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PSYCH > Insomnia > Flashcards

Insomnia Flashcards

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0
Q

perpetuating factors

A

mental arousal in bed (intrusive thoughts)
negative expectations
heightened somatic tension in bed
complaint more fixed over time
cognitions; cognitive distortions and catastrophization

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1
Q

insomnia is associated with

A

psychiatric disorders- major depressive disorder
certain substances
medical/neurological disorders

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2
Q

cognitive distortions

A

things you believe about your sleep

“chemical imbalance” “i should stay in bed even if i cant sleep”

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3
Q

catastrophization

A

worrying about what a poor night of sleep will mean for the rest of the day

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4
Q

daytime consequences

A

only one required to make diagnosis

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5
Q

4 nature of complaints

A

difficulty falling asleep
mid cycle awakening sustained
mid cycle awakening brief/repetitive
early morning awakening

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6
Q

difficulty falling asleep

A

anxiety, depression, delayed sleep phase, conditional arousal

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7
Q

mid cycle awakening

A

conditioned arousal, depression, anxiety

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8
Q

MCA (brief/repetitive)

A

phyisological event/other-Obstructive sleep apnea or other underlying medical sisue

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9
Q

early motnign awakening

A

depression
advanced sleep phase
cnditioned arousal

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10
Q

sleep logs

A

if person has ocd or anxiety- bad

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11
Q

epworth sleepiness scale

A

rate the likelihood of dosing off in following circumstances..

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12
Q

polysomnography

A

not indicated for routine evaluation of insomnia

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13
Q

Chronic Insomnia Disorder

A

> 3x/week, >3x/month

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14
Q

short-term insomnia disorder

A

symptoms present for <3 months

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15
Q

arousal and affective disturbance in insomnia

A

HPA axis: cortisol in insomnia patients higher during early sleep period- lacking cortisol drop

symp elevated HR and BP at sleep onset

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16
Q

medication beliefs

A

provide effect short-term relief for many with insomnia; improvements typically wane with discontinuation of medication

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17
Q

FDA approved hypnotics

A

benzos
BzRAs- benzo receptor agonists- Imidazopyridines, cycopyrrolones, pyrazolopyrmidines
melatonin agonists
histamine agonists

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18
Q

sedating anti-depressants

A

tricyclic antideprssants- amitriptyline
trazodone
mirtazpaine

19
Q

most effective long term management

A

CBT

20
Q

important in CBT

A

cogntiive distrotions, relaxation training, biofeedback, stimulus control, slepe rstriction (restrict time in bed to actual sleep time)

21
Q

for average sleep efficiency greater than 85%

A

increase TIB by 15 minutes

22
Q

for average sleep efficiency over one week less than 85%

A

decrease TIB by 15 mins

23
Q

short term insomnia may be complicated by

A

conditioned arousal

24
Q

treatment focused on short term insomnia

A

sleep hygiene! get out of bed

hypnotics as indicated

25
Q

restless leg vs perioic limb mobement

A

bed partner telling story in periodic limb movement

clinical features of interrupted, light sleep and/or daytime sleepiness

26
Q

etiology of periodic limb movement disorder

A 
familial
neuropathy/radiculopathy/myelopathy
Fe deficiency
end-stage renal
RA
substances (caffeine, alch)
27
Q

PLMS polysomnograph

A

repeptive episodes of muscle contraction

28
Q

treatment PLMS

A

dopamine agents - ropnirole, carbidopa
benzos
opioids
anticonvulsants

29
Q

parasomnias tessted for by

A

multiple sleep latency test

4-5 nap opportunites at 2 hr intervals

30
Q

narcolepsy

A

disorder of sleep-wake regulation involving inappropriate manigestations of REM sleep

31
Q

etiology narcolepsy

A

destruction of orexin neurons in hypothalamus– maybe via HLA (inconclusive)

32
Q

CSF-orexin

A

significantly reduced in patients with narcolepsy and cataplexy

33
Q

cataplexy

A

inappropriate intrusion of REM atonia into waking

34
Q

sleep-onset REM

A

sleep paralysis

35
Q

in catalplexy, you typically maintain

A

consciousness

36
Q

15% with full Nercoleptic tetrade

A 
excessive sleepiness/sleep attacks
cataplexy
sleep paralysius
hypnagogic/hypnapompic- really clear hallucinations with intruder
disturbed nocturnal sleep
37
Q

treatment narcolepsy

A

sleepiness- stimulations- amphetamine, metylphenidate, modonifil, gamahydroxybutryate, planned naps

cataplexy-rem suppressant (tricycle/ssri/snri), GHB

psychosocial support-education

38
Q

idiopathic hypersomnia

A

excessive sleepiness daily for > 3 months (MSLT will show a mean latency <8 mins)
insufficient sleep ruled out
supportive features- long nocturnal sleep, sleep drunkeness, long unrefreshing naps, possible autnomic disturbance

39
Q

parasomnias

A

abnormal events or behaviors whcih arise from sleep or sleep-wake transition

40
Q

types of parasomnias

A

nREM

REM -rem behavior disorder, nightmares, sleep paralysis

41
Q

nREM-disorder of arousal

A

sleep walking, night terrors, confusional arousals

42
Q

patho of nREM

A

arise from stage 3/4 sleep

high amplitude delta waves
first third of the night (when we get most of our N3 sleep)
amnesia/partial recall

43
Q

treatment nREM

A 
gently guide back to bed
remove dangerous items
benzos
psychogical treatment
stop ambien if ambien started it!
44
Q

REM behavior disorder

A

dream enactment associated with loss of muscle atonia in REM sleep
predom male
45-50% with neuropath but others are idiopathic

45
Q

REM behavior associated neuropathy

A

synucleopathies
parkinsons
dementia with lewy bodies
multisystem atrophy

46
Q

treatment of REM behavior disorder

A

neuro eval
pharm treatments-clonazepam
safety

PSYCH (25 decks)

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