Sleep Disorders (Insomnia): Prevention

To prevent insomnia (sleep disorders), attention must be paid to reducing individual risk factors. Behavioral risk factors

• Diet
  • Physiological causes – eating or drinking at night.
• Consumption of stimulants
  • Alcohol
  • Coffee, tea (caffeine)
  • Tobacco (smoking)
• Drug use
  • Amphetamines (indirect sympathomimetic): ecstasy (3,4-methylenedioxy-N-methylamphetamine, MDMA), crystal meth (methamphetamine) or methylphenidate.
  • Cannabis (hashish and marijuana).
  • Cocaine
• Physical activity
  • Immobility and bedriddenness (common causes of insomnia in the elderly).
  • Sitting activity or sitting too long.
  • Competitive sports
  • Professional sports
  • Intense training <1 hour before bedtime → longer time to fall asleep and less total sleep.
• Psycho-social situation
  • Psychological causes such as anger, unresolved problems, marital crises, stressful situations, overwork, pressure to perform.
  • Computer and internet use: a strong association was shown with:
    • Girls: excessive music listening (≥ 3 h /day).
    • Boys: Use of computer or Internet (≥ 3 h / daily).
    • Total time spent in front of the screen of an electronic device (≥ 8 h/ daily).
  • Stress (including at work).
• Absence of the usual sleep ritual
• Overweight (BMI ≥ 25; obesity) – is also associated with sleep apnea.

Medication

• Alpha-2 agonist (tizanidine)
• Antibiotic
  • Quinolones (cinoxacin, ciprofloxacin clioquinol, danofloxacin, difloxacin, enrofloxacin, fleroxacin, flumequin, gatifloxacin, grepafloxacin, ibafloxacin levofloxacin, Marbofloxacin moxifloxacin, nalidixic acid, norfloxacin, ofloxacin, orbifloxacin, oxolinic acid, pipemidic acid, sarafloxacin, sparfloxacin, temafloxacin, nadifloxacin).
• Antiarrhythmics
  • Ic antiarrhythmics (flecainide).
• Anticholinergics (darifenacin, solifenacin, tolterodine).
• Antidepressants
  • Noradrenergic and specific serotonergic antidepressants (NaSSA) – mirtazapine.
  • Selective dopamine and norepinephrine (marginally also serotonin) reuptake inhibitors (NDRIs) – bupropion
  • Selective norepinephrine reuptake inhibitor (NARI) – reboxetine, viloxazine.
  • Selective serotonin reuptake inhibitors (SSRI) – citalopram, fluoxetine, paroxetine, sertraline, trazodone).
  • Selective serotonin–norepinephrine reuptake inhibitors (SSNRI) – duloxetine, venlafaxine.
  • Tricyclic antidepressants (TCAs) – amitriptyline, amitriptyline oxide, clomipramine, desipramine, doxepin, imipramine, opipramol, nortriptyline, trimipramine).
• Antihistamines (ketotifen).
• Antimalarials (atovaquone, chloroquine, proguanil).
• Antiparkinsonian agents (levodopa* , pergolide, pramipexole* * ).
• Antipsychotics (neuroleptics).
  • Atypical antipsychotics (neuroleptics) – aripiprazole.
• Antisympathetic drugs (alpha-methyldopa).
• Α2-receptor agonists (clonidine, moxonidine).
• Beta-blockers, local (betaxolol, timolol).
• Beta-blockers, systemic
  • Nonselective beta-blockers (e.g., carvedilol, pindolol, propranolol, soltalol).
  • Selective beta blockers (e.g., atenolol, acebutolol, betaxolol, bisoprolol, celiprolol, nebivolol, metoprolol).
• Calcium sensitizer (levosimendan).
• Hormones
  • Dopamine agonists (prolactin inhibitors) – bromocriptine, cabergoline, lisuride, pramipexole, ropinirole).
  • Oral contraceptives (non-REM sleep phase elevated, body temperature elevated) [sleep disturbances especially at the beginning of use].
  • Thyroxine (thyroid hormone).
• MAO inhibitors (moclobemide, tranylcypromine).
• Medications containing caffeine (e.g., guarana) or theophylline.
• Monoclonal antibodies – pertuzumab, trastuzumab.
• MTOR inhibitors (everolimus, temsirolimus).
• Multi-tyrosine kinase inhibitor (vandetanib).
• Non-steroidal anti-inflammatory drugs (NSAID) or NSAID (non steroidal anti- inflammatory drugs) – acetylsalicylic acid (ASA), indometacin.
• Nicotine agonists (varenicline).
• Opioid antagonists (nalmefene, naltrexone).
• Phytotherapeutics (ginseng).
• Proton pump inhibitors (PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
• Psychotropic substances/psychostimulants such as amphetamine and its derivatives ephedrine or pseudoephedrine; methylphenidate (MPH); modafinil.
• Sedatives (bromazepam, oxazepam).
• Sympathomimetics (etilefrin)
• Tyrosine kinase inhibitors (vandetanib).
• Antivirals
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, nevirapine, rilpivirine.
  • Nucleoside analogues (entecavir, lamivudine, telbivudine).
  • Nucleoside analogues (aciclovir, brivudine, cidofovir, famciclovir, foscarnet, ganciclovir, valaciclovir).
• Cytokines (interferon ß-1a, interferon ß-1b, glatiramer acetate).

* Administered at low doses, levodopa appears to be sleep-inducing, but suppressive at higher doses. * * Limited fitness to drive due to sudden attacks of sleep.

Environmental exposure – intoxications

• Physical causes – altitude-induced sleep disturbance, noise (esp. night noise/noise from night flights), bright lights, high temperatures, etc.
• Residential and environmental toxins – particle board, paints, wood preservatives, wall paint, floor coverings, etc.

Other risk factors

• Nightmares
• Lack of social contact, loneliness, worry (common causes of insomnia in old age).
• Gravidity (pregnancy)
• Disturbance of the biorhythm
  • Light from e-book readers, smartphones, laptops or tablet PCs (higher blue content than that of a bedside lamp) switches the internal clock to sleep mode with a delay
  • Shift work
  • Time zone changes (jet lag) etc.
• Snoring

Prevention factors (protective factors)

• Children with high fish consumption (at least once a week) sleep better and score higher on IQ tests (verbal IQ but not performance IQ).
• Compensating for sleep deficit: Those who sleep too little on weekdays can make up the deficit on weekends – without harming health. When making up for the missing night’s rest on days off, sleep deprivation is not associated with an increased mortality risk (risk of death) in the long term. Other results of the study showed:
  • People <65 years of age who slept ≤ 5 hours each night had an increased risk of mortality during the study period compared with people with this amount of sleep.
  • People <65 years of age who slept >9 hours each night had an increased mortality rate.