Anxiety and Sleep Disorder Flashcards
Anxiety
Anxiety is a generalized feeling of worry, fear or uneasiness about a perceived threat
Panic Disorder
intense, immediate feelings of fear, impending doom, increased sympathetic effects
Generalized anxiety Disorder
Excessive anxiety that lasts more than 6 months
Symptoms include restlessness, fatigue, difficulty focusing, sense of dread, sleep disturbances
Sympathetic effects are common as part of stress response
Phobias
Excessive fear related to objects or situations
OCD
Recurrent intrustive thoughts or behaviours
PTSD
Anxiety associated with past event
What can worsen anxiety
Medications that may worsen/cause anxiety symptoms
Medical conditions that may be associated with anxiety
Limbic system associated with
emotion, learning and memory
Connects to hypothalamus to mediate responses related to anxiety, fear, anger
Hypothalamus influences sympathetic response
Reticular Formation (part of Reticular Activating System
Stimulation of reticular formation increases arousal and alertness
Inhibition of reticular formation promotes drowsiness and sleep
In anxiety, messages from hypothalamus and limbic are carried by way of reticular activating system to cortex – this is thought to be basis of fear and anxiety
Sleep patterns remain the same throughtout our life cycle
Sleep patterns vary during the life cycle and can vary from person to person
Circadian rhythms
Circadian rhythms associated with sleep as well – occur due to changes in light during day and secretion of melatonin; melatonin can promote sleep
Types of insomnia
Sleep-onset insomnia
Difficulty falling asleep
Sleep-maintenance insomnia
Difficulty staying asleep
Sleep-offset insomnia
Waking up too early
Non-Resorative sleep
Adequate sleep duration but sleepy during day
Insomnia AE
reduced glucose tolerance, obesity, increased blood pressure, and increased inflammatory markers in healthy adults, heart disease, and mortality
Non pharm tx of insomnia
Avoid exercise 4 hours before bed
Avoid large meals in evening
Read a book
Go to sleep and wake up at same time
Cooler temperature
Relax before bed
MoA of Nexodiazepines
bind GABAA receptor which causes its Cl- channel to open, decreasing excitability of post-synaptic neurons in limbic system
Metab by liver, excreted by kidneys
Benzodiazepines
Drugs of choice for Generalized Anxiety disorder (GAD) and Short-term insomnia therapy (up to about 4 weeks)
AE of Benxodiazepines
Drowsiness, ataxia, sedation. blurred vision
Benzo interactions
Resp depression can occur when mixed with other CNS depressants
Antagonized by flumazenil
Examples of benzodiazepien
LorzaPAM
DiazoPAM
end in PAM
Lorazepam
Benzodiazepine
Tx of General Anxiety Disorder (GAD)
Anxiolytic, sedative-hypnotic
Anti-seizure
Pre-anaesthetic
MoA: Binds to GABA
AE of Lorzaepam
Same as for benzodiazepines in general
Drowsiness, sedation, ataxia, blurred vision, disorientation, anterograde amnesia
Increased dose can promote sleep and coma
Versed uses
A benzodiazepine that does not cause the Pt to become unconscious but keeps them sedated.
Puts pt kind of under, but can still obey instructions
Decreases narcotic caused twitching
PO, IV, Nasal/cheek spray
General anesthetic, Final stage of EOL care, schiz mgmt, First line agent in palliative continueous deep sedation therapy
Barbituates
Used less commonly now for anxiety and insomnia compared to benzodiazepines
More severe withdrawl symptoms
- Dependence – both psychological and physiological dependence occur; withdrawal is severe and can be fatal
