13 sleep disorders

Question 1

Describe the stages of sleep.

Answer 1

Light sleep includes N1 and N2, deep sleep is N3, and vivid dreaming occurs during REM sleep.

Question 2

What is the purpose of the homeostatic sleep drive?

Answer 2

It reminds the body to sleep after a certain time, regulates sleep intensity, and gets stronger with each hour of wakefulness.

Question 3

Define circadian rhythms in relation to sleep regulation.

Answer 3

They are the 24-hour internal clock in the brain that regulates cycles of alertness and sleepiness based on light changes in the environment.

Question 4

How does shift work disorder affect individuals?

Answer 4

It causes difficulty adjusting to different sleep/wake schedules, sleep disturbances, excessive sleepiness, fatigue, cognitive impairment, and increased risk of various health conditions.

Question 5

What are some measures to promote better sleep according to the content?

Answer 5

Using a sleep diary, consuming caffeinated drinks to counteract sleepiness, maintaining optimal working schedules and environment, seeking support from Occupational Health, and balancing commitments while managing stress, anxiety, or depression.

Question 6

Describe jet lag disorder.

Answer 6

It occurs due to travel across time zones, causing a misalignment between the individual’s internal circadian rhythm and the required sleep/wake cycles in the new time zone.

Question 7

Describe strategies for managing jet lag during travel stays of different durations.

Answer 7

For short stays (≤2 days), continue activities like sleeping and eating on ‘home time’. For longer stays, maximize pre-flight sleep, shift bedtimes before travel, adopt destination time schedule from boarding, eat light, stay hydrated, limit alcohol.

Question 8

Define insomnia and its symptoms.

Answer 8

Insomnia is difficulty in getting to sleep, maintaining sleep, early wakening, or non-restorative sleep. Symptoms include fatigue, mood changes, poor concentration, and cognitive impairment.

Question 9

How can short-term insomnia be managed?

Answer 9

Address associated stressors, manage co-morbidities, advise on sleep hygiene, consider a short course of z-drug if necessary, and offer CBT-I if insomnia persists.

Question 10

Do complications of insomnia exist? If so, what are they?

Answer 10

Yes, complications include impaired daytime functioning, fatigue, mood changes, poor concentration, and cognitive impairment.

Question 11

Describe the management approach for chronic insomnia.

Answer 11

Optimally manage co-morbidities, advise on sleep hygiene, consider CBT-I with or without short-term hypnotic medication if insomnia is persistent.

Question 12

Describe Z-drugs.

Answer 12

Z-drugs are non-benzodiazep hypnotics that act at the benzodiazepine receptor, not licensed for long-term use, with risks of tolerance, dependence, and withdrawal syndrome.

Question 13

What are some contrainations for Z-drugs?

Answer 13

Contraindications include marked neuromuscular respiratory weakness, respiratory failure, obstructive sleep apnoea, pregnancy and breastfeeding, severe hepatic impairment, and psychotic illness.

Question 14

How should Zopiclone and Zolpidem tartrate be taken?

Answer 14

Zopiclone is taken at 7.5mg once daily at bedtime, while Zolpidem tartrate is taken at 10mg once daily at bedtime, with a warning not to readminister during the same night.

Question 15

Define the use of Melatonin in adults.

Answer 15

Melatonin is used for short-term treatment in insomnia in adults over 55 years and for short-term treatment of jet lag.

Question 16

Describe the dosing regimen for Melatonin.

Answer 16

Melatonin is taken as 2mg once daily for up to 13 weeks in insomnia, and 3mg once daily for up to 5 days in jet lag, with specific timing instructions.

Question 17

What is Daridorexant indicated for?

Answer 17

Daridorexant is indicated for chronic insomnia in adults with significantly affected daytime functioning, after unsuccessful CBT-I or when unavailable or unsuitable.

Question 18

What are some considerations for Daridorexant use and the dose

Answer 18

Daridorexant should be used for the shortest duration possible, with a starting dose of 50mg once daily, taken within 30 minutes before bedtime, caution in depression, older individuals, and psychiatric illness.

Question 19

Describe Benzodiazepines.

Answer 19

Benzodiazepines are GABA receptor agonists used for severe, disabling, or distressing insomnia, with varying durations of action and potential residual effects.

Question 20

What are some MHRA/CHM advice regarding benzodiazepines?

Answer 20

MHRA/CHM advises monitoring closely for potentially fatal respiratory depression with opioids, and warns of withdrawal symptoms in around 40% of individuals taking benzodiazepines continuously for over 6 weeks.

Question 21

Describe the action of barbiturates on the GABAA receptor/chloride channel.

Answer 21

Barbiturates enhance the action of GABA by binding to a site on the GABAA receptor/chloride channel.

Question 22

What are the two approaches for benzodiazepine and z-drug withdrawal?

Answer 22

The two approaches for withdrawal are slow dose reduction of the current benzodiazepine or z-drug, or switching to an equivalent dose of diazepam which is then tapered down.

Question 23

Why is the use of phenobarbital as a sedative considered unjustified?

Answer 23

The use of phenobarbital as a sedative is considered unjustified due to its long-acting nature and the availability of safer alternatives.

Question 24

How long may drug withdrawal from benzodiazepines or z-drugs take, and why should they not be stopped abruptly?

Answer 24

Drug withdrawal may take 3 months to a year, and they should not be stopped abruptly to avoid producing confusion, toxic psychosis, or convulsions.

Question 25

Why should barbiturates be avoided in older people?

Answer 25

Barbiturates should be avoided in older people due to their less specific action compared to benzodiazepines and the increased risk of adverse effects in this population.