Melinda S. and her two children (ages 13 and 11) come to see you, their family p
ID: 299954 • Letter: M
Question
Melinda S. and her two children (ages 13 and 11) come to see you, their family physician, about their problems sleeping. They have great difficulty falling asleep in the evening, but once asleep have a normal night’s sleep. Typically, they fall asleep around 4 am and wake up around noon. You decide to prescribe tasimelteon. Melinda is skeptical about its efficacy and is worried about its possible side effects, typically found with other sleep aids such as sedation and addiction. Explain how you would educate Melinda about sleep, and why you think tasimelteon would be effective in treating her symptoms without the problems associated with hypnotics and anxiolytics, often prescribed for insomnia.
Explanation / Answer
Melinda have confusion about their sleeping disorders, problem of their sleeping is due to circadian rhythm sleep wake disorder not due to insomnia. Circadian rhythm or biological clock control processes that ocuur daily such as body temperature, alertness as well as sleep timing. A person desire to sleep and ability to fall asleep is influenced by both the length of time since the person wake from an adequate sleep and by internal circadian rhythm. Melinda and their children unable to sleep on time and awaken at the time required for work and school as well as social need. This symptoms indicates that they are suffering from circadian rhythm sleep wake disorder. They are confused with other sleeping disorder insomnia, difficulty to fall asleep/or staying asleep. In this disorder people waking up often during the night, having trouble going back to sleep, waking up early in the morning, feeling tired upon waking.
For the treatment of insomnia sleeping pills provided for a short time to avoid the drowsiness effect due to insomnia during the day. Hypnotics called depressant and anxiolytic (antianxiety) drugs, slow down the brain activity, higher use of this drug cause drug tolerance means body adjust to them and it takes higher and higher doses to achieve desired effect or dependence develop along with various side effects.
Tasimelteon is a melatonin receptor agonists, it act on high density melatonin receptor present on circadian pacemaker, which result in melatonergic action leads to phase shift circadian rhythm and promote sleep. This drug is well tolerated and does not induce impairment of next day functioning or dependence. It is safe for short term treatment so it is a best option for treatment of melinda sleep wake disorder because it is not slow down the brain activity where as act on improving circadian rhythm for proper sleep pattern.