Ch 9 Insomnia Flashcards
How are sleep disorders classified as?
Transient - days
Short term - up to 3 weeks
Chronic - longer than 3 weeks (referral)
What are some of the causes of sleeping difficulty?
Depression
Anxiety
Elderly
What are the different types of sleeping problems:
Difficulty in falling asleep Waking during the night Early morning Waking Poor sleep quality Snoring
Contributory factors to sleeping problems?
- Shift work
- Alcohol
- Life changes e.g. change/loss of job, bereavement
- Stressful events e.g. interviews, exams
- Obesity
Name some drugs that can cause/contribute to insomnia
Decongestants Fluoxetine MAOIs Corticosteroids Appetite suppressants Phenytoin Theophylline
When to refer?
Suspected depression
Chronic problem - longer than 3 weeks
Children under 16
Which antihistamines are used and how do they work?
Diphenhydramine & Promethazine
They reduce sleep latency (time taken to fall asleep) and also reduce nocturnal walking
Tolerance can be built up using antihistamines. How long should they not be used for?
Also what are the possible side effects?
7-10 days
Anti-cholinergic side effects e.g. dry mouth/throat, constipation, blurred vision and tinnitus.
Which patients should not use and which conditions are contraindicated in diphenhydrate and promethazine?
Pregnant/Breastfeeding women
Prostatic Hypertrophy
Closed -angle glaucoma
How long should benzodiazepines be used for?
No longer than 3 weeks
What are alternative therapies for insomnia?
Herbal - Valerian
Not recommended for pregnant or breastfeeding
Aromatherapy - lavender oil
Melatonin - POM
St John’s Wort - depression
Nasal plasters for snoring
What are the practical points to help?
Sleep hygiene: Establish a regular bedtime and waking time create a relaxing period no meals just before bedtime no naps during day no caffeine after lunch Warm bath
