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zolpidem
sleep latency, awakenings, total sleep time, empty stomach, DOA-8 hours, SL-edluar, spray-zolpimist
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zaleplon
sonata, ONLY latency, short DOA-6 hours, useful to nighttime awakenings, less psychomotor and memory impairment vs zolpidem, food delays by 2 hours, shortest half-life
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eszopiclone
reducing sleep latency, sleep maintenancy, number of awakenings, and total sleep time (20 minutes), unpleasant taste, 6 hours, high fat delays 1 hour
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rozerem
ramelteon, agonist at MT1 and MT2, not specific, reduced sleep latency, improved total sleep time and efficiency, no SE, high fat delays and lowers AUC, no abuse, not a lot of efficacy, not controlled
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trazodone
sedating and can improve sleep continuity, antagonist at H1, 5-HT2, weak 5-HT reuptake inhibitor, not approved for hypnotic, not a lot of efficacy after weeks 1 and 2, decreased awakenings X 3,no latency or total sleep time, reduced stage 1 and REM sleep, increased stages 3 and 4, 25-150mg(lower dose than for depression), good if substance abuse, orthostatic hypo, daytime sedation, priapism, tolerance
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benzos
decrease stage I, increase II, decrease IV, increase latency of REM-no effect on quantity
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temazepam
water-soluble, longer onset of action
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flurazepam, quazepam
longer half-life due to active metabolites
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CPAP
zolpidem does not worsen, and research has shown some hypnotics may improve CPAP tolerability
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modafinil
provigil, non-stimulant wakefullness for residual daytime sleepiness despite optimal CPAP treatment
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narcolepsy tetrad
sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis, can use modafinil or stimulants to treat EDS (excessive daytime sleepiness), TCAs, venla, and fluoxetine most effective for cataplexy and hypnogogic hallunationss
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sodium oxybate (Xyrem)
for potent sedative hypnotic to improve EDS and decreases sleep paralysis, cataplexy and hypnogogic hallucinations, when taken at bedtime can change sleep architecture to resemble normal sleep
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