A diagnosis of chronic insomnia occurs when the patient has symptoms at least

3 times per week for at least 3 months

Which medications can be used if a patient needs help falling asleep

eszopiclone, zolpidem, ramelteon, zaleplon

Which medications can be used if a patient needs help staying asleep

eszopiclone, zolpidem, doxepin, suvorexant

Which medications can be used if a patient needs help falling and staying asleep

eszopiclone, zolpidem

Drugs that can worsen insomnia

donepezil, alcohol, antiretrovirals, aripiprazole, atomoxetine, bupropion, caffeine, decongestants, diuretics, fluoxetine, steroids, stimulants, varenicline

Brand name eszopiclone

Lunesta

Brand name for zolpidem

Ambien

Brand name for sublingual zolpidem

Edluar

Brand name for zaleplon

Sonata

MOA of orexin receptor antagonist

block the orexin neuropeptide signaling system, resulting in drowsiness

Drugs that are orexin receptor antagonist

Quviviq, DayVigo, Belsomra

Brand name for daridorexant

Quviviq

Brand name for lemborexant

DayVigo

Brand name for suvorexant

Belsomra

MOA of melatonin receptor agonists

agonist at the melatonin receptors, MT1 and MT2. this promotes sleepiness and regulates the circadian rhythm to coordinate the sleep-wake cycle

Which medications are melatonin receptor agonists

ramelteon, tasimelteon

Brand name for ramelteon

Rozerem

Brand name for tasimelteon

Hetlioz

Which TCA is approved for insomnia

doxepin

Brand name for doxepin

Silenor

What is restless legs syndrome (RLS)

an urge to move the lower legs

RLS is thought to be due to a

dysfunction of dopamine in the brain's basal ganglia circuits

Brand name of doxylamine

Unisom SleepTabs

Primary treatment of RLS

dopamine agonists and the anticonvulsant gabapentin

Brand name for gabapentin ER approved for RLS

Horizant

When should gabapentin be taken for RLS

at 5pm daily

What is narcolepsy

excessive daytime sleepiness with cataplexy (sudden loss of muscle tone) and sleep paralysis

Stimulants for wakefulness

modafinil, armodafinil

Brand name for modafinil

Provigil

Brand name for armodafinil

Nuvigil

R-isomer of modafinil

armodafinil

Brand name of sodium oxybate

Xyrem