Insomnia Flashcards
What is insomnia?
Difficulty falling or staying asleep
How long is short term insomnia?
Less than 3 months
How long is long term insomnia?
More than 3 months
When is it considered insomnia?
3 times per week for at least 1 month
Symptoms of insomnia? (3)
Difficulty falling asleep
Waking up several times
Tired during the day
Causes of insomnia (4)
Stress
Psychiatric conditions
Other medical conditions
Medications
Risk factors of insomina
- comorbid conditions such as chronic obstructive pulmonary disease, heart failure, chronic pain and psychiatric conditions
- Substance misuse such as alcohol and illicit drug
How many stages of sleep?
5
What are the 5 stages of sleep.
Stage 1-4 and REM
4 treatment type for insomnia
- Changes in sleep pattern/lifestyle
- Tackle the stress/anxiety
- Psycohtrepay
- Pharmcotherapy
2 types of drugs used for insomnia (hypnotics)
Barbiturates
Benzodiazepine
Ethanol binding site
Between alpha and beta subunit
Barbiturates binding site
Between alpha and beta subunit
Barbiturates disadvantages
- Narrow therapeutic dosage range (easy to overdoes)
- Can be fatal if combined with antidepressants, alcohol and other drugs
Wake promoting circuits
Neurons releasing serotonin, noradrenaline, dopamine, acetylcholine and histamine
NREM promoting circuits
Neurons releasing GABA in the forebrain
REM promoting circuits
Neurons releasing GABA in the brainstem
What can be given for short-term insomnia OTC?
Antihistaminergic
First line treatment for long term insomnia
Benzodiazepine
Z drugs
Other drugs used for insomnia
Z drugs
Melatonin
How do Z drugs work?
Similar to benzodiazepine
What are the crucial neurotransmitters sin the insomnia circuits?
GABA, histamine, other monoamines, and acetylcholine
How often would it occur for it to considered insomnia?
3 times a week for at least 1 month.
Risk factors of insomnia?
Comorbid conditions and substance misuse such as alcohol and illicit drug.
What are comorbidities are risk factors?
Chronic obstructive pulmonary disease, heart failure, chronic pain and psychiatric conditions
What kind of drug is diazepam?
GABAergic drug that causes sedation.
What side effect might diazepam cause?
Drowsiness, muscle weakness, light-headedness, dizziness, ataxia, blurred vision, confusion
Short-acting versions of diazepam
Temazepam
Lormetazepam
Loprazolam
What are shot acting version of diazepam used for?
Reserved for treatment of insomnia to reduce risk of hangover persisting the following day
Is it appropriate to ask about asthma for insomnia?
Yes, poor control may lead to poor sleep, and increased inhaler use may indicate poor asthma control.
What advice can be given for sleep hygiene? (4)
- Environment
- Regular sleep schedule
- Relaxation before bed
- Limiting/avoiding caffeine/nicotine and large meal before bed
