1. Sedative Hypnotics
Anti-Anxiety Agents
Pharmacology
Clinical Management of Anxiety &
Sleep Disorders

2. Anxiety & Panic Disorders
• Uneasiness, worry,
apprehension
• Fearful feelings
• Interferes w/life
• Inappropriate
response
• Self-tx w/ Etoh

3. Sleep Disorders
• Transient
– Results from stress or
change (days)
• Short Term
– Persistent major life
stress(3 weeks)
• Chronic
– Medical/psych illness

4. Stages of Sleep
Stage2
Stage 1
Non REM
2-5%
67-75%
Stage 3 & 4
REM sleep
Deep sleep
25-33%
15-25%

5. Sleep Hygiene
• Arise same time • Alternative medicines
• Avoid daytime naps • Antihistamines
• Avoid Etoh, large • OTC
meals, nicotine, • Sedating
caffeine antidepressants
• Good sleep area • benzodiazepines
• Increase exercise
• Got Milk?

6. Etiology
• Situational • Organic Disease
– Acute – GIT
– Unpleasantness • Ulcer
– Procedure (MRI) – Cardiovascular
• MI
• Chronic • Angina
– Excessive,
unreasonable
worry/panic about life

7. CNS Pathway (Dose Dependant)
• Sedation
• Hypnosis
• Anesthesia
• Coma

8. Treatment Options for anxiety & insomnia
• Non Pharmacologic • Pharmacologic
– Good sleep hygiene Overview
– Sleep restriction – Alternative medicines
– Relaxation training – Antihistamines
– Cognitive behavior – Barbiturates
therapy • Phenobarbitol
– Benzodiazepines
– Non-Benzodiazepines
• OTC sleep aids
• Sedating Anti-
depressants

9. Bens & Barbs (no, it’s not Barbie’s new
boyfriend)
• Benzodiazepines • Tolerance
• Organ Effects – Psychological
– Sedation – Physiological
– Hypnosis • Selected Agents
– Anesthesia – Diazepam
– Muscle Relaxation – Flurazepam
– Respiratory – Prazepam
– Cardiovascular – Clorazepate
– Alprazolam

10. Miscellaneous Agents
• Buspirone (Buspar)
– Non-controlled, non-addicting
• Zaleplon (Sonata)
• Zolidem (Ambien)
• Meprobamate (Miltown)
• Hydroxyzine (Atarax)
– Antihistamine

11. Sedative Drug Interactions
• Other CNS depressants & Etoh
• Herbals (Kava, valerian root)
• Barbs & warfarin
– increase metabolism of warfarin reduce effect
• Barbs & BCP
– Increase metabolism of BCP reduce effect

12. Clinical Management
• Long term use of sedative hypnotics is
irrational & dangerous medical practice.
• Stepped Care
• Risk versus Benefit
– Taper
• Go low, go slow