Insomnia

Question 1

Two types of sleep disorders?

Answer 1

Dyssomnias and Parasomnias

Question 2

Dyssomnias: Definition?

Answer 2

Problems with timing, amount and quality of sleep

Question 3

Examples of Dyssomnias?

Answer 3

insomnia, narcolepsy, sleep apnea

Question 4

Parasomnias: Definition?

Answer 4

abnormal sleep physiology OR behavior

Question 5

Examples of parasomnia

Answer 5

nightmare disorder, sleep terror disorder, sleepwalking disorder, bruxism

Question 6

DSM5 insomnia definition

Answer 6

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

Question 7

Other DSM5 criteria

Answer 7

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

Question 8

Other DSM5 criteria

Answer 8

MUST happen 3 times per week for at least 3 months

Question 9

Other DSM5 criteria

Answer 9

Not due to substance or other disorder

Question 10

Most common cause of insomnia?

Answer 10

caffeine

Question 11

More insomnia with who?

Answer 11

elderly and women

Question 12

What neurotransmitters are increased in insomnia?

Answer 12

NE, serotonin, dopamine, histamine

Question 13

Formation locations of NE, Serotonin, dopamine and histamine

Answer 13

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

Question 14

What neurotransmitters are decreased in insomnia?

Answer 14

GABA, melatonin, adenosine

Question 15

Exogenous causes of insomnia?

Answer 15

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

Question 16

Mental Disorder causes of Insomnia?

Answer 16

1. MDD
2. Bipolar
3. GAD, PTSD

Question 17

Anxiety Causes of insomnia

Answer 17

1. Thinking of past, future, etc

2. anxiety about falling asleep

Question 18

Results/Effects of insomnia

Answer 18

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

Question 19

First 2 steps in Management of insomnia

Answer 19

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

Question 20

Next 3 steps in management of insomnia

Answer 20

3. sleep restriction therapy (limit amt of time in bed to force sleep later)
4. Cognitive therapy- talk it through
5. behavioral therapy- diary, hypnosis, relaxation

Question 21

LAST OPTION for insomnia management?

Answer 21

PHARMACOTHERAPY

Question 22

first (out of 4) step in PHARM

Answer 22

1. OTC

Question 23

2 OTC examples for insomnia

Answer 23

1. melatonin

2. antihistamines

Question 24

second (out of 4) step in PHARM

Answer 24

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

Question 25

non habit forming antihistamines? (1)

Answer 25

Doxepin

Question 26

nonhabit forming melatonin 1&2 agonists? (2)

Answer 26

1. Ramelteon | 2. Tasimelteon

Question 27

third (out of 4) step in PHARM

Answer 27

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

Question 28

Benzo agonists?

Answer 28

1. zolpidem 2. zaleplon 3. ezoplicone

Question 29

orexin antag?

Answer 29

suvorexant

Question 30

fourth step in PHARM?

Answer 30

ADDICTING agents- benzos and off label

Question 31

addicting benzos?

Answer 31

1. triazolam 2. temazepam 3. flurazepam

Question 32

off label?

Answer 32

trazodone, quetiapine

Question 33

Trazodone

Answer 33

sedating antidepressant

Question 34

Quetiapine

Answer 34

sedating antipsychotic

Question 35

Who don't get addictive rx?

Answer 35

addictive or riskier pts

Question 36

Restless leg pts rx?

Answer 36

Get d2 agonists-treat underlying medical prob

Question 37

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

Answer 37

No sedative rx!!!

Question 38

Theoretical insomnia meds target where?

Answer 38

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