Insomnia Flashcards
Clinical Formulation (7 Categories)
Sleep History Sleep Diary Self Report Measures PPP Lifespan Issues Comorbidity Daytime Functioning
Medical Contributors to Insomnia (7)
Lung disease Chronic pain Renal failure Parkinson's Congestive heart failure Coronary artery disease Medication use
Cannot diagnose insomnia if comorbid with… (5)
sleep-related breathing disorder periodic limb movement disorder and restless legs syndrom circadian rhythm disorders parasomnias narcolepsy
Is PSG necessary?
Not need for diagnosis (based on self-report)
PSG not recommended for routine assessment
Used if diagnosis uncertain or treatment fails, or if sleep apnea, PLMD, or paradoxical insomnia are suspected
How is actigraphy in insomnia?
not well validated in insomnia patients
not indicated for routine diagnosis, assessment, or treatment
can be useful screening tool
What to assess for daytime functioning? (4)
Fatigue
Mood
Quality of Life and Function
Sleepiness
Examples of Fatigue Measures (2)
Multidimensional Fatigue Inventory
Fatigue Severity Scale
Examples of Mood Measures (3)
Inventory of Depressive Symptomatology
Beck Depression Inventory-II
State Trait Anxiety Inventory (STAI)
Examples of Quality Measures (1)
SF-36
Examples of Sleepiness Measures (3)
Stanford Sleepiness Questionnaire
Epworth Sleepiness Questionnaire
Multiple Sleep Latency Test (MSLT)
Fatigue vs Sleepiness (def.)
fatigue: subjective feeling of physical/mental weariness
sleepiness: actual tendency to sleep
Is fatigue necessarily associated with increased sleep propensity?
No
What is and is not the common compliant among insomnia patients?
Fatigue is the common complaint, not sleepiness
Is there a significant difference in MSLT between controls and individuals with insomnia?
No
What does the graph for sleepiness over the day look like?
W-shaped
PPP Model (3)
predisposing
precipitating
perpetuating
Psychiatric assessment of comorbidity (eg)
Structured Clinical Interview for Diagnosis (SCID-IV)
Medical assessment of comorbidity (3)
interview
physical examination
questionnaires (eg. Cornell Medical Checklist)
Patients in insomnia tend to __________ their SOL
overestimate
Patients with insomnia tend to _________ their TST
underestimate
The puzzle is ubiquitous across…
subtypes, instruments, contexts, mutliple nights
When woken up during different stages in sleep, insomnia patients are more likely to report that…
they had been awake the moment just before they were woken
Paradoxical Insomnia: diagnosti criteria (3)
1) meet criteria for insomnia
2) one of:
a) reports little or no sleep
b) mismatch of PSG and sleep diary
3) one of:
a) reports almost constant awareness of the environment across the night
b) conscious thoughts or rumination throughout the night
Indivduals with sleep state misperception represent _________________ of a continuum
only one extreme
Does the tendency to misperceive sleep preclude the presence of a real sleep deficit?
No, it can be a mechanism that escalates insomnia
Transition of wakefulness to sleep is marked by: (3)
progressive loss of consciousness
reduction of stimulus reception
absence of memory
(exact point is elusive)
Time seems ________ when the number of units of information processed per unit of time increases
longer
Many patients with insomnia report that they ______ when they cannot get to sleep
worry
People with insomnia exhibit more_____ frequency EEG (in the _____ to _____ range) at or around sleep onset and during NREM sleep
high frequency (cortical arousal)
Beta
Gamma
How does cortical arousal contribute to sleep mispecreption?
By reducing the differentiation between sleep and wakefulness
Sleep is controlled by a “switch” between: (2)
VLPO (during sleep)
Arousal system
VLPO
ventrolateral preoptic nucleus
Relationship between VLPO and arousal system
VLPO is fully activated during sleep but unable to flip off the arousal system because it’s being excited intensely by the limbic system
Possible resolutions to misperception of insomnia: (9)
1) The challenge of the context
2) An artefact of sleep onset definition?
3) A deficit in time estimation ability?
4) Worry
5) Selective attention
6) memory bias
7) cortical arousal
8) brief arousals
9) balance of neuronal systems
