Insomnia

Question 1

What is insomnia?

Answer 1

Difficulty falling or staying asleep

Question 2

How long is short term insomnia?

Answer 2

Less than 3 months

Question 3

How long is long term insomnia?

Answer 3

More than 3 months

Question 4

When is it considered insomnia?

Answer 4

3 times per week for at least 1 month

Question 5

Symptoms of insomnia? (3)

Answer 5

Difficulty falling asleep
Waking up several times
Tired during the day

Question 6

Causes of insomnia (4)

Answer 6

Stress
Psychiatric conditions
Other medical conditions
Medications

Question 7

Risk factors of insomina

Answer 7

• comorbid conditions such as chronic obstructive pulmonary disease, heart failure, chronic pain and psychiatric conditions
• Substance misuse such as alcohol and illicit drug

Question 8

How many stages of sleep?

Answer 8

5

Question 9

What are the 5 stages of sleep.

Answer 9

Stage 1-4 and REM

Question 10

4 treatment type for insomnia

Answer 10

1. Changes in sleep pattern/lifestyle
2. Tackle the stress/anxiety
3. Psycohtrepay
4. Pharmcotherapy

Question 11

2 types of drugs used for insomnia (hypnotics)

Answer 11

Barbiturates

Benzodiazepine

Question 12

Ethanol binding site

Answer 12

Between alpha and beta subunit

Question 13

Barbiturates binding site

Answer 13

Between alpha and beta subunit

Question 14

Barbiturates disadvantages

Answer 14

• Narrow therapeutic dosage range (easy to overdoes)

- Can be fatal if combined with antidepressants, alcohol and other drugs

Question 15

Wake promoting circuits

Answer 15

Neurons releasing serotonin, noradrenaline, dopamine, acetylcholine and histamine

Question 16

NREM promoting circuits

Answer 16

Neurons releasing GABA in the forebrain

Question 17

REM promoting circuits

Answer 17

Neurons releasing GABA in the brainstem

Question 18

What can be given for short-term insomnia OTC?

Answer 18

Antihistaminergic

Question 19

First line treatment for long term insomnia

Answer 19

Benzodiazepine

Z drugs

Question 20

Other drugs used for insomnia

Answer 20

Z drugs

Melatonin

Question 21

How do Z drugs work?

Answer 21

Similar to benzodiazepine

Question 22

What are the crucial neurotransmitters sin the insomnia circuits?

Answer 22

GABA, histamine, other monoamines, and acetylcholine

Question 23

How often would it occur for it to considered insomnia?

Answer 23

3 times a week for at least 1 month.

Question 24

Risk factors of insomnia?

Answer 24

Comorbid conditions and substance misuse such as alcohol and illicit drug.

Question 25

What are comorbidities are risk factors?

Answer 25

Chronic obstructive pulmonary disease, heart failure, chronic pain and psychiatric conditions

Question 26

What kind of drug is diazepam?

Answer 26

GABAergic drug that causes sedation.

Question 27

What side effect might diazepam cause?

Answer 27

Drowsiness, muscle weakness, light-headedness, dizziness, ataxia, blurred vision, confusion

Question 28

Short-acting versions of diazepam

Answer 28

Temazepam
Lormetazepam
Loprazolam

Question 29

What are shot acting version of diazepam used for?

Answer 29

Reserved for treatment of insomnia to reduce risk of hangover persisting the following day

Question 30

Is it appropriate to ask about asthma for insomnia?

Answer 30

Yes, poor control may lead to poor sleep, and increased inhaler use may indicate poor asthma control.

Question 31

What advice can be given for sleep hygiene? (4)

Answer 31

• Environment
• Regular sleep schedule
• Relaxation before bed
• Limiting/avoiding caffeine/nicotine and large meal before bed