Menopausal insomnia
Menopause is a special physiological stage, and insomnia is undoubtedly the most unbearable part of it. Are you wondering why nights that once eased to sleep are now so far away?
So, for menopausal insomnia, how can we safely use medication?
With the rapid development of medical treatment, there are many kinds of insomnia drugs, including Western medicine and Chinese patent medicine, but how to choose? When we need medication to "help" us get a good night's sleep, how do we choose to work quickly and have fewer side effects? How long should I take insomnia medication orally? When should I stop taking the drug?
In this issue, let's talk about the "insomnia medicine" in everyone's eyes!
Be cautious and reiterate: insomnia drugs are prescription drugs, please take them under the guidance of a specialist!
Features of drugs commonly used to treat insomnia
01. Benzodiazepines:
Peculiarity:
It can improve the difficulty of falling asleep, increase total sleep time, and reduce nocturnal awakenings in patients with insomnia.
Short-acting:
Triazolam, a short-half-life hypnotic drug, has been classified as a class I psychotropic drug management in mainland China due to its high incidence of addiction and retrograde amnesia, and is usually not used for the treatment of insomnia.
Intermediate:
It is mainly used for people who sleep lightly, wake up easily and need to keep their minds awake in the morning, and the commonly used drugs are estazolam (1~2 mg/night), alprazolam (0.4~0.8 mg/night) and lorazepam (0.5~1.0 mg/night).
Long:
It has the characteristics of slow onset and long half-life, and is mainly used for early awakening, and the commonly used drugs are diazepam (5~10 mg/night).
Notes:
(1) Common adverse reactions include drowsiness, dizziness, fatigue, forgetfulness, falling, etc., long-term continuous medication can produce dependence and addiction, such as sudden discontinuation of the drug may cause withdrawal symptoms and rebound insomnia, which need to be gradually reduced.
and (2) the potential risk of substance abuse in patients with insomnia with a history of substance abuse should be considered.
(3) Patients with liver and kidney impairment, myasthenia gravis, dementia with Lewy bodies, and moderate to severe obstructive sleep apnea are prohibited.
02. Non-benzodiazepines:
Peculiarity:
They are similar to benzodiazepines in terms of hypnotic efficacy but are less drug-dependent. The treatment of insomnia is safe and effective, without serious adverse drug reactions, with good safety, low residual effect on the next day, and generally no daytime drowsiness. The main ones include zolpidem, zaleplon, dexzopiclone, and zopiclone.
唑吡坦（5~10 mg/晚）：
The half-life is less than 0.7~3.5 h, which can quickly induce sleep and treat difficulty in falling asleep and sleep maintenance disorders.
扎来普隆（5~10 mg/晚）：
The half-life is less than 1 h, which is suitable for the treatment of difficulty falling asleep. When used in the long term, the effect on cognition and psychomotor is less than that of zolpidem and zopiclone.
右佐匹克隆（1~3 mg/晚）和佐匹克隆（3.75~7.50 mg/晚）：
The half-life is less than 6 h, which has a better sleep maintenance effect than zolpidem.
Notes:
(1) Common adverse reactions include abnormal taste, dry mouth, dizziness, etc.
(2) This kind of drug should be taken before going to bed, and a certain amount of sleep time must be ensured after taking the drug, and driving, operating machines and dangerous operations should be avoided during the period of taking the drug, and drinking alcohol and alcoholic beverages should be prohibited.
03. Melatonin and melatonin receptor agonists:
Peculiarity:
Involved in regulating the sleep-wake cycle and may improve circadian rhythm disorders. No dependence and addiction, no withdrawal symptoms and no respiratory depression, with little residual effect the next day.
Ramelteon (8mg/day, not available in China):
It can shorten sleep latency, improve sleep efficiency, and increase total sleep time, and is used for the treatment of insomnia and circadian rhythm disorders with complaints of difficulty falling asleep.
agomelatine (25~50mg/day):
It has the dual effects of hypnotic and antidepressant, which can improve depression-related insomnia, shorten sleep latency, and increase sleep continuity.
Notes:
(1) Ramelteon can cause adverse reactions such as fatigue, dizziness, nausea and vomiting, worsening insomnia, and hallucinations; It is forbidden to use it in combination with fluvoxamine
(2) Agomelatine is prohibited for hepatitis B/C virus carriers and patients with liver impairment.
04. Antidepressants with hypnotic effect:
Peculiarity:
It is especially suitable for patients with insomnia who have symptoms of anxiety and depression.
曲唑酮（25~150 mg/天）：
Administered 1 h before bedtime, it can shorten the sleep latency, reduce the number of awakenings during sleep, increase the sleep maintenance time, and increase slow-wave sleep, so as to exert a calming and hypnotic effect, and will not cause daytime sleepiness.
mirtazapine (3.75~15 mg/day):
It can quickly sedate, improve sleep, increase slow-wave sleep, help sleep last, and is suitable for patients with increased light sleep, early awakening and insomnia with anxiety and depression.
Notes:
(1) The adverse reactions of trazodone include orthostatic hypotension, dizziness, priapism, etc.
(2) Mirtazapine can cause excessive sedation, appetite/weight gain, and extrapyramidal adverse reactions are prone to occur after long-term use.
05. Chinese patent medicine
Baile Mian Capsule, Kuntai Capsule, Wuling Capsule, Kun Bao Pill (need to be used dialectically under the guidance of a Chinese medicine practitioner)
The pharmacist has something to say
1. Focus on cognitive, behavioral and psychological adjustment
Although the short-term efficacy of drug treatment for insomnia is good, the main methods of correcting insomnia are behavioral modification and psychological adjustment, and long-term dependence on drug therapy should not be used.
2. Pay attention to hormone levels
The management of menopausal insomnia requires attention to hormone levels. The first priority is to identify and treat common sleep disorders-related disorders in this age group, such as depression, anxiety, and sleep apnea, and to initiate hormone replacement therapy as appropriate depending on symptoms and hormone levels.
3. Non-pharmacological treatment
psychotherapy
Cognitive-behavioral therapy, psychoanalytic therapy, marriage therapy, family psychotherapy, behavioral therapy, etc., make their personality develop in a more positive direction. (Consult a psychologist if necessary)
Social support: Positive support
For patients in a state of stress, it provides protection and buffers against the adverse effects of various life events on the patient's mental health.
other
Such as acupuncture, foot bath, stellate ganglion block, magnetic stimulation therapy, etc.
Integrative Treatment: Drug + Psychological + Social
For patients with intractable sleep disorders, a comprehensive treatment model of individualized, drug + psychological + social support can be advocated under the treatment of professional doctors to achieve the best treatment effect for menopausal mood disorders.
In the face of menopausal insomnia, the cause should be clarified under the guidance of a doctor and the appropriate treatment plan should be selected. Understand the effects and risks of medications, use them as directed, and avoid abuse. At the same time, maintain a healthy lifestyle, such as regular work and rest, moderate exercise, balanced diet and emotional management, and comprehensively treat insomnia.
Reviewers:
Mo Xiaolan, Chief Pharmacist, Department of Pharmacy, Women and Children's Medical Center Affiliated to Guangzhou Medical University
He Yaojuan, Chief Physician of the Department of Gynecology, Women and Children's Medical Center Affiliated to Guangzhou Medical University
Author: Feng Wanhua, Department of Pharmacy, Women and Children's Medical Center, Guangzhou Medical University