CNS OTC - Insomnia

Question 1

Define insomnia. (1)

Answer 1

Complaint of poor quality or inadequate sleep.

Question 2

What are the risk factors of insomnia? (4)

Answer 2

Female
Divorced, widowed, separated
Lower socio-economic status
Increased age

Question 3

What are 3 classes of insomnia? (3)

Answer 3

Transient (days)
Short-term (up to 3 weeks)
Chronic (> 3 weeks) = always refer!

Question 4

What are the causes of insomnia? (5)

Answer 4

Physical
Physiological
Psychological
Psychiatric
Pharmacological

Question 5

Give e.g. of physical causes of insomnia.

Answer 5

Pain
Nasal congestion
Cough
CHF
Respiratory/Parkinson’s Disease
Pregnancy
Cramps
Nocturia

Question 6

Give e.g. of physiological causes of insomnia.

Answer 6

Jet Lag
Shift Work
Eating late
Exercise late
External Stimuli
Increasing Age

Question 7

Give e.g. of psychological causes of insomnia.

Answer 7

Stress/tension
Bereavement
Abnormal concern about sleep

Question 8

Give e.g. of psychiatric causes of insomnia.

Answer 8

Anxiety/depression
Psychosis
Dementia

Question 9

Give e.g. of pharmacological causes of insomnia.

Answer 9

Caffeine
Decongestants
Theophylline
BB
Bronchodilators
Thyroxine
CS
Alcohol
BZP/Antidepressant/opioate withdrawal

Question 10

What are the symptoms of insomnia? (3)

Answer 10

Difficulty falling asleep (sleep latency insomnia)
Difficulty in staying asleep (multiple waking through night, early morning waking)
Poor quality sleep (daytime drowsiness, inability to concentrate)

Question 11

What tx options are available for insomnia?

Answer 11

Non pharmacological: Relaxation techniques, sleep hygiene measures.
OTC remedies: sedative antihistamines, complementary therapies.
Prescribed hypnotics

Question 12

Give e.g. of non-pharmacological tx for insomnia.

Answer 12

Relaxation techniques: Deal with physical tension, deal with worry, deal with difficult situations.

Sleep hygiene:
- Keep sleep diary
- Light exercise if early evening
- Wind down during evening
- Avoid caffeine, meals, alcohol, close to bedtime.
- Go to bed only when tired.
- Relax/temp of bedroom
- Get up at same time every morning.

CBT

Question 13

Give e.g. of pharmacological tx for insomnia.

Answer 13

Complimentary therapies (natural/non-addictive): Herbal (valerian, hops, passion flower, Jamaica dogwood) Aromatherapy (lavender, camomile), Nasal plasters

Antihistamines: Diphenhydramine, Promethazine.
- 20-30 Mins before bedtime.
- Not longer than 14 consecutive night.
- S/E: Anticholinergics, hangover effect.
- C/I: prostatic hypertrophy, closed angle glaucoma, pregnancy, breastfeeding.

Rx Hypnotics:
- Lowest dose
- Short course
- Withdraw gradually
- Zopiclone, Zolpidem, Zaleplon
- BZP (Nitrazepam, Temazepam = not recommended)

Question 14

Explain when melatonin is used for insomnia.

Answer 14

Produced by body’s pineal gland during dark and is thought to regulate sleep.
Levels are lower in elderly.
Supplementation can raise levels and aid restoration of sleep patterns.
Regularly used for jet lag and insomnia in children.
Available on Rx (from 55+ only)
Recommended 2mg MR (ST use) once daily (1-2 hrs before bedtime and after food) for up to 13 weeks.
Initial tx duration = 3 weeks continued if there’s a response to tx for a further 10 weeks only.

Question 15

What are the alarm symptoms for Insomnia? (3)

Answer 15

Suspected depression
Chronic problem
< 16 yrs