REM

Rapid Eye Movement (associated with sleep cycle) is important because a hypnotic drug should not alter the normal REM cycle.



Transient insomnia can result from stress. The FDA doesn’t approve any drug for the management of stress, but there are obviously drugs for insomnia and anti-anxiety. People with acute medical illnesses, including pain, as a cause of their insomnia are not managed by hypnotics alone. One of the major problems with travelers is jet-lag, in which one’s circadian rhythm is disturbed. Ambien is a popularly prescribed drug for business travelers who travel a lot and must stay alert on arrival in a new time zone. The pt will fall asleep once they get on the plane, and when they arrive they are bright and alert. Pts who are heavy caffeine drinkers also have an inability to fall asleep, but you wouldn’t want to prescribe a drug to counter caffeine’s stimulatory effects, just reduce caffeine. “Some people are exquisitely sensitive to caffeine. If I were to drink 3 cups of coffee at 8pm I would have no trouble falling asleep… I’m very tolerant to caffeine. In fact in the morning I have to have about 4 cups before I can get going. In fact, I have a drug seeking behavior! Wherever I am, the first thing I look for is coffee.”

Category: Pharmacology Notes