Insomnia Flashcards
What drugs have been associated with insomnia? (7)
Alcohol Amphetamines Caffeine Cannabis Nicotine Opioids Sedatives, hypnotics, anxiolytics
What other pharmacological agents have been associated with insomnia? (8)
Adrenergic agonists and antagonists Antihistamines Cholinergic agonists and antagonists Corticosteroids Dopamine agonists and antagonists Hormonal therapy Serotonergic modulators Smoking cessation agents
What is stimulus control therapy and its goal?
Based on the concept that sleep is a conditioned response to temporal (bedtime) and environmental cues
Goal is the eliminate maladaptive behaviours so that we only associate the bedroom with sleep
What are 3 relaxation techniques?
Progressive muscle relaxation
Biofeedback (teaches patients how to facilitate increased slow brain wave activity)
Imagery training
What is paradoxical intention?
Focuses on removing performance anxiety (sleeping) by having the patient partake in their most feared behaviour (staying awake)
Describe the mainstay OTC treatment for insomnia?
Diphenhydramine, but efficacy and safety is limited.
What are principles for non-prescription therapy to treat insomnia?
May not be suitable in the elderly due to anticholinergic side effects
Use intermittent dosing (up to 4 times weekly) and no longer than 2 weeks
Discontinue medication gradually if used long term
What are common side effects of non-prescription therapy when treating insomnia?
Morning drowsiness
Constipation (diphenhydramine)
Confusion (diphenhydramine)
What are 6 reasons that would warrant referral to a health care practitioner?
Symptoms associated with shift work
Urge to move legs at night/unpleasant leg sensations
Patient snores, snorts, or experiences breathing pauses
Irrepressible need to sleep, fall asleep or nap within the same day
Sleepwalks or complains of sleep terrors/nightmares
Symptoms possibly due to drugs
What is the recommended dose of diphenhydramine?
12.5-50mg 30-60 minutes before bedtime
50mg is the optimal dose
What three NHPs can be used to treat insomnia and their recommended doses?
Melatonin: 0.3-5mg 30-60 minutes before bedtime
L-tryptophan: 1-15g 30-60 minutes before bedtime
Valerian: 400-900mg 30-60 minutes before bedtime
