Insomnia

Question 1

Types of sleep disturbances include:

Answer 1

sleep onset disorder, nocturnal awakenings, early am awakenings, global sleep disturbance

Question 2

Dyssomnias include: ___, ___, and ___ ___ sleep disorders.

Answer 2

intrinsic, extrinsic, circadian rhythm

Question 3

Intrinsic sleep disturbances originate ___ the body or from causes that develop within the body. This includes: ___ insomnia, ___ ___ misperception, ___, and ___ insomnia.

Answer 3

psychophysiologic, sleep state, RLS, idiopathic

Question 4

Hypersomnia includes: central ___ ___, obstructive ___ ___, and ___ hypersomnia.

Answer 4

sleep apnea, sleep apnea, posttraumatic

Question 5

Extrinsic sleep disorders arise from ___ the body and affect sleep. These include: inadequate sleep ___, ____ sleep disorder, ___ insomnia, ___ sleep syndrome, nocturnal ___/___ syndrome, ___ dependent sleep syndrome, and ___ dependent sleep syndrome.

Answer 5

outside, hygiene, environmental, altitude, insufficient, eating/drinking, hypnotic, alcohol

Question 6

Circadian rhythm sleep disorders include: ___ ___ change, ___ ___ sleep disorder, irregular ___-___ pattern, delayed ___ ___ syndrome, and ___-___ hr sleep-wake syndrome.

Answer 6

time zone, shift work, sleep-wake, sleep phase, non-24

Question 7

Parasomnia’s are the ___ ___ phenomena that occur primarily during sleep and include: ___, sleep ___, sleep ___, and ___ arousal.

Answer 7

undesirable physical, arousal, walking, terrors, confusional

Question 8

Parasomnia’s ass. w/REM sleep include: ___, sleep ___, impaired sleep-related ___ ___, REM sleep related ___ ___, REM sleep ___ disorder.

Answer 8

nightmares, paralysis, penile erections, sinus arrest, behavior

Question 9

Medical/psychiatric sleep disorders are ___ and ___ disorders that may include: depression, anxiety, schizo, seizure disorders, etc.

Answer 9

mental, neurologic

Question 10

____ tx is the best tx for insomnia when possible.

Answer 10

Nonpharmacologic

Question 11

Nonpharmacologic tx includes: setting ___ time for sleep, having a ___ and ___ environment, omitting ___ and ___ late in the date, reserving the BR for ___ and ___ only, avoiding ___ and ___ late in the day, using ___ techniques like meditation, and considering ___ (which are affective as benzo’s).

Answer 11

regular, comfortable, safe, ETOH, caffeine, sleep, sex, meals, exercise, relaxation, psychotherapy

Question 12

OTC sleep aids include ___ like diphenhydramine, ___ like lavendar and chamomile, ___ which has a metabolic precursor to ___, and ___ which is a normal body hormone.

Answer 12

antihistamines, herbs, tryptophan, melatonin

Question 13

Barbiturates include: ___. Downfalls include: have a ___ margin of safety, ___ potential for abuse, ___ interactions, suppression of ___ sleep, ___ rebound.

Answer 13

pentobarbital (Nembutal), secobarbital (Seconal), amobarbital (Ambal), narrow, high, drug, REM, REM

Question 14

Nonbarbiturates/Nonbenzo’s include: methaqualone (Qualude) which may cause ___ arousal, glutethianide (Doriden) which can be used to get a ___-like high from codeine, and ___ ___ which may cross-react w/___ and can cause the person to act like they are ___.

Answer 14

sexual, heroine, chloral hydrate, ETOH, drunk

Question 15

___ are the DOC for sleeping aids.

Answer 15

Benzodiazepines

Question 16

Benzo’s end in either ___ or ___.

Answer 16

Z, lam, pam

Question 17

Benzo’s include:

Answer 17

flurazepam (Dalmane), triazolam (I lalcion), temazepam (Restoril), estazolam (ProSam), and quazepam (Doral)

Question 18

Benzo’s have the potential adverse effects of: drug ___ insomnia, ___ insomnia, ___ rebound, withdrawal ___. All can be treatable by gradual ___ of dose.

Answer 18

withdrawal, rebound, REM, seizures, tapering

Question 19

Nonbenzo’s are not ___ prone to tolerance w/long-term use, do not change sleep ___, and ___ is less common.

Answer 19

as, stages, withdrawal

Question 20

Non-benzo’s include all the ___ names and include:

Answer 20

zolpidem (Ambien), zalaplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)

Question 21

Zolpidem interacts w/___ receptors and has a half-life of ___ hrs.

Answer 21

GABA, 2.5

Question 22

Zalaplon is similar to ___ but has half-life of ___ hr and may be taken again if time of arousal more than ___ hrs away.

Answer 22

zolpidem, 1, 4

Question 23

eszoplicone interacts w/___ receptors with a half-life of ___ hrs.

Answer 23

GABA, 6

Question 24

Common s/e of Z drugs include:

Answer 24

bitter taste, h/a, dry mouth, daytime drowziness, dysmenorrhea, aggressive behavior, visual hallucinations, amnesia

Question 25

The newest non-benzo is ___ and acts essentially like ___ b/c it is a potent agonist for its receptors.

Answer 25

ramelteon, melatonin

Question 26

Important not to use sleeping aids in these pts:

Answer 26

sleep apnea, pregnancy, substance abuse, suicidal pts

Question 27

The Z drugs (zolpidem, zalelpon, and eszopiclone have no ___ syndrome like many of the other sleeping aids.

Answer 27

withdrawal

Question 28

___ are DOC for insomnia and include all the “___”. ___ is the actual DOC.

Answer 28

Benzo’s, “pams”, temazepam/Restoril

Question 29

___ has half-life of 1hr, so can be taken if arousal occurs more than 4 hrs from need to awake.

Answer 29

Zalaplon/Sonata