Insomnia Flashcards
Does insomnia require a counselling room?
Yes
What are 4 red flags for referral with insomnia?
- Suspected depression
- Chronic problem (longer than 3 weeks’ duration)
- Children <12
- Irrational insomnia
Does insomnia have a PSA self-care card?
Yes (Sleeping Problems)
What are the directions for Doxylamine 25mg (Restavit) in insomnia?
Adults and Children over 12 years: One or two tablets 20 minutes before bed.
What are 3 practice points to consider with Doxylamine 25mg (Restavit) in insomnia?
- If the patient has never trialled a sedating antihistamine, recommend starting with a quarter or half a tablet 20 minutes before bed.
- For short term use only: 3 to 4 days in duration at a maximum.
- Can cause grogginess or “hungover” effect next day.
Is Doxylamine 25mg (Restavit) safe in pregnancy?
Yes (however you should refer pregnant women suffering from insomnia)
Is Doxylamine 25mg (Restavit) safe in breastfeeding?
No
What is the age range for Doxylamine 25mg (Restavit)?
Safe in adults and children over 12 years
What are the directions for Melatonin 2mg (Circadin) in insomnia?
Adults over 55 years with no diagnosed sleep condition: Take 1 tablet (2mg) at night 1 to 2 hours before bed at the same time each night may only provide a single box for once-off use as melatonin is only Schedule 3 for primary insomnia
Is Melatonin 2mg (Circadin) safe in pregnancy?
No: endogenous melatonin is necessary for a safe pregnancy, so you want to avoid disrupting this.
Is Melatonin 2mg (Circadin) safe in breastfeeding?
No
What is the age range for Melatonin 2mg (Circadin)?
Only indicated in adults over 55.
What are 13 pieces of non-pharmacological advice for insomnia (i.e. sleep hygiene)?
- Address underlying causes
- Regular bedtime and waking time
- Regular daytime exercise
- Creating a comfortable temperature and quiet environment for sleep
- Taking a hot bath before bedtime
- Having a warm milk drink before bedtime
- Get up if you can’t sleep and sit in another room until feel more sleepy
- Avoid large meals, excessive alcohol, smoking and drinking caffeine-containing beverages close to bedtime
- Avoid Daytime napping
- Avoid Strenuous exercise close to bedtime
- Use bedroom for sleeping and sexual activity only
- Avoid Pets and clocks in the bedroom
- Avoid alcohol whilst taking insomnia medications!!
Describe the side effects of doxylamine.
Doxylamine commonly causes anticholinergic side effects (dry mouth, constipation, blurred vision, tinnitus).
What is a practice point to consider when using sedating antihistamines for sleep?
Sedating antihistamines can cause paradoxical excitement, restlessness, or nervousness especially in children or elderly
