Insomnia Flashcards
Transient Classification
- self-limiting
- lasts <1 week
- may be caused by travel, hospitalization, anticipation of an important or stressful event
Short Term Classification
- Lasts 1-3 weeks
* May result from transient that involves severe stresses (death, divorce, loss of job)
Chronic or long-term classification
- lasts more than 3 weeks to years
* often caused by medical problems, mental disorders, substance abuse
Treatment Goals
- normal sleep
- awake feeling rested
- no difficulty with daytime fatigue or drowsiness
Treatment of transient or short term insomnia
- good sleep hygiene
- Diphenhydramine, if needed
- Doxylamine also available OTC but no data to support efficacy, not recommended
Diphenhydramine dosing
- take 2 or 3 nights, skip a night and evaluate, then continue pattern if necessary
- 25-50mg per dose taken 1-2hrs before bed
When can tolerance to diphenhydramine develop?
- if taken nightly
* max use for insomnia is 14 days
When should you refer for insomia?
- Chronic insomnia
* Diphenydramine is ineffective after 14 days
Drug-drug interactions
- CNS depressants
* anticholinergics
Contradictions/precautions/warnings
- prostatic hyperplasia/difficulty urinating
- narrow/closed angle glaucoma
- CV disease
- Dementia
- > 80 (more SE)
Possible Side Effects to be cautious about
- next day hangover is possible
- cognitive impairment possible
- delirium possible
- anticholinergic SE
If using a combo product (diphenhydramine/apap or asa), what should they be warned about?
Do not take any additional apap or asa
What does the PM mean?
it has a sedating antihistamine - diphenhydramine
Melatonin should be recommended when?
- individuals who cannot take diphenhydramine or it does not work
- Jet lag (A rating) (ideal for traveling 3-5 time zones)
- insomnia, insomnia in the elderly, delayed sleep phase syndrome, sleep enhancement in healthy people (B rating)
When shouldn’t melatonin be recommended?
- in children less than 12
* pregnant or breastfeeding
