Insomnia

Question 1

dyssomnia

Answer 1

sleep disorder characterized by problems in timing, quality, or amount of sleep. insomnia is a dyssomnia

Question 2

parasomnia

Answer 2

sleep disorder characterized by abnormalities in physiology or behavior associated with sleep

Question 3

insomnia DSM-5 criteria

Answer 3

complaint of dissatisfaction with sleep quality or quantity, associated with one or more of the following: difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening with inability to return to sleep. sleep disturbance causes distress or impairment in life. Happens at least 3 nights a week for at least 3 months

Question 4

who reports insomnia more, women or men?

Answer 4

women!

Question 5

endogenous etiology

Answer 5

excitatory neurotransmitters in excess at night. Norepi from locus ceruleus, serotonin from raphe nucleus, dopamine from ventral tegmental area, histamine from tuberomammillary nucleus. Inhibitory neurotransmitter deficiency at night (loss of GABA, melatonergic, and adenosinergic tone!)

Question 6

exogenous etiology

Answer 6

physical causes: use of CNS stimulants aka caffeine. withdrawal of sedating agents like alcohol, benzos, and barbituates. Medical conditions like chronic pain, pulmonary disease, and endocrine disorders.

Question 7

common psychiatric causes of insomnia

Answer 7

major depressive disorder: short REM sleep latency, repeated nighttime awakenings, waking too early in the morning.
Anxiety/PTSD: trouble falling asleep + nightmares
bipolar disorder: problems falling and maintaining sleep

Question 8

anxiety symptoms that can lead to insomnia

Answer 8

getting caught up in thoughts about past events. excessive worrying over the future. feeling overwhelmed by responsibilities

Question 9

effects of insomnia

Answer 9

decreased quality of life. complaints of impaired daytime performance. self-medication and risk of substance abuse occurs. association between insomnia and psychiatric disorders.

Question 10

first 2 steps to managing insomnia

Answer 10

1. diagnosis, informed consent, and education

2. behavioral counseling (sleep hygiene/stimulus control)

Question 11

types of therapy for insomnia

Answer 11

sleep restriction therapy, cognitive therapy (talking through, imagery), behavioral therapy (diary/log book, progressive relaxation, self hypnosis)

Question 12

stepwise approach to pharm management of insomnia

Answer 12

1. OTC agents (melatonin, antihistamines)
2. Rx agents/non-habit forming (antihistamines, melatonin agonists [the melteons])
3. Rx agents/mild habit forming (benzo receptor agonists, Orexin antagonists)
4. Rx agents/habit forming (benzos, trazodone, quetiapine)

Question 13

serotonin receptors and sleep

Answer 13

antagonizing 5-HT2a creates deeper sleep patterns. antagonizing 5-HT1d and 7 promotes a more accurate circadian clock