Lower doses of sublingual Zolpidem are more effective than oral Zolpidem to anticipate sleep onset in healthy volunteers.

OBJECTIVE: To compare the efficacy of sublingual Zolpidem (5 and 10mg) to conventional oral Zolpidem (10mg). METHODS: This was an open, randomized, double-blind, double-dummy, controlled, and single center study. The study took place at the Laboratory of Clinical Neurophysiology and total number of participants was 58 volunteers completed the study whose demographics of age, gender, body mass index (BMI) were similar among everyone. Scores in Epworth, Pittsburgh, Beck and Hamilton Scales did not differ among groups. A model of transient insomnia was determined by the sleep anticipation in 120minute. Subjects were randomly divided in three groups for drug administration (5mSL; 10mgSL and 10mg oral), given in a single dose prior to polysomnography (PSG). Sleep parameters were assessed by PSG and post-sleep questionnaires. RESULTS: A significant main treatment effect was evident considering the sleep onset latency (SOL) and persistent sleep latency (PSL). An earlier sleep onset was induced by SL Zolpidem 10mg (SOL=p<0.004; PSL=p<0.006) and SL Zolpidem 5mg (SOL=p<0.025; PSL=p<0.046) compared to oral Zolpidem 10mg. Subjects that received SL Zolpidem 10mg reported an earlier sleep onset (latency to sleep and latency until persistent sleep) when compared to subjects from other groups (p<0.005). CONCLUSIONS: Sublingual Zolpidem, both 5 and 10mg, induced faster sleep initiation than 10mg oral Zolpidem. A subjective perception of earlier sleep onset was reported by subjects using SL 10mg.

Jactatio capitis nocturna with persistence in adulthood: case report

Rhythmic movement disorder, also known as jactatio capitis nocturna, is an infancy and childhood sleep-related disorder charactherized by repetitive movements occurring immediately prior to sleep onset and sustained into light sleep. We report a 19-year-old man with a history of headbanging and repetitive bodyrocking since infancy, occurring on a daily basis at sleep onset. He was born a premature baby but psychomotor milestones were unremarkable. Physical and neurological diagnostic workups were unremarkable. A hospital-based sleep study showed: total sleep time: 178 min; sleep efficiency index 35.8; sleep latency 65 min; REM latency 189 mim. There were no respiratory events and head movements occurred at 4/min during wakefulness, stages 1 and 2 NREM sleep. No tonic or phasic electromyographic abnormalities were recorded during REM sleep. A clinical diagnosis of rhythmic movement disorder was performed on the basis of the clinical and sleep studies data. Clonazepam (0.5 mg/day) and midazolam (15 mg/day) yielded no clinical improvement. Imipramine (10 mg/day) produced good clinical outcome. In summary, we report a RDM case with atypical clinical and therapeutical features.

Tolerância e dependência a benzodiazepínicos: a respeito de um caso / Tolerance and dependence to the benzodiazepines: apropos of a case

E estudado um caso de abso e dependência a benzodiazepinicos com tolerância a alguns (psicomotor, sedativo), mas näo a todos (amnéstico) os efeitos dessas drogas (tolerância diferencial) e síndrome de abstinência com acentuaçäo de traços paranóides de personalidade