misunderstood with respect to its health consequences and “treatability.” At the core of this is the widespread misconception that insomnia is prim

Disrupted Sleep: Approaches to Assessment and Treatment in Children and Adolescents

Topics: Child Psychiatry | Sleep Disorders

Although sleep problems occur frequently in the pediatric population, with rates between 25%–40%, they too often go unrecognized and untreated (Sheldon S, Ferber R, Kryger M., Principles and Practice of Pediatric Sleep Medicine. Philadelphia, PA: Elsevier; 2005). In his Q&A interview in this issue, Dr. Rafael Pelayo nicely addresses how common sle

Got Zeitgebers? You Should

Topics: Child Psychiatry | Sleep Disorders

There are many potential causes of poor sleep in children, but regardless of the cause, it is important to be aware of overarching environmental factors that can affect sleep. The German word zeitgeber (literally “time-giver”) refers to any cue in the environment such as a change in light or temperature that can set the body’s internal clock. To s

Poor Sleep in Children and Adolescents: A Primer

Topics: Child Psychiatry | Sleep Disorders

A Narcolepsy Primer, With a Focus on Xyrem

Topics: Psychopharmacology Tips | Sleep Disorders

Narcolepsy affects about 1 out of 2000 people, for a prevalence rate of 0.05%. This puts it officially in the category of rare diseases. It’s about as common as Charcot-Marie-Tooth disease, or polycythemia vera, just to put it in perspective. So why are we asking you to read about such a rare disorder? Partly because there’s a lot of comorbidity bet