Melatonin agonists and insomnia.
ABSTRACT The ability of melatonin to shift biological rhythms is well known. As a result, melatonin has been used in the treatment of various circadian rhythm sleep disorders, such as advanced and delayed sleep phase disorders, jet lag and shiftwork disorder. The current evidence for melatonin being efficacious in the treatment of primary insomnia is less compelling. The development of agents that are selective for melatonin receptors provides opportunity to further elucidate the actions of melatonin and its receptors and to develop novel treatments for specific types of sleep disorders. The agonists reviewed here - ramelteon, tasimelteon and agomelatine - all appear to be efficacious in the treatment of circadian rhythm sleep disorders and some types of insomnia. However, further studies are required to understand the mechanisms of action, particularly for insomnia. Clinical application of the agonists requires a good understanding of their phase-dependent properties. Long-term effects of melatonin should be evaluated in large-scale, independent randomized controlled trials.
Article: “Nurse, I Can’t Sleep!”[Show abstract] [Hide abstract]
ABSTRACT: Insomnia frequently presents during cancer therapy in a symptom cluster along with pain, fatigue, and mood disturbance, negatively affecting functional status and quality of life in many patients. Patients often first report their sleep disturbance to nurses. During each clinical contact across all oncology practice settings, nurses should inquire, “Do you experience difficulty sleeping?” and “Do you have difficulty falling asleep and/or staying asleep?” The National Institutes of Health Consensus and the American Academy of Sleep Medicine Practice Parameters recommend Cognitive Behavioral Therapy for Insomnia to be standard treatment based on the high level of empirical support. The most frequently used therapies utilized in oncology clinics include stimulus control therapy, sleep restriction therapy, relaxation therapies, paradoxical intention, and sleep hygiene education. Cognitive Behavioral Therapy for Insomnia has similar efficacy with more sustainability when compared with sleep medicines. When adequately trained with proper assessment skills, nurses can identify contributing factors for sleep disturbance and are in a better position to intervene across all settings of cancer care and improve patient and family caregiver quality of life.Journal of Hospice and Palliative Nursing 01/2013; 15(5):267-275. DOI:10.1097/NJH.0b013e318296839b · 0.48 Impact Factor
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ABSTRACT: Alzheimer's disease (AD) is an age-associated neurodegenerative disease characterized by the progressive loss of cognitive function, loss of memory and insomnia, and abnormal behavioral signs and symptoms. Among the various theories that have been put forth to explain the pathophysiology of AD, the oxidative stress induced by amyloid β-protein (Aβ) deposition has received great attention. Studies undertaken on postmortem brain samples of AD patients have consistently shown extensive lipid, protein, and DNA oxidation. Presence of abnormal tau protein, mitochondrial dysfunction, and protein hyperphosphorylation all have been demonstrated in neural tissues of AD patients. Moreover, AD patients exhibit severe sleep/wake disturbances and insomnia and these are associated with more rapid cognitive decline and memory impairment. On this basis, the successful management of AD patients requires an ideal drug that besides antagonizing Aβ-induced neurotoxicity could also correct the disturbed sleep-wake rhythm and improve sleep quality. Melatonin is an effective chronobiotic agent and has significant neuroprotective properties preventing Aβ-induced neurotoxic effects in a number of animal experimental models. Since melatonin levels in AD patients are greatly reduced, melatonin replacement has the potential value to be used as a therapeutic agent for treating AD, particularly at the early phases of the disease and especially in those in whom the relevant melatonin receptors are intact. As sleep deprivation has been shown to produce oxidative damage, impaired mitochondrial function, neurodegenerative inflammation, and altered proteosomal processing with abnormal activation of enzymes, treatment of sleep disturbances may be a priority for arresting the progression of AD. In this context the newly introduced melatonin agonist ramelteon can be of much therapeutic value because of its highly selective action on melatonin MT(1)/MT(2) receptors in promoting sleep.12/2010; 2011:741974. DOI:10.4061/2011/741974
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ABSTRACT: Air travel is a common mode of transportation in today's society, particularly for individuals traveling long distances. Sleep disturbances associated with air travel frequently result in cognitive and physiologic impairments that may be detrimental to the traveler's experience and intent. A primary consequence of air travel is the development of acute sleep deprivation, which may result in reduced attention/vigilance, alteration in mood states, diminished memory processing, and alteration in executive function. Along with and contributing to acute sleep deprivation, circadian rhythm misalignment resulting in jet lag disorder (JLD) is frequently encountered by air travelers traversing multiple time zones. JLD is characterized by insomnia or excessive daytime sleepiness associated with physical or mental impairment associated with travel. This review focuses on the neurocognitive manifestations of acute sleep deprivation and the pathophysiology and treatment of JLD to provide the practicing clinician a greater understanding of the sleep abnormalities manifest in air travelers. Treatment recommendations for the traveler, including the use of light/melatonin therapy, sleep scheduling, and pharmacologic aids for both sleep and alertness, are provided.Chest 10/2013; 144(4):1394-1401. DOI:10.1378/chest.12-2963 · 7.13 Impact Factor