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Insomnia Flashcards

1
Q

most people how much sleep per night?

A

8 hours

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2
Q

how much population does insomnia affect?

A

at least 30%

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3
Q

insomnia is classified as a

A

dyssomnia

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4
Q

what is dyssomnia?

A

sleep disorder characterized by problems in timing, quality, or amount of sleep

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5
Q

what is parasomnia?

A

sleep disorder characterized by abnormalities in physiology or behavior associated with sleep

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6
Q

based on DSM5, insomnia is associated with at least one of the following symptoms:

A
  1. difficulty initiating sleep
  2. difficulty maintaining sleep
  3. early-morning awakening with inability to return to sleep
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7
Q

sleep disturbance causes distress or impairment in

A

social, occupational, educational, academic, behavioral, or other important areas of functioning

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8
Q

disturbance occurs at least

A

3 nights per week and is present for at least 3 months

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9
Q

disturbance is NOT attributable to the

A
  1. physiologic effects of a substance or

2. a coexisting medical or mental disorder

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10
Q

women report insomnia

A

50% more often than men

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11
Q

what are the 2 major endogenous etiology for insomnia?

A
  1. excitatory neurotransmitters in excess at night

2. inhibitory neurotransmitter deficiency at night

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12
Q

what are the 4 causes of excitatory neurotransmitters in excess at night?

A
  1. norepinephrine from the locus ceruleus
  2. serotonin from the raphe nucleus
  3. dopamine from the ventral tegmental area
  4. histamine from the tuberomammillary nucleus
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13
Q

what are the 3 causes of inhibitory neurotransmitter deficiency at night

A
  1. loss of GABA tone
  2. loss of melatonergic tone
  3. loss of adenosinergic tone
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14
Q

what are the psychiatric causes for insomnia?

A
  1. major depressive disorder
  2. bipolar disorder
  3. generalized anxiety disorder/PTSD
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15
Q

Insomnia is classified as a

A

dyssomnia

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16
Q

Dyssomnia =

A

sleep disorder characterized by problems in

  1. timing,
  2. quality, or
  3. amount of sleep
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17
Q

Parasomnia =

A

sleep disorder characterized by abnormalities in physiology or behavior associated with sleep

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18
Q

what is insomnia?

A

Complaint of dissatisfaction with sleep quantity or quality, associated with at least one of the following symptoms:

  1. Difficulty initiating sleep
  2. Difficulty maintaining sleep
  3. Early-morning awakening with inability to return to sleep
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19
Q

to be considered as insomnia

A
  1. Disturbance occurs at least 3 nights per week and is present for at least 3 months
  2. Disturbance is not attributable to the physiologic effects of a substance or a coexisting medical or mental disorder
20
Q

summary of the insomnia?

A
  1. Diagnosis of insomnia requires that sleep disturbance causes distress or impairment in functioning
  2. Always address underlying medical, psychiatric or environmental causes of insomnia and treat those 1st
  3. Always address substance use or withdrawal that may be causing insomnia –> avoid caffeine and alcohol
  4. Begin with patient education, behavioral hygiene or counseling focusing or document why you skipped this step
  5. Consider OTC and Rx agents when needed
21
Q

Antagonizing 5HT2a creates

A

deeper sleep patterns

22
Q

Antagonizing 5HT1d and 7 promotes a more accurate

A

circadian clock

23
Q

When patients are depressed or even anxious, one can often choose

A

an antidepressant or antipsychotic with these properties (instead of the more standard SSRI, SNRI, NDRI antidepressants that often have insomnia as a key side effect)

24
Q

A bonus would be if the antidepressant also antagonizes

A

the histamine-1 (H1) receptor which decreases arousal and produces sedation for sleep initiation…

25
Q

Anxiety symptoms that can lead to insomnia

A
  1. Getting caught up in thoughts about past events
  2. Excessive worrying about future events
  3. Feeling overwhelmed by responsibilities
26
Q

After many nights of insomnia, some may experience anxiety about the possibility of not being able to sleep

A
  1. Worrying about how many hours of sleep one can get
  2. Concern about next day functioning if sleep is not attained
  3. Anxiety about sleep may cause insomnia and insomnia may cause anxiety about sleep…
  4. Essentially, at night patients get their brain into a more wakeful, vigilant state. This is conditioned that a stimulus and response relationship exists ie. I get in bed, therefore I am wide awake and worried about failing to sleep yet again
27
Q

what are the 3 psychiatric causes of insomnia?

A

Psychiatric causes are common:

  1. Major depressive disorder
    - Short sleep latency, repeated nighttime awakenings, waking too early in the morning
  2. Bipolar disorder
    - Manic and hypomanic patients have problems falling asleep and maintaining sleep
  3. Generalized anxiety disorder/PTSD
    - Trouble falling asleep/nightmares
28
Q

hardcore of insomnia def

A
  1. difficulty initiating sleep
  2. difficulty maintaining sleep
  3. early morning awakening with inability to return to sleep
29
Q

sleep disturbance causes

A

distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning

30
Q

to be qualiified as insomnia, it can’t be

A

Disturbance is not attributable to the physiologic effects of a substance or a coexisting medical or mental disorder

31
Q

Excitatory neurotransmitters in excess at night

A
  1. Norepinephrine from the locus ceruleus
  2. Serotonin from the raphe nucleus
  3. Dopamine from the ventral tegmental area
  4. Histamine from the tuberomammillary nucleus (–> histamine wakes you up!)
32
Q

you can get insomnia if Inhibitory neurotransmitter deficiency at night

A
  1. Loss GABA tone
  2. Loss of melatonergic tone
  3. Loss of adenosinergic tone
33
Q

3 exogenous causes for insomnia

A
  1. use of CNS stimulants –> caffeine
  2. withdrawal from sedative drugs
  3. Medical conditions
34
Q

what is the 1st step for insomnia treatment?

A

1st Step and Initial management strategy is

  1. diagnosis,
  2. informed consent and
  3. education
35
Q

what is the 2nd step for insomnia treatment?

A
  1. Behavioral counseling

2. Sleep hygiene/Stimulus control

36
Q

to manage the insomnia

A
  1. Sleep restriction therapy
  2. Cognitive therapy
    - Talking through
    - Imagery
  3. Behavioral therapy
    - Diary/Log book (wake/bed time, #hrs asleep, abnormal events at night, next day consequences)
    - Progressive relaxation
    - Self hypnosis
37
Q

Behavioral therapy

A
  • Diary/Log book (wake/bed time, #hrs asleep, abnormal events at night, next day consequences)
  • Progressive relaxation
  • Self hypnosis
38
Q

Rx agents/non-habit forming

Antihistamines

A

doxepin

39
Q

Melatonin1+2 agonists

A

ramelteon

tasimelteon

40
Q

Rx agents/mild-habit forming

Benzodiazepine Receptor Agonists (BZRA)

A

zolpidem
zaleplon
ezopiclone

41
Q

Orexin 1+2 antagonists

A

suvorexant

42
Q

2nd step of management in insomnia is

A

behavioral counseling that includes sleep hygiene/stimulus control

43
Q

what are cognitive therapy for insomnia?

A
  1. talking through

2. imagery

44
Q

what are the components for behavioral therapy?

A
  1. diary/log book (wake/bed time, # hrs asleep)
  2. progressive relaxation
  3. self hypnosis
45
Q

You have to also decide if the are medically compromised

A

Apnea patients do not get sedatives

Patients with restless legs get D2 agonists

BS (15 decks)

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