INSOMNIA Flashcards
What are the symptoms of insomnia?
- Difficulty falling a sleep
- Frequent waking during the night
- Early morning waking
- Daytime sleepiness
- General loss of well-being due to a bad night’s sleep
Causes
- Primary insomnia
- No identifiable cause - Secondary insomnia
- Sleep apnoea
- Circadian rhythm disorders
- Stress/anxiety/depression
- Meds
Which medications can cause insomnia (as a side-effect)?
- Anti-depressants
- SSRIS, Venlafaxine, Bupropion, Duloxetine, MOAIS - Antiepileptics
- Lamotrigine, Phenytoin - Antihypertensives
- BB (e.g. Lipid soluble), CCBs - Hormones
- CS, thyroid hormones - NSAIDs
- Stimulants
- Sympathomimetics
- Salbutamol, salmeterol, theophylline, pseudoephedrine
What are the different types of insomnia?
- Transient - shift, jet lag
- Acute - 1-4 weeks
- Chronic - more than 4 weeks
Management
- Cause?
- Good sleep hygiene
- ONLY consider short-term hypnotic if symptoms are severe
- Refer to psychological services e.g. CBT (if chronic insomnia)
What constitutes
“good sleep hygiene”?
- Fixed bedtime
- Maintain a comfortable sleeping environment (e.g. not too cold or hot, noisy or bright)
- AVOID napping during the day
- AVOID caffeine, nicotine and alcohol within 6 hours of going bed
- AVOID exercise within 4 hours of bedtime
- AVOID eating a heavy meal at night
- AVOID watching or checking the clock throughout the night
- Only use the bedroom for sleep and sexual activity
Drug treatment
Hypnotics:
- Benzodiazepines
OR
- Z-drugs (e.g. Zopiclone)
When do you give pharmacological treatment for insomnia?
- ONLY if symptoms are severe and debilitating and interfere with normal daily living
How long do you give pharmacological treatment for insomnia? And why?
- MAX 4 weeks(although you may not necessarily see this in practice!)
- Because there is a risk of dependence
- Rebound insomniaonce you try to stop (as withdrawal symptom), resulting in a vicious cycle of starting the drug again (relapse)
If someone has transient insomnia, e.g. due to shift work or jet lag, can you give them medication?
- Yes
- BUT ONLY 1 or 2 doses
Do patients with chronic insomnia benefit from hypnotics?
- Yes, but ONLY max 4 weeks
- The real cause of insomnia should be established in order to cure it in the long-term
What are the common causes of chronic insomnia and what can be done to cure it?
Common causes:
- Psychiatric disorders
- Depression
Address underlying cause:
- depression = sedating antidepressant e.g. mirtazipine
What are the other treatments for insomnia (apart from hypnotics)?
- Melatonin
- Helps to correct circadian rhythm - Sedating antihistamines
- Chlorphenamine
- Promethazine
- Diphenydramine - Chlomethiazole
- Herbal (very small evidence)
- Valerian
- Passion-flower
- Jamaica dogwood
What is the usual dose of Melatonin and who can take it?
- 2mg MR OD
- Adults 55 years old and over
- Children = specialist only
- NOTE: You will see doses higher than 2mg OD e.g. up to 10mg daily