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Insomnia Flashcards

1
Q

Two types of sleep disorders?

A

Dyssomnias and Parasomnias

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2
Q

Dyssomnias: Definition?

A

Problems with timing, amount and quality of sleep

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3
Q

Examples of Dyssomnias?

A

insomnia, narcolepsy, sleep apnea

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4
Q

Parasomnias: Definition?

A

abnormal sleep physiology OR behavior

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5
Q

Examples of parasomnia

A

nightmare disorder, sleep terror disorder, sleepwalking disorder, bruxism

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6
Q

DSM5 insomnia definition

A

Not satisfied with sleep quality or quantity + 1 of the following:

  1. difficulty INITIATING sleep
  2. difficulty MAINTAINING sleep
  3. difficulty GOING back to sleep after early awakening
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7
Q

Other DSM5 criteria

A

MUST cause distress or impairment in life (social, occupational, educational, etc)

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8
Q

Other DSM5 criteria

A

MUST happen 3 times per week for at least 3 months

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9
Q

Other DSM5 criteria

A

Not due to substance or other disorder

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10
Q

Most common cause of insomnia?

A

caffeine

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11
Q

More insomnia with who?

A

elderly and women

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12
Q

What neurotransmitters are increased in insomnia?

A

NE, serotonin, dopamine, histamine

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13
Q

Formation locations of NE, Serotonin, dopamine and histamine

A

NE=locus ceruleus
Serotonin=raphe nucleus
Dopamine=Ventral tegmentum area
Histamine=tuberomamary nucleus

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14
Q

What neurotransmitters are decreased in insomnia?

A

GABA, melatonin, adenosine

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15
Q

Exogenous causes of insomnia?

A
  1. caffeine
  2. withdrawal from alcohol, benzos and barbs (sedating agents)
  3. Pain, endocrine disorders, pulm disorders (hyperthyroidism, COPD, obstructive sleep apnea, etc)
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16
Q

Mental Disorder causes of Insomnia?

A
  1. MDD
  2. Bipolar
  3. GAD, PTSD
17
Q

Anxiety Causes of insomnia

A
  1. Thinking of past, future, etc

2. anxiety about falling asleep

18
Q

Results/Effects of insomnia

A
  1. substance and alcohol abuse
  2. decreased quality of life
  3. increased absenteeism, impaired daytime performance,
  4. self medication
  5. mental disorders
19
Q

First 2 steps in Management of insomnia

A
  1. Dx, informed consent, education (underlying medical issue that needs to be addressed?)
  2. BEHAVIORAL COUNSELING (sleep hygeine or stimulus control)
20
Q

Next 3 steps in management of insomnia

A
  1. sleep restriction therapy (limit amt of time in bed to force sleep later)
  2. Cognitive therapy- talk it through
  3. behavioral therapy- diary, hypnosis, relaxation
21
Q

LAST OPTION for insomnia management?

A

PHARMACOTHERAPY

22
Q

first (out of 4) step in PHARM

A
  1. OTC
23
Q

2 OTC examples for insomnia

A
  1. melatonin

2. antihistamines

24
Q

second (out of 4) step in PHARM

A
  1. Nonhabit forming agents (1. antihistamines, 2. melatonin 1 &2 agonists)
25
Q

non habit forming antihistamines? (1)

A

Doxepin

26
Q

nonhabit forming melatonin 1&2 agonists? (2)

A
  1. Ramelteon

2. Tasimelteon

27
Q

third (out of 4) step in PHARM

A

mild habit forming agents (1. Benzo agonists and 2. orexin antags)

28
Q

Benzo agonists?

A
  1. zolpidem
  2. zaleplon
  3. ezoplicone
29
Q

orexin antag?

A

suvorexant

30
Q

fourth step in PHARM?

A

ADDICTING agents- benzos and off label

31
Q

addicting benzos?

A
  1. triazolam
  2. temazepam
  3. flurazepam
32
Q

off label?

A

trazodone, quetiapine

33
Q

Trazodone

A

sedating antidepressant

34
Q

Quetiapine

A

sedating antipsychotic

35
Q

Who don’t get addictive rx?

A

addictive or riskier pts

36
Q

Restless leg pts rx?

A

Get d2 agonists-treat underlying medical prob

37
Q

What should be kept in mind for pts with sleep apnea?

A

No sedative rx!!!

38
Q

Theoretical insomnia meds target where?

A

Serotonin receptors:
2a=deeper sleep patterns
1d and 7=more accurate circadian clock

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