Insomnia Flashcards
Which of the following is used to describe when someone doesn’t get sufficient sleep because they have persistent wakefullness?
1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders
1 - Insomnia
- classed as a symptom rather than a disorder
- this is NOT a diagnosis
- clinically significant in 10% of people
Hypersomnia = excessive sleepiness
What is the estimated prevlance of insomnia?
1 - 5-15%
2 - 10-15%
3 - 10-30%
4 - 30-50%
1 - 5-15%
Which of the following is NOT typically affected by insomnia?
1 - Women
2 - Shift workers
3 - Young children
4 - Medical and psychiatric comorbidity
3 - Young children
What is short term/acute insomnia?
1 - <4 weeks
2 - <3 months
3 - <6 months
4 - <12 months
2 - <3 months
- insomnia typically gets worse if untreated
- must impact daily function
Acute insomnia typically last <3 months and self resolves. What is acute insomnia typically caused by?
1 - life stressors
2 - chronic illness
3 - death of close relative
4 - all of the above
1 - life stressors
If it goes beyond 3 months, then it becomes chronic and may need treatment
What is long term/chronic insomnia?
1 - >4 weeks
2 - >3 months
3 - >6 months
4 - >12 months
2 - >3 months
- insomnia typically gets worse if untreated
- must impact daily function
Chronic insomnia typically lasts >3months. How many nights per week must patients struggle to go to sleep or remain asleep to be diagnosed with chronic insomnia?
1 - 7 days/week
2 - >5 days/week
3 - >3 days/week
4 - >1 day/week
3 - >3 days/week
Important part of diagnosis is that it must impact daily function
Does insomnia typically affect quality or quantity of sleep, or both?
- both
Which of the following can be used to help diagnose a patient with insomnia?
1 - Epworth Sleepiness Scale
2 - Medication review and timings
3 - Sleep diary
4 - Blood tests
5 - Sleep study
6 - all of the above
6 - all of the above
Epworth Sleepiness Scale can be used to help diagnose a patient with insomnia. What score is considered abnormal?
1 - >2
2 - >4
3 - >10
4 - >20
3 - >10
Blood tests may be performed in order to rule out other diagnoses that account for a patients inabiity to sleep enough and diagnose insomnia. Which of the following is the least likely blood test that would be performed?
1 - thyroid stimulating hormone
2 - FBC
3 - metabolic panel
4 - LFTs
5 - iron and ferritin levels
6 - B12
4 - LFTs
When managing insomnia, which of the following is NOT typically performed?
1 - Identify the cause
2 - Treat any underlying cause e.g. depression, anxiety, pain
3 - Explain clearly what is happening and why
4 - Ensure good sleep hygiene (psychoeducation or CBT)
5 - Advise the person not to drive if they feel sleepy
6 - prescribe sleeping medication
7 - In certain sleep disorders, the DVLA must be informed (sleep apnea)
6 - prescribe sleeping medication
- this would only be prescribed if the insomnia is though to be short lived, like loss of a loved one
- benzodiazepines or non-benzodiazepines
Some patients with insomnia may have high levels of which of the following?
1 - CRP
2 - cortisol
3 - melatonin
4 - GABA
2 - cortisol
- patients may also be more sensitive to cortisol
Involved in waking us up in the mornings
For long term insomnia, CBT is the 1st line treatment. But what other medication can be offered if there is an acute exacerbation in patients aged >55 y/o?
1 - cortisol
2 - benzodiazepines
3 - melatonin
4 - all of the above
3 - melatonin
Which of the following does NOT help keep us awake?
1 - glutamate
2 - acetylcholine
3 - serotonin
4 - GABA
5 - noradrenaline
4 - GABA
All others are mono-amines
Which of the following does NOT help us sleep?
1 - glutamate
2 - melatonin
3 - galanin
4 - GABA
5 - adenosine
1 - glutamate
Which of the following is important for maintaining the state it is present in, either sleep or wakefulness?
1 - galanin
2 - adenosine
3 - orexin
4 - serotonin
3 - orexin
- hypocretins, are orexigenic neuropeptides involved in the regulation of the sleep–wake cycle and feeding.
Sleep pressure describes a phenomena that involves making you tired, and eventually sleeping. Which of the following reduce sleep pressure, and thus make it harder for you to go to sleep?
1 - intentional naps
2 - going to bed to early
3 - napping late in the evening
4 - aiming for more sleep than your body requires
5 - all of the above
5 - all of the above
What is the 1st line and best treatment for insomnia?
1 - phototherapy
2 - cognitive behavioural therapy for insomnia
3 - sleep restriction
4 - melatonin
5 -zopiclone
2 - cognitive behavioural therapy for insomnia
Not the same as CBT in psychology
Cognitive behavioural therapy for insomnia is the 1st line and best treatment for insomnia. Is this better delivered face to face or online?
- face to face
BUT harder to reach the masses and an online or app is being developed
When talking about psychoeducation, we can talk about preparing for bed called sleep hygiene, including:
- bed time routine
- milky drink (contains tryptophan) and no caffeine
- keep lights low and no electronics
- limit napping
- manage stress
We should also aim to wind down, but what is the minimum time advised to wind down?
1 - >30 minutes
2 - >1 hour
3 - >2 hours
4 - >6 hours
2 - >1 hour
- tryptophan is a precursor for serotonin and effects melatonin synthesis
If medications are to be prescribed to a patient with insomnia, typically how long should they be prescribed for?
1 - <72h
2 - <1 week
3 - <2 weeks
4 - <6 weeks
2 - <1 week
There are benzodiazepine’s and non-benzodiazepines, which are classed as z-drugs. Which 2 of the following are recognised as Z-drugs and used commonly to treat insomnia?
1 - zopiclone
2 - diazepam
3 - zolpidem
4 - flumazenil
1 - zopiclone
3 - zolpidem
Remember both begin with Z
Which 2 of the following medications are used most commonly in patients with insomnia?
1 - zopiclone
2 - diazepam
3 - zolpidem
4 - flumazenil
1 - zopiclone
3 - zolpidem
- need to be careful with benzodiazepines or non-benzodiazepines as these can lead to rebound insomnia
Which of the following is used to describe when someone gets too much sleep?
1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders
2 - Hypersomnia
Which of the following are associated with causing hyper insomnia?
1 - psychiatric conditions (depression)
2 - medications
3 - sleep/breathing disorders
4 - central causes (narcolepsy)
5 - general medical conditions (hypothyroidism)
6 - all of the above
6 - all of the above
