Saturday, July 2, 2011

Afternoon Sleepiness

GABA Benzodiazepine Receptors

Benzodiazepines are a class of drugs used for their highly sedating properties varying in strengths and weaknesses. Gamma-aminobutyric acid (GABA) is the most prevalent inhibitory neurotransmitter found in the brain. GABA works by reducing the action potential of a cell which prevents it from firing. Drugs that work on GABA are barbiturates, benzodiazepines, baclofen and many more. Clonzaepam (Klonopin) is a benzodiazepine that is used as a sleeping agent and also a treatment for anxiety, seizures and muscle spasms. In general, benzodiazepines are very effective in helping people to fall asleep easy, but they are used cautiously because they often are known to cause dependency, tolerance, withdrawal and rebound insomnia if used on a nightly basis for a long period of time.

Dependence meaning the person needs the medication in order to sleep while tolerance means that the drug has to be increase to achieve the same affect. Dependence is not to be confused with an addiction to the medication. Addiction is when someone has a physical dependence along with impaired control over drug use, compulsive use and continued use despite harm, and craving. Benzodiazepines can also bring about agitation, nausea, sweating and palpitations common symptoms of withdrawal. Rebound insomnia occurs after withdrawal of the drug, but usually for only one to two nights.

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The trouble with Clonazepam in particular is that it takes a long time to clear the system and its sedating effects can last into the next day causing afternoon sleepiness. Although this drug can cause withdrawal symptoms if stopped suddenly, but it is less likely to cause rebound insomnia like other shorter acting benzos. Besides afternoon sleepiness it is known to trigger sleepwalking and sleep eating, two sleep parasomnias. Parasomnia is defined as a sleep disorder in which odd or dangerous events occur that intrude on sleep. The parasomnias include sleep talking, sleepwalking (somnambulism), sleep eating, sleep terrors, REM behavior disorder, and nocturnal dissociative disorder. People with kidney or liver disorders should be on lower doses. See: How Do You Beat Afternoon Sleepiness

To avoid afternoon sleepiness doctors may recommend a benzos with a medium half life which usually helps someone to get to sleep easily and stay asleep most of the night without the drug “hangover” in the morning. Medications like Ambien are called non-benzodiazepines, but this is misleading because they also act on the GABA benzodiazepine receptors in the brain. Drugs like Ambien have no anti-anxiety properties and most people with non-medical insomnia have anxiety that is causing their insomnia or it is a symptom of their insomnia. Often a doctor will recommend cognitive behavioral therapy if a person has a chronic case of insomnia that is caused by anxiety and stress. See more info: 18 Tips and Techniques How To Wake a Sleepy Head

Intermittent use of benzos can help reduce the possibility of afternoon sleepiness, dependency and withdrawal and anyone struggling with withdrawal is highly aware how the effects the drugs have had on their mind and body. Benzodiazepines can impair cognitive function, cause memory lapse, confusion, increase anxiety, nightmares and other physical symptoms. Because benzos enhance GABA, the brains output of excitatory neurotransmitters that applies energy to nerve cells, serotonin and dopamine are reduced. Excitatory neurotransmitters are responsible for normal alertness, muscle tone and coordination, emotional responses, memory, endocrine gland secretions, heart rate and blood pressure control, as well as other functions, all of which may be impaired by benzodiazepines. These direct increases in neurotransmitter output are the very reason there are adverse side effects with benzodiazepines.

GABA receptors also combine chemically with other medications and alcohol which may explain why people become addicted to alcohol when they are on benzodiazepines. Since many patients build up a tolerance to the medication this often leads to an increase in anxiety which causes the individual to raise their dosage or become addicted to another drug. Because the natural action of GABA is augmented by benzos, regular use can alter the natural balance of GABA and too much GABA by increased dosage can increase anxiety, cause shortness of breath tingling in the extremities and numbness around the mouth.

[caption id="attachment_1311" align="alignright" width="300" caption="Afternoon Sleepiness "][/caption]

Prolonged use or increased dosage causes the brain to reduce its own production of GABA and this is why the withdrawal of the drug can result in insufficient GABA activity producing symptoms worse than the ones originally treated. The heart rate increases while sleep decreases due to the mind is in a constant state of alertness known as the flight/fright response. GABA is required to calm the central nervous system, relax body muscles, regulate sex hormones and promote sleep. 50% of the millions of neurons in the brain respond to GABA…GABA has a quieting influence on the mind and body. It is therefore imperative to stop taking benzodiazepines and allow the GABA receptors to regenerate and restore to normal levels for peace of mind and restful nights.

The content provided in Afternoon Sleepiness is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.

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