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phar 253 - therapeutics (2) > Insomnia > Flashcards

Insomnia Flashcards

1
Q

What is SL (sleep latency)

A

time to get to sleep following bedtime

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2
Q

What is WASO (Wake after sleep onset)?

A

sum of wake times from sleep onset to final awakaning

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3
Q

What is TIB

A

time from bedtime to getting out of bed

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4
Q

What is TST?

A

total sleep time = TIB-SL-WASO

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5
Q

What is sleep efficiency percent?

A

SE= TST/TIB x 100

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6
Q

What stage of sleep does most sleep occur?

A

stage 2

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7
Q

What sleep stage is it hardest to wake up from?

A

stage 3

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8
Q

What stage of sleep do we dream?

A

stage 4 or REM sleep

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9
Q

Generally How many times does does sleep cycle through?

A

4-5 cycles

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10
Q

WHat are some wake promoting neurotransmitters?

A

Glutamate, Acetylocholine, dopamine, Nor E, 5Ht, his

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11
Q

What is some sleep promoting neurotransmitters?

A

GABA, Melatonin, glycine, adenosine

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12
Q

What structure promotes wakefulness?

A

RAS

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13
Q

What are some major things to be diagnosed insomnia for DSM 5?

A

difficulty initiating sleep or maintaining or non restorative,
and impairment of daytime= cognitive, tired, mood
at least 3 x per week for at least 3 months
hard even though opportunity to sleep

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14
Q

What is the definition of insomnia?

A

SL of > 30 min, efficiency of < 85%, less than 6 hours of total sleep for > 3 days a week for 3 months

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15
Q

When is it acute insomnia?

A

1 month

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16
Q

What is sub chronic insomnia?

A

1-3 months

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17
Q

What is persistent insomnia?

A

> 3 months

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18
Q

What is primary insomnia?

A

no causation

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19
Q

What is secondary insomnia?

A

caused by medical condition or s/e

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20
Q

What would hyperthyroidism cause for sleep?

A

insomnia

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21
Q

What is some other conditions other than insomnia that it could be?

A

obstructive sleep apnoea
restless leg syndrome
narcolepsy- sleep in daytime
circadian rythym syndrome- sleep at wrong time
parasomnia

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22
Q

What can stimulate narcolepsy sleeping during day?

A

laughing

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23
Q

What is parasomnia?

A

unpleasant experiences with sleep that stops you from sleeping

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24
Q

What test can we use to see if it is sleep apnoea?

A

STOP-BANG

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25
Q

What is the general insomnia assessment?

A

Epworth sleepiness scale
SLEEP DIARY
Insomnia severity scale

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26
Q

For AIS what is mild moderate and sever insomnia score?

A

mild= 6-9
mod= 10-15
severe= 16-24

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27
Q

Which gender struggles more with sleep?

A

females

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28
Q

How does age relate to sleep?

A

older= worse sleep

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29
Q

What percentage of people meet criteria for insomnia?

A

6-10%

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30
Q

How does old make sleep worse?

A

delayed onset, less REM, wake up more

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31
Q

Why would women have worse sleep?

A

lots of hormonal changes

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32
Q

What comorbidities is very common with insomnia?

A

depression anxiety, congestive heart failure

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33
Q

What are some risk factors for poor sleep?

A

stress, age, female, Comorbidities, shift work, lower status

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34
Q

What meds could make sleep hard?

A

diuretic= pee
statin= muscle pain
prednisone, levodopa, stims, venlafaxine, fluvoxamine

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35
Q

Les than how many hours increases risk of obesity?

A

<5 hours

36
Q

Why can lack of sleep cause obesity?

A

lower leptin levels

37
Q

What is our primary goal of therapy for insomnia?

A

increase sleep quality, lower daytime impairments

38
Q

What are some general secondary goals of therapy?

A

Sl <30 min
WASO <30 min
lower awakening
>6 total hours

39
Q

What is the best way to treat insomnia?

A

treat underlying cause first/ psychological

40
Q

How does CBT help?

A

lower SL and WASO
and lower severity NOT TST

41
Q

What component of CBT is the most important?

A

sleep restriction

42
Q

What are some good sleep hygiene?

A

don’t stay too long in bed, schedule, exercise, get out of bed if can’t sleep, comfortable, no stims, dark, no screens

43
Q

What are the components of CBT?

A

cognitive=misconceptions
stim control=only go to bed sleepy, don’t do none sleep things in bed
sleep restriction
sleep hygiene
relaxation

44
Q

How do you plan sleep restriction?

A

set wake time
set a bedtime

45
Q

How long to use benzes and z drugs?

A

LESS than 4 weeks

46
Q

How much do the drugs GENERALLY improve sleep?

A

25 min
SL decrease of 10 min
and lower awakenings

47
Q

Why is drug therapy not very good?

A

not super helpful and NNH high

48
Q

How do benzos and z drugs work?

A

bind to GABA which inhibits CNS and calms you

49
Q

What are some benzos?

A

PAM’s and am’s

50
Q

What are the short acting benzos

A

end in am

51
Q

What side effects are we worried about with midazolam?

A

amnesia and withdrawal and dependency

52
Q

Why are we worried with older people with these drugs?

A

falls and accidents

53
Q

DO we want a short, medium or long acting benzo?

A

medium

54
Q

What are the medium benzos?

A

LOT
lorazepam, oxazepam, temazepam

clonazepam

55
Q

Which is better eszopiclone vs zopiclone?

A

maybe better efficiency in eszopiclone but the same everywhere else

56
Q

How many awakenings will you have if on z drug or benzo?

A

1 less

57
Q

Can you have alcohol while on benzos and z drugs?

A

fuck no

58
Q

IS antihistamines good? And what are we concerned about

A

no, tolerance in 4 days

59
Q

S/E of antihistamines?

A

anticholinergic

60
Q

What value does melatonin have?

A

8 minute improvement of SL

61
Q

What is rationale behind melatonin?

A

levels decline as we age

62
Q

Where is melatonin produced?

A

pineal and is increased in dark

63
Q

Is TCA’s an option?

A

increase TST, SL, efficiency, lower awake
but not much benefit

64
Q

Who is a no for TCA?

A

old people

65
Q

S/E of TCA

A

anticholinergic, BPH, hypotension, arrythmias, epilepsy

66
Q

When may we use TCA?

A

if they have depression too

67
Q

What is MOA of doxepin?

A

H1 may help older with quality, time, efficiency NO for SL

68
Q

S/E of doxepin?

A

anticholinergic

69
Q

What must be said if giving doxepin?

A

no within 3 hours of meal
and next day drowsy

70
Q

MOA of trazodone

A

weak 5 HT reuptake inhibitor

71
Q

What is a positive of trazodone?

A

lower risk of morning hangover and tolerance

72
Q

Is trazodone worth it?

A

very limited evidence

73
Q

What is con of mirtazepine?

A

weight gain

74
Q

What is pro of mirtazepine?

A

can get less sedation etc higher doses

75
Q

Should we use mirtazepine and quetiapine JUST for insomnia?

A

noooooo

76
Q

What are the drugs that work on orexin receptor antagonist?

A

end in orexant

77
Q

What are some s/e that are more uncommon for orexin drugs?

A

weird dreams, sleep paralysis, mood changes, suicide

78
Q

What is a pro with orexin drugs?

A

no rebound insomnia

79
Q

Which is better orexin or z drugs?

A

orexin

80
Q

When should the patient maybe be informed of deprescribing benzos?

A

> 65
recent hospitalization
long term car
falls
substance use

81
Q

How do you deprescribe these agents?

A

taper- with long acting, by 5 mg of diazepam
no refills so they must see someone

82
Q

Which is better for tappering benzo or z drug?

A

neither

83
Q

When is tapering required?

A

> 8 weeks

84
Q
A
85
Q
A

phar 253 - therapeutics (2) (8 decks)

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