Nihon rinsho. Japanese journal of clinical medicine
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Current treatment of insomnia with hypnotics, GABA(A) receptor modulators, induces various side effects, including cognitive impairment, motor disturbance, dependence, tolerance, hang-over, and rebound insomnia. Ramelteon (Rozerem) is an orally active, highly selective melatonin MT1/MT2 receptor agonist. Unlike the sedative hypnotics that target GABA(A) receptor complexes, ramelteon is a chronohypnotic that acts on the melatonin MT1 and MT2 receptors, which are primarily located in the suprachiasmatic nucleus. Ramelteon has demonstrated sleep-promoting effects in clinical trials, and coupled with its favorable safety profile and lack of abuse potential or dependence, this chronohypnotic provides an important treatment option for insomnia.
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Insomnia is common in many patients with chronic obstructive pulmonary disease (COPD). The causes of insomnia are sleep induced pathophysiological effect of COPD itself, COPD comorbidities and the presence of coexisted obstructive sleep apnea. Sleep has profound adverse effects on respiration and gas exchange in patients with COPD. ⋯ They include decreased functional residual capacity, decreased ventilatory responses to hypoxia and hypercapnia, impaired respiratory mechanical effectiveness, respiratory muscle fatigue, decreased respiratory drive, and increased upper airway resistance. COPD comorbidities include DM, cardiovascular diseases, osteoporosis, depression, and GERD. The coexistence of COPD and sleep apnea-hypopnea syndrome has been denominated "overlap syndrome".
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Insomnia has mainly been treated with the hypnotic benzodiazepine (BZ). Recent studies have revealed the role and mechanisms of BZ receptors and have led to the development of non-BZ hypnotics. ⋯ Antipsychotics, antidepressants, and antihistamines are also used for the treatment of insomnia in patients with other medical problems such as schizophrenia and depression. Currently, novel hypnotics are being developed with the manipulation of neurotransmitters and non-GABAergic receptors such as the melatonin and serotonin receptors.