Pharm

• 1. To modify circadian rhythms
• 2. To promote alertness
• 3. and wakefulness (e.g. CNS stimulants)
• 4. Most frequently used for excessive daytime sleepiness
• 5. To promote and improve the quality of sleep
• 6. To treat the large group of sleep disorders which lead to abnormal experiences, autonomic, and immunological activity, and motor activity during sleep, usually by modifying the nature or duration of individual sleep stages.

• 1. Drugs used to treat psychiatric or neurological disorders
• 2. Drugs used for non-psychiatric or non-neurological disorders (Most of these affect sleep and wakefulness by altering neurotransmitter function within the brain)

• 1. Produced in the pineal gland
• 2. Rapidly absorbed from the GI tract
• 3. Peak concentration around 60 minutes

1. Sleep-phase alteration - Melatonin is excreted during the absence of light exposure and influences the timing of the SCN. If taken late in the evening it advances the next phase of sleep. If it is taken in the morning is causes a delay in the next phase of sleep.

2. Hypnotic Effect - Melatonin is a mild hypnotic when given in the day at the time when levels are low. Causes the body temperature to decrease. Usually associated with sleep onset.

3. Other actions - Vasoconstrictor, has a slight hypotensive effect.

• Can accelerate the adaptations of the circadian rhythms to time zone changes causing jet lag
• Can promote a more regular sleep-wake cycles in those who are blind and experience insomnia or EDS due to failure to entrain their circadian rhythms to environmental light exposure
• Use in treating early morning wakening pattern of insomnia when there is a deficient secretion of melatonin

• Used to combat EDS
• Limited use due to tolerance, dependency, withdrawal symptoms, side-effects, drug interactions and the dangers of overdose.

• Caffeine
• 1. Has a greater effect on the CNS and skeletal muscle
• 2. Reduce total sleep time
• 3. Increase sleep latency
• 4. Reduce the duration of N3 and REM
• 5. Prolong wakefulness
• 6. Increase mental activity
• 7. Improve attention and vigilance (Does not improve mental function requiring originality)

• 1.Respiratory stimulant and bronchodilator
• 2. Diuresis
• 3. Tachycardia
• 4. Nausea, vomiting, abdominal pain and gastroesphogeal reflux
• 5. Temors and muscle twitching

• 1.EDS
• 2. Central Sleep Apnea and Chyne-Stokes breathing
• 3. Nocturnal Asthma

• 1. In low does it is excitatory and in high does an inhibitory.
• 2. Increase the release of dopamine.

• 1. Reduces the total sleep time
• 2. Increases sleep latency
• 3. Reduces sleep efficiency
• 4. Reduces the duration of REM

• Low doses
• 1. lead to mental relaxation
• 2. Mild sedative
• 3. Promotes sleep
• High doses
• 1. Stimulant
• 2. Increasing arousal
• 3. May cause agitation
• 4. Can improve motor performance
• 5. Commonly causes muscle tremors
• 6. Overdoses can lead to dizziness, fits and delirium

• 1. Loss of appetite
• 2. Nausea
• 3. tachycardia

• Increase alertness
• Relieves fatigue
• Euphoric action
• Increases motor activity

• Chronic use - sleep deprivation
• Reduces total sleep time
• Increases sleep latency
• Reduces N3 and REM sleep

• Reduces total sleep time
• Increases sleep latency
• Reduces total REM time (10% of total sleep time is spent in REM)

• Prolongs wakefulness
• increases level of alertness
• reduces fatigue
• increases confidence and concentration
• can lead to agitation and aggression
• paranoid psychosis with auditory hallucinations (indistinguishable from schizophrenia)

• appetite suppression
• respiratory stimulant
• raises body temp
• tachycardia
• mild hypertension
• dry mouth
• headache
• tremors