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A. MLA Map Others > Insomnia > Flashcards

Insomnia Flashcards

1
Q

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

A

1 - Insomnia
- classed as a symptom rather than a disorder
- this is NOT a diagnosis
- clinically significant in 10% of people

Hypersomnia = excessive sleepiness

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2
Q

What is the estimated prevlance of insomnia?

1 - 5-15%
2 - 10-15%
3 - 10-30%
4 - 30-50%

A

1 - 5-15%

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3
Q

Which of the following is NOT typically affected by insomnia?

1 - Women
2 - Shift workers
3 - Young children
4 - Medical and psychiatric comorbidity

A

3 - Young children

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4
Q

What is short term/acute insomnia?

1 - <4 weeks
2 - <3 months
3 - <6 months
4 - <12 months

A

2 - <3 months
- insomnia typically gets worse if untreated
- must impact daily function

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5
Q

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

A

1 - life stressors

If it goes beyond 3 months, then it becomes chronic and may need treatment

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6
Q

What is long term/chronic insomnia?

1 - >4 weeks
2 - >3 months
3 - >6 months
4 - >12 months

A

2 - >3 months
- insomnia typically gets worse if untreated
- must impact daily function

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7
Q

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

A

3 - >3 days/week

Important part of diagnosis is that it must impact daily function

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8
Q

Does insomnia typically affect quality or quantity of sleep, or both?

A
  • both
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9
Q

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

A

6 - all of the above

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10
Q

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

A

3 - >10

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11
Q

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

A

4 - LFTs

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12
Q

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)

A

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

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13
Q

Some patients with insomnia may have high levels of which of the following?

1 - CRP
2 - cortisol
3 - melatonin
4 - GABA

A

2 - cortisol
- patients may also be more sensitive to cortisol

Involved in waking us up in the mornings

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14
Q

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

A

3 - melatonin

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15
Q

Which of the following does NOT help keep us awake?

1 - glutamate
2 - acetylcholine
3 - serotonin
4 - GABA
5 - noradrenaline

A

4 - GABA

All others are mono-amines

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16
Q

Which of the following does NOT help us sleep?

1 - glutamate
2 - melatonin
3 - galanin
4 - GABA
5 - adenosine

A

1 - glutamate

17
Q

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

A

3 - orexin

  • hypocretins, are orexigenic neuropeptides involved in the regulation of the sleep–wake cycle and feeding.
18
Q

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

A

5 - all of the above

19
Q

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

A

2 - cognitive behavioural therapy for insomnia

Not the same as CBT in psychology

20
Q

Cognitive behavioural therapy for insomnia is the 1st line and best treatment for insomnia. Is this better delivered face to face or online?

A
  • face to face

BUT harder to reach the masses and an online or app is being developed

21
Q

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

A

2 - >1 hour

  • tryptophan is a precursor for serotonin and effects melatonin synthesis
22
Q

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

A

2 - <1 week

23
Q

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

A

1 - zopiclone
3 - zolpidem

Remember both begin with Z

24
Q

Which 2 of the following medications are used most commonly in patients with insomnia?

1 - zopiclone
2 - diazepam
3 - zolpidem
4 - flumazenil

A

1 - zopiclone
3 - zolpidem

  • need to be careful with benzodiazepines or non-benzodiazepines as these can lead to rebound insomnia
25
Q

Which of the following is used to describe when someone gets too much sleep?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

A

2 - Hypersomnia

26
Q

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

A

6 - all of the above

A. MLA Map Others (21 decks)

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