insomnia

Question 1

insomnia via DSM

Answer 1

complaint of dissatisfaction with quality or quantity of sleep associated with at least one of trouble initiating, maintaining, early waking. the disturbance causes distress or impairment of functioning. must occur 3 nights per week and for at least 3 months.

Question 2

dyssomnia

Answer 2

trouble with the timing, quality or quantity of sleep

Question 3

parasomnia

Answer 3

abnormalities in the physiology or behavior associated with sleep. such as movements RLS.

Question 4

prevalence with age and gender?

Answer 4

increases with age and women are 50% more often than men. 30% of the population.

Question 5

endogenous etiology for excitation

Answer 5

too much norepi from the locus ceruleus, too much serotonin from raphe nucleus, too much dopamine from the VTA, and too much histamine from the tuberomammillary nucleus.

Question 6

endogenous etiology for inhibition

Answer 6

loss of GABAnergic tone, loss of melatoninergic tone, loss of adenosine tone.

Question 7

etiology exogenous

Answer 7

caffeine, withdrawal from depressants such as alcohol, medical conditions such as pain, pulmonary disease, or endocrine disorders.

Question 8

psychiatric disorders that cause insomnia

Answer 8

MDD, bipolar (mania and hypomania), anxiety disorder (trouble falling asleep due to nightmares)

Question 9

anxiety and insomnia

Answer 9

thinking about past events, worrying about the future, overwhelmed about responsibilities. some even have anxiety about not being able to get to sleep (concerned about the next day functioning if sleep is not obtained, worrying about not getting to sleep, etc.) this gets their minds into a vigilant, excitable state.

Question 10

affects of insomnia

Answer 10

decreased quality of life. daytime performance issues, such as absenteeism, presenteeism. risk of self-medication and substance abuse. it is a predictor for MDD and alcoholism.

Question 11

steps in treatment of insomnia

Answer 11

proper diagnosis, behavioral counseling, cognitive therapy, and then pharmacology.

Question 12

pharmacology of insomnia treatment

Answer 12

this is a step-wise approach. first OTC (melatonin and antihistamines). 2nd non habit Rx, such as antihistamines and melatonin with ramelteon and transimelteon. 3rd mildly habit-forming benzodiazapine receptor agonists (zolpidem, zaleplon, and ezopiclone). orexin angonists such as suvorexant. 4th use habit-forming benzodiazepines

Question 13

why be careful of the half-lives and absorption rates of the sleep-aids?

Answer 13

we want fast absorption to allow people to fall asleep. we want shorter half-life for people that need to wake-up in the morning, but longer for people who can sleep in.
the risk is waking up too early and also not being awake when needed.

Question 14

best way to diagnose insomnia?

Answer 14

detailed history

Question 15

what is the initial treatment for insomnia?

Answer 15

information and education for the patient with behavioral therapy