INSOMNIA Flashcards

1
Q

What are the symptoms of insomnia?

A
  • 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
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2
Q

Causes

A
  1. Primary insomnia
    - No identifiable cause
  2. Secondary insomnia
    - Sleep apnoea
    - Circadian rhythm disorders
    - Stress/anxiety/depression
    - Meds
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3
Q

Which medications can cause insomnia (as a side-effect)?

A
  1. Anti-depressants
    - SSRIS, Venlafaxine, Bupropion, Duloxetine, MOAIS
  2. Antiepileptics
    - Lamotrigine, Phenytoin
  3. Antihypertensives
    - BB (e.g. Lipid soluble), CCBs
  4. Hormones
    - CS, thyroid hormones
  5. NSAIDs
  6. Stimulants
  7. Sympathomimetics
    - Salbutamol, salmeterol, theophylline, pseudoephedrine
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4
Q

What are the different types of insomnia?

A
  1. Transient - shift, jet lag
  2. Acute - 1-4 weeks
  3. Chronic - more than 4 weeks
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5
Q

Management

A
  1. Cause?
  2. Good sleep hygiene
  3. ONLY consider short-term hypnotic if symptoms are severe
  4. Refer to psychological services e.g. CBT (if chronic insomnia)
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6
Q

What constitutes
“good sleep hygiene”?

A
  1. Fixed bedtime
  2. Maintain a comfortable sleeping environment (e.g. not too cold or hot, noisy or bright)
  3. AVOID napping during the day
  4. AVOID caffeine, nicotine and alcohol within 6 hours of going bed
  5. AVOID exercise within 4 hours of bedtime
  6. AVOID eating a heavy meal at night
  7. AVOID watching or checking the clock throughout the night
  8. Only use the bedroom for sleep and sexual activity
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7
Q

Drug treatment

A

Hypnotics:
- Benzodiazepines
OR
- Z-drugs (e.g. Zopiclone)

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8
Q

When do you give pharmacological treatment for insomnia?

A
  • ONLY if symptoms are severe and debilitating and interfere with normal daily living
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9
Q
A
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10
Q

How long do you give pharmacological treatment for insomnia? And why?

A
  • 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)
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11
Q

If someone has transient insomnia, e.g. due to shift work or jet lag, can you give them medication?

A
  • Yes
  • BUT ONLY 1 or 2 doses
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12
Q

Do patients with chronic insomnia benefit from hypnotics?

A
  • Yes, but ONLY max 4 weeks
  • The real cause of insomnia should be established in order to cure it in the long-term
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13
Q

What are the common causes of chronic insomnia and what can be done to cure it?

A

Common causes:
- Psychiatric disorders
- Depression
Address underlying cause:
- depression = sedating antidepressant e.g. mirtazipine

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14
Q

What are the other treatments for insomnia (apart from hypnotics)?

A
  1. Melatonin
    - Helps to correct circadian rhythm
  2. Sedating antihistamines
    - Chlorphenamine
    - Promethazine
    - Diphenydramine
  3. Chlomethiazole
  4. Herbal (very small evidence)
    - Valerian
    - Passion-flower
    - Jamaica dogwood
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15
Q

What is the usual dose of Melatonin and who can take it?

A
  • 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
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16
Q

Is melatonin addictive?

A

Melatonin mimics natural melatonin and it is not addictive and well tolerated

17
Q

Who normally is indicated for Clomethiazole? And why?

A
  • Elderly patients
  • Because they don’t get a hangover effect the next day
  • However, dependence/ tolerance can still occur, and respiratory depression in overdose