CMS Manual System - Louisiana Department of Health and Hospitals

Medication Issues and Concerns
fluticasone
triamcinolone
acetonide
Miscellaneous, e.g.,
cromolyn
nedocromil sodium
Sedatives/Hypnotics (sleep
medications)
All hypnotics
Benzodiazepine hypnotics,
e.g.,
estazolam
flurazepam
quazepam
temazepam
triazolam
Non-benzodiazepine
hypnotics, e.g.,
eszopiclone
zaleplon
zolpidem
Melatonin receptor agonists,
e.g.,
ramelteon
Other hypnotics, e.g.,
chloral hydrate
Miscellaneous agents used
for sleep, e.g.,
sedating
antidepressants (e.g.,
trazodone)
sedating
antihistamines (e.g.,
hydroxyzine)
Indications
Most cases of insomnia are associated with
underlying conditions (secondary or co-morbid
insomnia) such as psychiatric disorders (e.g.,
depression), cardiopulmonary disorders (e.g.,
COPD, CHF), urinary frequency, pain, obstructive
sleep apnea, and restless leg syndrome. Insomnia
may be further described by the duration of
symptoms
Before initiating medications to treat insomnia,
other factors potentially causing insomnia should
be evaluated, including, for example:
o environment, such as excessive heat, cold,
or noise; lighting
o inadequate physical activity
o facility routines that may not accommodate
residents‘ individual needs (e.g., time for
sleep, awakening, toileting, medication
treatments)
o provision of care in a manner that disrupts
sleep
o caffeine or medications known to disrupt
sleep
o pain and discomfort
o underlying conditions (secondary or comorbid
insomnia) such as psychiatric
disorders (e.g., depression),
cardiopulmonary disorders (e.g., COPD,
CHF), urinary frequency, pain, obstructive
sleep apnea, and restless leg syndrome
It is expected that interventions (such as sleep