Pharmacotherapy for insomnia

Feren, Stephen D.; Schweitzer, Paula K.; Walsh, James K.

doi:10.1016/b978-0-444-52007-4.00005-9

Cited by 8 publications

(7 citation statements)

References 94 publications

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“…Both GABA A and GABA B receptors, along with GABA, are known to play an important role in sleep. Most hypnotic drugs act upon the benzodiazepine binding site of the GABA A R to enhance GABA-mediated currents ( Wafford and Ebert, 2008 ; Winsky-Sommerer, 2009 ; Feren et al, 2011 ). Some, like anesthetic agents (eg, barbiturates), act directly upon the GABA A R ion channel ( Franks, 2008 ).…”

Section: Discussionmentioning

confidence: 99%

GABA Receptors on Orexin and Melanin-Concentrating Hormone Neurons Are Differentially Homeostatically Regulated Following Sleep Deprivation

Toossi

Cid-Pellitero

Jones

2016

eneuro

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Though overlapping in distribution through the hypothalamus, orexin (Orx) and melanin-concentrating hormone (MCH) neurons play opposite roles in the regulation of sleep–wake states. Orx neurons discharge during waking, whereas MCH neurons discharge during sleep. In the present study, we examined in mice whether GABAA and GABAB receptors (Rs) are present on Orx and MCH neurons and might undergo differential changes as a function of their different activities following sleep deprivation (SD) and sleep recovery (SR). Applying quantitative stereological image analysis to dual-immunofluorescent stained sections, we determined that the proportion of Orx neurons positively immunostained for GABAARs was significantly higher following SD (∼48%) compared with sleep control (SC; ∼24%) and SR (∼27%), and that the luminance of the GABAARs was significantly greater. In contrast, the average proportion of the MCH neurons immunostained for GABAARs was insignificantly lower following SD (∼43%) compared with SC (∼54%) and SR (56%), and the luminance of the GABAARs was significantly less. Although, GABABRs were observed in all Orx and MCH neurons (100%), the luminance of these receptors was differentially altered following SD. The intensity of GABABRs in the Orx neurons was significantly greater after SD than after SC and SR, whereas that in the MCH neurons was significantly less. The present results indicate that GABA receptors undergo dynamic and differential changes in the wake-active Orx neurons and the sleep-active MCH neurons as a function of and homeostatic adjustment to their preceding activity and sleep–wake state.

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Section: Discussionmentioning

confidence: 99%

GABA Receptors on Orexin and Melanin-Concentrating Hormone Neurons Are Differentially Homeostatically Regulated Following Sleep Deprivation

Toossi

Cid-Pellitero

Jones

2016

eneuro

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“…Used in the treatment for insomnia, most sedative-hypnotic drugs also act upon GABA A receptors [59][60][61][62]. Depending upon the precise receptor sub-type upon which the drug acts, different drugs, such as the benzodiazepine-receptor agonists and direct GABA A receptor agonists, can act most prominently upon neurons within particular sites, such as the thalamus or cortex, to effect particular changes, such as enhanced spindle-like activity or slow waves in the EEG normally associated with SWS.…”

Section: Preoptic Area and Hypothalamusmentioning

confidence: 99%

“…A role for HA neurons in cortical activation and attentive W has been known for years in view of the effects of anti-HA medications [61,62]. Yet, despite H1 receptor antagonist actions of these drugs, which are responsible for the increased slow wave activity, most of the anti-HA drugs, like many of the drugs prescribed for insomnia, also act on other arousal systems, including ACh, NA, DA, and serotonin transmission.…”

Section: Histamine Neuronsmentioning

confidence: 99%

Arousal and sleep circuits

Jones

2019

Neuropsychopharmacol.

165

109

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The principal neurons of the arousal and sleep circuits are comprised by glutamate and GABA neurons, which are distributed within the reticular core of the brain and, through local and distant projections and interactions, regulate cortical activity and behavior across wake-sleep states. These are in turn modulated by the neuromodulatory systems that are comprised by acetylcholine, noradrenaline, dopamine, serotonin, histamine, orexin (hypocretin), and melanin-concentrating hormone (MCH) neurons. Glutamate and GABA neurons are heterogeneous in their profiles of discharge, forming distinct functional cell types by selective or maximal discharge during (1) waking and paradoxical (REM) sleep, (2) during slow wave sleep, (3) during waking, or (4) during paradoxical (REM) sleep. The neuromodulatory systems are each homogeneous in their profile of discharge, the majority discharging maximally during waking and paradoxical sleep or during waking. Only MCH neurons discharge maximally during sleep. They each exert their modulatory influence upon other neurons through excitatory and inhibitory receptors thus effecting a concerted differential change in the functionally different cell groups. Both arousal and sleep circuit neurons are homeostatically regulated as a function of their activity in part through changes in receptors. The major pharmacological agents used for the treatment of wake and sleep disorders act upon GABA and neuromodulatory transmission.

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“…Pharmacological therapy is generally the first-line treatment. 17 18 However, pharmacological therapy has been associated with numerous adverse effects and complications, including memory loss, prolongation of mechanical ventilation, altered sleep stages, longer length of hospitalisation, tolerance, bradycardia, hypotension, residual daytime effects, dysmotility, weakness and delirium. 19 20 In addition, the medications used are expensive.…”

Section: Introductionmentioning

confidence: 99%

Use of music to enhance sleep and psychological outcomes in critically ill patients: a protocol for a systematic review and meta-analysis

Chen

Wang

et al. 2021

BMJ Open

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IntroductionMusic listening is used as a non-pharmacological intervention in various populations with positive results; however, evidence for its effect on sleep and psychological outcomes in critically ill patients remains unclear. It is essential to understand the impact of music listening for critically ill patients to optimise care and minimise the risk for harm. We will assess whether music listening improves sleep and psychological outcomes in critically ill patients.Methods and analysisWe will systematically search scientific databases for relevant studies, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest, the Cochrane Central Register of Controlled Trials, China Biological Medicine Database, China National Knowledge Infrastructure Library, Wan fang databases, VIP Database for Chinese Technical Periodicals and the Chinese Clinical Trial Registry. Databases will be searched for articles published from inception to 10 June 2020. Music therapy journals and reference lists in some articles will be hand-searched. Grey literature will also be searched. We will include randomised and quasi-randomised controlled trials that used music listening to improve sleep and psychological outcomes in critically ill patients. The primary outcomes will be sleep-related outcomes, and secondary outcomes will be anxiety and depression scores and physiological outcomes. Two reviewers will independently verify study eligibility and methodological quality; disagreements will be resolved by a third reviewer or through discussion. The risk of bias will be independently determined using the Cochrane Risk of Bias Tool. The Consolidated Standards of Reporting Trials checklist will be used to examine the quality of included papers. Data will be extracted from eligible studies by two researchers. RevMan V.5.3 will be used for meta-analysis.Ethics and disseminationThis work will review existing trial data and will not introduce new patient data or interventions; therefore, ethics committee approval is not required. We will disseminate this protocol in a related peer-reviewed journal.PROSPERO registration numberCRD42019147202.

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Pharmacotherapy for insomnia

Cited by 8 publications

References 94 publications

GABA Receptors on Orexin and Melanin-Concentrating Hormone Neurons Are Differentially Homeostatically Regulated Following Sleep Deprivation

GABA Receptors on Orexin and Melanin-Concentrating Hormone Neurons Are Differentially Homeostatically Regulated Following Sleep Deprivation

Arousal and sleep circuits

Use of music to enhance sleep and psychological outcomes in critically ill patients: a protocol for a systematic review and meta-analysis

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