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Psych 133 Sleep > Insomnia > Flashcards

Insomnia Flashcards

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1
Q

Clinical Formulation (7 Categories)

A 
Sleep History
Sleep Diary
Self Report Measures
PPP
Lifespan Issues
Comorbidity
Daytime Functioning
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2
Q

Medical Contributors to Insomnia (7)

A 
Lung disease
Chronic pain
Renal failure
Parkinson's
Congestive heart failure
Coronary artery disease
Medication use
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3
Q

Cannot diagnose insomnia if comorbid with… (5)

A 
sleep-related breathing disorder
periodic limb movement disorder and restless legs syndrom
circadian rhythm disorders
parasomnias
narcolepsy
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4
Q

Is PSG necessary?

A

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

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5
Q

How is actigraphy in insomnia?

A

not well validated in insomnia patients
not indicated for routine diagnosis, assessment, or treatment
can be useful screening tool

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6
Q

What to assess for daytime functioning? (4)

A

Fatigue
Mood
Quality of Life and Function
Sleepiness

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7
Q

Examples of Fatigue Measures (2)

A

Multidimensional Fatigue Inventory

Fatigue Severity Scale

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8
Q

Examples of Mood Measures (3)

A

Inventory of Depressive Symptomatology
Beck Depression Inventory-II
State Trait Anxiety Inventory (STAI)

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9
Q

Examples of Quality Measures (1)

A

SF-36

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10
Q

Examples of Sleepiness Measures (3)

A

Stanford Sleepiness Questionnaire
Epworth Sleepiness Questionnaire
Multiple Sleep Latency Test (MSLT)

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11
Q

Fatigue vs Sleepiness (def.)

A

fatigue: subjective feeling of physical/mental weariness
sleepiness: actual tendency to sleep

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12
Q

Is fatigue necessarily associated with increased sleep propensity?

A

No

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13
Q

What is and is not the common compliant among insomnia patients?

A

Fatigue is the common complaint, not sleepiness

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14
Q

Is there a significant difference in MSLT between controls and individuals with insomnia?

A

No

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15
Q

What does the graph for sleepiness over the day look like?

A

W-shaped

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16
Q

PPP Model (3)

A

predisposing
precipitating
perpetuating

17
Q

Psychiatric assessment of comorbidity (eg)

A

Structured Clinical Interview for Diagnosis (SCID-IV)

18
Q

Medical assessment of comorbidity (3)

A

interview
physical examination
questionnaires (eg. Cornell Medical Checklist)

19
Q

Patients in insomnia tend to __________ their SOL

A

overestimate

20
Q

Patients with insomnia tend to _________ their TST

A

underestimate

21
Q

The puzzle is ubiquitous across…

A

subtypes, instruments, contexts, mutliple nights

22
Q

When woken up during different stages in sleep, insomnia patients are more likely to report that…

A

they had been awake the moment just before they were woken

23
Q

Paradoxical Insomnia: diagnosti criteria (3)

A

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

24
Q

Indivduals with sleep state misperception represent _________________ of a continuum

A

only one extreme

25
Q

Does the tendency to misperceive sleep preclude the presence of a real sleep deficit?

A

No, it can be a mechanism that escalates insomnia

26
Q

Transition of wakefulness to sleep is marked by: (3)

A

progressive loss of consciousness
reduction of stimulus reception
absence of memory
(exact point is elusive)

27
Q

Time seems ________ when the number of units of information processed per unit of time increases

A

longer

28
Q

Many patients with insomnia report that they ______ when they cannot get to sleep

A

worry

29
Q

People with insomnia exhibit more_____ frequency EEG (in the _____ to _____ range) at or around sleep onset and during NREM sleep

A

high frequency (cortical arousal)
Beta
Gamma

30
Q

How does cortical arousal contribute to sleep mispecreption?

A

By reducing the differentiation between sleep and wakefulness

31
Q

Sleep is controlled by a “switch” between: (2)

A

VLPO (during sleep)

Arousal system

32
Q

VLPO

A

ventrolateral preoptic nucleus

33
Q

Relationship between VLPO and arousal system

A

VLPO is fully activated during sleep but unable to flip off the arousal system because it’s being excited intensely by the limbic system

34
Q

Possible resolutions to misperception of insomnia: (9)

A

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

Psych 133 Sleep (9 decks)

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