Insomnia

Question 1

How long should the person have insomnia before an diagnosis

Answer 1

Greater than 3 nights per week and present greater than 3 months with no other cause of the insomnia (health issue).

Question 2

If a person has an environment barrier, (shift work, new baby) what should you do before diagnosis of insomnia?

Answer 2

Work on those barriers

Question 3

What it the hormones and system involved in sleep?

Answer 3

Melatonin
Orexin - regulates how long you have been awake to make you sleepy - why daytime napping is bad
GABA - promote sleep
GLUTAMATE - promotes wakefulness 
Histamine - promotes wakefulness
Serotonin

Question 4

Benzo’s are good for what stages of sleep but how long can you use it?

Answer 4

Short term

Used for all stages of sleep

Question 5

What is the most common Benzo used for sleep?

Answer 5

Temazepam (Restoril)

Question 6

What two benzo’s cause the biggest risk of day time sleepiness because of the long half life?

Answer 6

Flurazepam

Quazepam

Question 7

For the pts without cormorbid anxiety what med can be used for insomnia?

Answer 7

Non-benzo’s receptor agonist (NBRA) or Z drugs

Question 8

What do the Z drugs or non-benzo’s do to the GABA receptor site?

Answer 8

Bind to it

Question 9

What are some of the names of the Z drugs (non-benzo’s) and things to know about them.

Answer 9

Zolpidem (ambien) - sustain sleeping through the night with little hang over (women and elderly have a longer half life - watch for morning sedation) use lower doses in women

Zaleplon (sonata) - rapid onset but a half life of one hour - middle of the night awakings (don’t take after 3 am) can take up to 6 months of use

Eszcoplicone (Lunesta)

Question 10

Between benzo’s and the Z drugs, which group has a higher rate of sleep eating and sleep walking

Answer 10

Z drugs (zolpidem highest)

Question 11

What can you teach about Eszopiclone to the pt

Answer 11

It has a bad taste

Question 12

What drug is the only one not used for sleep onset?

Answer 12

Doxepin

Question 13

What is the MOA of Ramelteon?

Answer 13

Melatonin receptor antagonist (acts like melatonin)

Question 14

How long can you use Ramelteon? What is the other drug that can also be taken for 6 months?

Answer 14

6 months

Eszopiclone

Question 15

Why may people be unsatisfied with ramelteon?

Answer 15

If they took benzo’s before, they don’t get the Same physical feeling

Question 16

What is the MOA for Suvorexant?

Answer 16

Orexin receptor antagonist

Question 17

How long can you use Suvorexant

Why don’t people use it

Answer 17

1 year

Expensive

Question 18

Doxepin MOA and what is its indication (tricyclic antidepressant)

Answer 18

At low dose it is a potent antihistamine

Sleep maintenance because of longer half life (7 hours)

Question 19

What is the duration of therapy not to exceed with Benadryl and DOxylamine

Answer 19

10 days

Also not good for children and elderly

Question 20

What would be a good antidepressant to use when insomnia is bad?

Answer 20

Mirtazapine
Amitripyline
Trazodone

Question 21

If you have to give drugs to pregnant women with insomnia what would be good to use

Answer 21

Antihistimine

Doxepin

Zolpidem but may be associated with preterm birth

Question 22

With postpartum insomnia with lactation, what drugs to avoid

Answer 22

Zaleplon and Doxylamine

Question 23

What would be a good choice for elderly with insomiia?

Answer 23

Doxepin

Melatonin

Ramelteon

Trazodone

Z drugs

Question 24

What drugs should you avoid with insomnia and elderly

Answer 24

Antihistamines

BZD

TCA