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PHAR 253 Final > Insomnia > Flashcards

Insomnia Flashcards

1
Q

Define SL

A

SL = Sleep latency
- time to fall asleep following bedtime

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2
Q

Define WASO

A

WASO = Wake after sleep onset
–> sum of wake times from sleep onset to final awakening

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3
Q

Define TIB

A

TIB = Time in bed
–> time from bedtime to getting out of bed

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4
Q

Define TST. How is it calculated?

A

TST = total sleep time (TIB – SL – WASO)

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5
Q

How to calculate Sleep efficiency percent?

A

Sleep efficiency percent (SE = TST/TIB x 100

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6
Q

What are the 2 basic types of sleep? What stage is dominant?

A

Rapid eye movement (REM) sleep

Non-REM sleep (3 stages) - 75% of sleep

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7
Q

What stage of sleep is it hardest to wake a person up?

A

REM

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8
Q

In what stage of sleep does dreaming occur?

A

REM

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9
Q

Describe the sleep cycle

A
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10
Q

What are the wake-promoting neurotransmitters?

A

Glutamate
Acetylcholine
Dopamine
Norepinephrine
Serotonin
Histamine
Orexin/hypocretin
Substance P
Corticotropin

RAS (reticular activating system) which also contributes to arousal and wakefulness is under the control of DA
—> ⇓DA promote sleep

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11
Q

What are the Non-rem neurotransmitters?

A

NonREM appears to associated with GABA and adenosine in different regions of the brain

GABA
Galanin
Adenosine
Melatonin

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12
Q

What are the REM neurotransmitters?

A

REM appears to be turned on by cholinergic cells but turned off by the locus coeruleus which is activated by the noradrenergic system

Acetylcholine
Glutamate
GABA
Glycine (muscle atonia)

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13
Q

Define insomnia

A

Difficulty falling or staying asleep

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14
Q

What is insomnia defined as clinically?

A

sleep latency of more than 30 minutes

remaining awake after sleep onset for more than 30 minutes

sleep efficiency of less than 85%

OR

less than 6 to 6.5 hours total time asleep

occurring on three nights per week or more.

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15
Q

What is the clinical description of insomnia in the DSM-5?

A
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16
Q

How does the DSM-5 define insomnia?

A

Acute Insomnia <1 month
Sub chronic Insomnia 1-3 months
Persistent insomnia >3 months

17
Q

What are the types of insomnia?

A

Primary –> insomnia in the absence of a causative factor

Secondary –> insomnia caused by an underlying medical condition or medication adverse effect

18
Q

How can a pharmacist eliminate other sleep disorders?

A

Snoring –> OSA
Unpleasent, restless feelings in legs in eveing or at night –> Restless leg syndrome
Fall asleep in day without warning –> Narcolepsy
Sleep well but at wronfg times –> Circadian rythym sleep disorder
Unusual/unpleasent experiences associated with sleep that trouble you or are dangerous –> Parasomnias

19
Q

How can one conduct an insomnia assesment?

A

1) Consider using a sleep disorder questionnaire such as the Athens Insomnia Scale

2) Instruct patient to complete a sleep diary

3) Assess severity of insomnia using one or more of the following:
–> Insomnia Severity Index
Epworth Sleepiness Scale

4) Refer to a sleep clinic for further investigation if necessary

20
Q

What are the main categories to evaluate in an insomnia assesment?

A

Primary Insomnia Complaint
Pre-sleep Conditions
Sleep-Wake Schedule
Nocturnal Symptoms
Daytime activities and function

21
Q

What is the prevalence of insomnia?

A

25% of adults are dissatisfied with their sleep

10–15% report symptoms of insomnia associated with daytime consequences

6–10% meet criteria for an insomnia disorder

22
Q

Age and Insomnia Relationship

A

Sleep complaints increase with age

Up to 50% of seniors with sleep problems

23
Q

Gender and Insomnia Relationship

A

Twice as prevalent in women as in men

24
Q

Insomnia Comorbidities

A

Individuals with insomnia were more than five times as likely to present with anxiety or depression

more than twice as likely to present congestive heart failures as individuals without insomnia

25
Q

Why is insomnia more pronounced in woman?

A

Woman –> Hormone changes (menopause), menstruation, pregnancy

26
Q

What are some risk factors for insomnia?

A

Stress –> Relationships, work, school
Increased Age
Female Sex
Co-morbid conditions
Shift Worker
Lower socioeconomic status

27
Q

What are some comorbid conditions that are risk factors for insomnia?

A

Nocturia –> BPH in men, bladder instability in women
Heart Failure
COPD
Depression/anxiety
Dementia

28
Q

What are some drugs that may cause fragmented sleep, nightmares, nocturia, or stimulation?

A
29
Q

What are the five most common medications likely to disrupt sleep?

A

Levodopa
Prednisone
Venlafaxine
Fluvoxamine
Rotigotine

30
Q

What are some health outcomes of insomnia?

A

CV:
- Ischemic Stroke
- Coronary Heart Disease
- Inflammatory markers (c-reactive protein, tumour necrosis factor)

Metabolic
- Obesity
- Type 2 diabetes
- Impaired glucose tolerance

Cancer
- Breast cancer
- Colorectal cancer
- Prostate cancer

Accidents
- Daytime fatigue and sleepiness leading to human error related accidents

31
Q

What are the primary goals of therapy for insomnia?

A

Improvements on:

Primary:
- Sleep quality and/or time
- Insomnia related daytime impairements like energy, attention, or memory difficulties

32
Q

What are some other goals for insomnia?

A

Improvement on:

SL (30 mins) and/or
WASO (30 mins) and/or
Decreased frequency of awakenings and/or
TST >6 hours and/or
Sleep efficiency 80-85%

Sleep related psychological distress
Formation of a positive and clear associated between bed and sleeping

33
Q

Describe the management of insomnia

A
34
Q

What are the componenets of CBT-i? What types are there?

A

Cognitive therapy
Stimulus Control
Sleep Restriction
Sleep Hygiene
Relaxation

Cognitive only encompasses one component of CBT-i. Focus on the other four aspects.

35
Q
A
36
Q
A

PHAR 253 Final (8 decks)

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