Behav. Sci. Insomnia

Question 1

define insomnia

Answer 1

complaint of dissatisfaction with sleep quantity or quality, associated with:

• difficulty initiating, maintaining, or early morning awakening with inability to return to sleep
• causes distress/impairment
• at least 3 nights per week in the last 3 months

Question 2

dyssomnia

Answer 2

sleep disorder characterized by problems in timing, quality, or amount of sleep (insomnia is classified as this)

Question 3

parasomnia

Answer 3

sleep disorder characterized by abnormalities in physiology or behavior associated with sleep

Question 4

epidemiology of insomnia

Answer 4

1/3 of adults, 10-15 with impairments, women more often, increases with age

Question 5

etiology of insomnia

Answer 5

• excitatory neurotransmitters in excess at night (NE, serotonin, dopamine, histamine)
• inhibitory neurotransmitter deficiency at night (loss of GABA, melatonergic, adenosinergic)
• use of CNS stimulants (caffeine)
• withdrawal of sedating agents (alcohol, barbiturates, benzos)
• medical conditions (pain, pulmonary disease, endocrine disorders)
• psychiatric causes (MDD, bipolar, generalized anxiety/PTSD)

Question 6

where does NE come from?

Answer 6

locus ceruleus

Question 7

where does serotonin come from?

Answer 7

raphe nucleus

Question 8

where does dopamine come from?

Answer 8

ventral tegmental area

Question 9

where does histamine come from?

Answer 9

tubermammillary nucleus

Question 10

which symptoms commonly lead to insomnia?

Answer 10

anxiety (getting caught up in thoughts about past events, excessive worrying, overwhelmed) also anxiety about not falling asleep

Question 11

effects of insomnia

Answer 11

decreased quality of life, complaints of impaired daytime performance, self-medication, risk of psychiatric disorder

Question 12

management of insomnia step 1

Answer 12

diagnosis, informed consent and education

Question 13

management of insomnia step 2

Answer 13

behavioral counseling (sleep hygiene/stimulus control)

Question 14

sleep hygiene

Answer 14

“ten basic rules for a good night’s sleep” (regular sleep schedule, 20 min exercise in morning, avoid smoking and alcohol, adjust bedroom environ, etc)

Question 15

management of insomnia step 3

Answer 15

sleep restriction therapy, cognitive therapy (talking through and imagery), behavioral therapy (diary/log book, progressive relaxation, self hypnosis)

Question 16

management of insomnia step 4

Answer 16

pharmacotherapy

1. OTC: melatonin, antihistamines
2. Rx agents/nonhabit forming (antihistamines, melatonin1+2 agonists (ramelteon, tasimeltean)
3. Rx agnets/mild-habit forming (benzodiazepine, receptor agonists (zolpidem, zaleplon, ezopiclone, orexin 1+2 antagonists, suvorexant)
4. Rx agents/habit forming (benzodiazepines (triazolam, temazepam, flurazepam) and off label options

Question 17

pharmacokinetics of sleeping pills:
faster absorbed = ?
shorter half life = ?
longer half life = ?

Answer 17

faster absorbed allows = faster absorbed allows faster sleep onset
shorter half life allows = the drug to leave your system by the morning but risks less hours of sleep
longer half life allows = longer sleep, but greater chance of being under the influence in the morning

Question 18

what do patients with restless legs get to treat insomnia?

Answer 18

D2 agonists

Question 19

which patients cannot get sedatives?

Answer 19

apnea patients

Question 20

antagonizing what creates deeper sleep patterns?

Answer 20

5HT2a

Question 21

antagonizing what promotes a more accurate circadian clock?

Answer 21

5HT1d and 7