Insomnia

Question 1

What is insomnia classified as? This is in contrast to?

Answer 1

Dyssomnia: A sleep disorder characterized by problems in timing, quality, or amount of sleep…vs…Parasomnia: A sleep disorder characterized by abnormalities in physiology or behaviors associated with sleep.

Question 2

Define insomnia. List the needed symptoms, consequences, and timing.

Answer 2

Insomnia: “Dissatisfaction with sleep quantity or quality, w/ 1 of three: Difficulty initiating, maintaining, or early-morning awakening with inability to return to sleep.” Causes distress or impairment. Occurs 3 nights/week for 3+ months. (Not attributable to another disorder).

Question 3

Endogenous causes of insomnia?

Answer 3

Excitatory NTs in excess: NE (LC), 5HT (Raphe), Dopamine (VTA), Histamine (TBM). Inhibitory NT deficiency: Loss of GABA, melatonin, adenosine

Question 4

Exogenous causes of insomnia?

Answer 4

CNS stimulants, W/drawal of sedating agents (alcohol, barbs, benzos), Medical conditions (pain, pulmonary, endocrine)

Question 5

Most common cause of insomnia?

Answer 5

Caffeine use.

Question 6

Mental disorders that may lead to insomnia?

Answer 6

Major depressive disorder, bipolar disorder, generalized anxiety/PTSD

Question 7

Effects of insomnia?

Answer 7

Decreased quality of life, impaired daytime performance, self-medication with risk of substance abuse (especially alcohol), associations with psychiatric disorders (insomnia is a predictor of major depression).

Question 8

Four management steps of insomnia?

Answer 8

1: Diagnosis, educate. Address an underlying cause of insomnia! 2: Behavioral counseling (sleep hygiene, stimulus control). 3: Sleep restriction therapy, cognitive therapy, behavioral therapy. 4: Pharmacotherapy.

Question 9

OTC agents used for insomnia?

Answer 9

Melatonin, Antihistamines

Question 10

Rx agents/non-habit forming agents used for insomnia?

Answer 10

Antihistamine (doxepin), Melatonin agonists (Ramelteon & Tasimelteon)

Question 11

Rx agents/mild-habit forming agents used for insomnia?

Answer 11

Benzodiazepine Receptor Agonists (zolpidem, zaleplon, ezopliclone), Orexin antagonists (suvorexant)

Question 12

Rx agents/habit forming used for insomnia?

Answer 12

Benzodiazepines (triazolam, temazepam, flurazepam)

Question 13

Off label options for insomnia?

Answer 13

Trazodone (sedating antidepressant), Quetiapine (sedating antispychotic)