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Block 8 Week 1 > Gentry: UNR Grand Rounds > Flashcards

Gentry: UNR Grand Rounds Flashcards

1
Q

Criteria for insomnia?

A

A. 1 or more of the following: difficulty falling asleep, staying asleep, or early waking with the inability to fall back asleep

B. Sleep disturbance causes clinically significant distress or impairment in functioning

C/D. Sleep difficulty occurs at least 3 nights a week for at least 3 months

E. Sleep difficulty occurs despite adequate opportunity to sleep

F. Insomnia is not better explained by another sleep-wake disorder (i.e. narcolepsy)

G. Insomia is not attributable to a substance abuse

H. Co-existing mental/medical disorders don’t explain the insomnia

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2
Q

What percentage of primary care patients experience insomnia? How many mention the problem? How many seek treatment?

A

50%;
1/3;
5%

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3
Q

Up to (blank)% of adults are impacted by insomnia on a chronic basis

A

12

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4
Q

Increased rates of insomnia in these groups…

A

women
older adults
pts with chronic medical/psych problems

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5
Q

T/F: Individuals with chronic insomnia compared to those without insomnia have more difficulty with intellectual, social, and/or vocational functioning.

A

True

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6
Q

Poor sleep increases risk for development of widespread (blank)

A

pain

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7
Q

Cost of insomnia annually?

A

100 billion dollars

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8
Q

Patients with insomnia more likely to suffer from these conditions…

A 
pain
GI distress
HTN
heart disease
diabetes
depression
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9
Q

Depression disturbed sleep is associated with increased symptom severity, slower/lower rates of remission, higher treatment dropout rates, less stable response to treatment, and (blank)

A

increased suicide risk!

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10
Q

Insomnia is predictive of (blank) thoughts and behaviors

A

suicidal

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11
Q

What is the largest group of insomnia sufferers at sleep clinics?

A

major depression and insomnia

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12
Q

(blank) is prevalent after treatment for depression

A

residual insomnia

**also the case for PTSD

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13
Q

What are these?

Zolpidem (Ambien)
Sopidem ER
Zaleplon (Sonata)
Eszopiclone (Lunesta)

A

nonbenzpdiazepines

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14
Q

Pros of non-benzos?

Cons?

A

pros: bind to sub-types of GABA receptors that specifically modulate sleep and therefore are thought to have less unwanted side effects
cons: drowsiness, dizziness, unsteady gait, rebound insomnia and memory impairment

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15
Q

What are these?

Alprazolam (Xanaz)
Lorazepam (Ativan)
Clonazepam
Temazepam
Diazepam
A

benzos

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16
Q

Pros of benzos?

Cons?

A

Pros: enhance sleep, decrease anxiety

Cons: daytime sedation, unsteady gait, higher risk of tolerance, dependence, withdrawal and risk of abuse

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17
Q

What are these?

Doxepin (Sinequan)
Amitriptyline (Elavil)
Trazadone (Desyrel)
Mirtazapine (Remeron)

A

antidepressants

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18
Q

Pros of antidepressants?

Cons?

A

can be used for insomnia and depression;

side effects

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19
Q

What is Ramelteon (Rozerem)?

A

melatonin receptor agonist

20
Q

What are diphenhydramine and hydroxine?

A

antihistimines

21
Q

What are these?

Quetiapine
Chlorpromazine
Risperidone
Olanzapine
Ziprasidone
A

antipsychotics

22
Q

recommended as the first line treatment by National Institute of Health (NIH) and American Academy of Sleep Medicine.

A

Cognitive Behavior Therapy for Insomnia

23
Q

Goals of cognitive behavior therapy for insomnia?

A

improve sleep quality
decrease daytime impairment
decrease insomnia symptoms
form a clear association b/w bed and sleeping
decrease distress related to sleep deprivation

24
Q

How many sessions are included in CBTI? What are some pros of CBTI?

A

4-6 sessions (30+ minutes);

inexpensive, effective, well sustained after treatment is ofer

25
Q

T/F: CBTI is essentially sleep hygiene

A

False; it is NOT sleep hygiene, sleep hygiene by itself is not effective

26
Q

What is Spielman’s 3 P’s model?

A

predisposing factors: biological traits or social factors

precipitating factors: medical or psych illness, stressful life events

perpetuating factors: excessive time in bed, napping, conditioning

27
Q

Works through the extinction of a conditioned arousal- repeated experiences of anxiety, frustration and tension when unable to sleep.

A

stimulus control

28
Q

What is sleep restriction therapy?

A

reduce time in bed to the patients current sleep time only; if unwanted wakefulness decreases, then you can expand time in bed

29
Q

What is an example of hyper-attention to threats to sleep?

A

clock monitoring

30
Q

How to reduce hyperarousal?

A

relaxation techniques
create buffer time before bed
cognitive therapy **educate patients on facts/myths about underlying sleep beliefs

31
Q

What are some contradictions to treating sleep disorders?

A

active psychotic symptoms
current alcohol/drug (min of 30 days sobriety recommended before treatment)
excessive daytime sleepiness
bipolar disorder (use caution)

32
Q

How is CBTI better than hypnotics?

A

longer-lasting effects
no drug side effects or drug-drug interactions
cost effective
efficacy equivalent to medications

33
Q

What did Jacobs et al find when they evaluated zolpidem, CBTI, combo of zolpidem/CBTI and a placebo?

A

greatest effect on sleep latency for both groups involving CBTI

34
Q

In patients with persistent insomnia, when did the addition of medication to CBTI help?

A

during acute therapy, it provided added benefits, but long-term outcome was optimized when medication was discontinued during maintenance CBTI

35
Q

Which groups in the Jacobs study had the best outcomes with sleep?

A

CBTI and combined CBTI with medication

36
Q

Sustained benefits of CBTI have been reported up to (blank) months after end of treatment

A

24

37
Q

T/F: In larger randomized clinical trials, CBTI has been shown to be clinically effective for treating insomnia:
Superior to relaxation training, medication placebo, and a no treatment wait-list control.
Superior to usual “medication management strategies” (medications and sleep advice)

A

True

38
Q

T/F: Patients prefer medication to CTBI

A

False;

Patients express preference for CBTI versus medications:
Patients rate behavioral interventions over sleep medications. (Morin, 1999)
Patients state that they not only prefer CBTI over pharmacotherapy, but also expressed expectations that CBTI would produce greater improvements in daytime functioning, better long-term effects, and fewer negative side effects. (Morin, et al., 1992)

39
Q

So what can sleep medications be used for effectively?

A

reduction of sleep-related anxiety

relief for acute/brief forms of insomnia (ex: jet lag)

40
Q

What are some probs with sleep medications?

A

tolerance and decreased efficacy with continued use over time
risk of psychological and physiological dependence
unable to address the wide range of behaviors and cognitions

41
Q

BZRAs and CBTI are effective in treatment of insomnia in the (blank), but CBTI has more durable effects when active treatment is discontinued.

A

short term

42
Q

T/F: Depression and insomnia are linked, and treating insomnia helps treat depression.

A

True

**sleep meds and CBTI are important for depression therapy, too

43
Q

Could provide an alternative to CBTI; Shown to have the highest rates of treatment remission and response at 6 month follow-up

A

meditation based interventions

44
Q

T/F: Insomnia and OSA frequently co-occur.
Combination therapy, including both CBTI & OSA treatment resulted in greater improvements in insomnia than either treatment alone.

A

True

45
Q

What is one of the biggest barriers to CBTI?

A

lack of access to therapists with training in sleep

46
Q

T/F: Data suggests insomnia should not simply be understood as a symptom of other disorders.
AND
When it occurs in the context of medical and/or psychiatric illness may be better understood, and treated, as a comorbid condition.

A

True

**think of insomnia as its own disorder

Block 8 Week 1 (12 decks)

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