insomnia

Question 1

what are the diff sleep disorders

Answer 1

transient insomnia - external factors such as noise, shift work, jet lag
short-term insomnia - emotional problem or medical issue
chronic insomnia - usually has a cause such as depression/anxiety, alchohol/drug abuse

Question 2

how to treat transient insomnia

Answer 2

rapidly eliminated hypnotic

only 1 or 2 doses should be given

Question 3

how to treat short-term insomnia

Answer 3

hypnotic - should not be used for >3 weeks (preferably 1 week use)

intermittent use - missing some doses is appropriate

short acting drug

Question 4

how to treat chronic insomnia

Answer 4

underlying psychiatric complaint/cause should be treated

Question 5

use of benzodiazepines (most common anixolytics/hypnotics)

Answer 5

short term relief (2-4 weeks) of anxiety and insomnia only if its severe and disabling

long acting benzodiazepines:
flurazepam, diazepam, nitrazepam
- used for sleep maintenance
- higher hangover effect the following day

short acting benzodiazepines:
loprazolam, lormetazepam, temazepam
- little to no hangover effect
- used for sleep onset
- higher chance of withdrawal symptoms `

Question 6

use of z drugs - hypnotics

Answer 6

anxiolytics (sedatives) - induce sleep when given at night
hypnotics - sedate when given during the day

zolpidem and zopiclone - non benzo hypnotics

act at benzodiazepine receptors - increase GABA - CNS depression

dependency occurs within 3-14 days use
should only be used short term
should be used intermittently
max use 4 weeks

Question 7

use of z drugs + benzos

Answer 7

avoid in elderly

higher risk of becoming more ataxic + confused - leads to falls and injuries

Question 8

use in dental patients

Answer 8

anxious patients may benefit from hypnotic during dental procedure
temazepam preferred - no hangover effect the following day

Question 9

use of melatonin

Answer 9

pineal hormone

licensed for short term treatment of insomnia in adults >55
licensed for short term treatment of jet lag in adults

Question 10

use of beta blockers

Answer 10

don’t affect psychological symptoms of anxiety such as worry tension and fear

affect autonomic symptoms such as palpitations and tremor - can be used if patient has predominantly somatic symptoms - may in turn prevent worry, fear