Piotr Nowak, Dariusz Nowak

Farmakoterapia zaburzeń snu. Część II - Bezsenność, zespół niespokojnych nóg, nocne kurcze mięśni kończyn dolnych, parasomnie

Pharmacotherapy of sleep disorders. Part 2 - insomnia, restless legs syndrome, nocturnal leg clamps, parasomnias. Insomnia is the most frequent sleep disorder (about 30 % of general population experienced at least one episode of sleep disturbances) that can coexist with psychiatric and medical illness (secondary insomnia) or may exist in isolation with other diseases (primary insomnia). Untreated insomnia leads to important impairment of social and occupational functioning. It is classified according to the duration on transient - 1 to 3 nights, short-term - 3 nights to 1 month, and on chronic insomnia - more than 1 month. Insomnia, especially chronic insomnia may increase the risk of the development of psychiatric (depression) or somatic diseases (e.g. cardiovascular disorders, back and hip problems, peptic ulcer disease) and in consequence increase the risk of death. Therefore, appropriate diagnosis and treatment of insomnia is important challenge for clinicians and pharmacologists. A combination of pharmacologic and nonpharmacologic therapies is recognized as the most efficacious in the treatment of chronic insomnia. However, pharmacotherapy alone is the frequent intervention for insomnia when the immediate relief of symptoms is required (or patient prefers medication). Numerous hypnotic drugs have been developed. The newest ones almost fulfill the criteria for the ideal hypnotic drug: rapid absorption and rapid sleep induction, optimal duration of action, preservation of sleep architecture, and favorable safety profile (no development of tolerance, dependence, no rebound insomnia, minimal other adverse events). This paper describes pharmacotherapy of insomnia as well as clinical features and treatments of other sleep disorders such as: restless legs syndrome, bruxism, somnambulism, sleep terrors, and night mares.