Insomnia Flashcards
What disease states are more likely when suffering with insomnia?
Depression
Anxiety
Obesity
Hypertension
What are the main features of the sleep cycle?
As the night goes on there is less REM 4/5 sleep
Reduction in these sleep stages with age
What is transient insomnia?
Usually sleep well but disturbed due to jet lag, shift work, noise disturbance etc
What is short term insomnia?
May last for a few weeks and be due to physical illness or bereavement
What is chronic insomnia?
Inability to achieve or maintain sleep for the majority of nights over at least 3 months
What are the possible features of insomnia?
Difficulty falling asleep Frequent waking during the night Early morning waking Daytime sleepiness General loss of wellbeing
What is the first line treatment for insomnia?
Finding and treating the cause
When may hypnotics be used for insomnia?
In severe insomnia affecting everyday life
How long should hypnotics be used for?
Usually 2 weeks, for the shortest time period possible
Use for no longer than 4 weeks
Which drugs should be used in difficulty to fall asleep?
Shorter acting agents i.e. temazepam or zolpidem
Which drugs should be used in frequent waking?
Longer acting drugs i.e. nitrazepam or zopiclone
How do the effects of long and short acting hypnotics vary?
Increased risk of rebound insomnia and tolerance with short acting agents
Risk of next day sedation with longer acting agents
How do BZDs work in insomnia?
Stimulate activity at GABA-A receptors
Can reduce stage 3 and 4 non-REM sleep
What must be considered when starting BZDs?
Operating machinery
Extreme caution in elderly and previous addiction
Rebound insomnia commn
How do Z drugs work in insomnia?
Stimulate activity at GABA-A receptors
Shorten stage 1 sleep and increase stage 2
Describe the use of melatonin in insomnia.
Mimics natural melatonin
2mg daily
Licensed for mono therapy in over 55s
What effect does melatonin have on sleep?
Very short acting
Promotes sleep initiation and uninterrupted sleep
Give 3 examples of sedating antihistamines.
Dephenhydramine
Chlorphenamine
Promethazine
What are the disadvantages of sedating antihistamines?
Commonly produce ‘hangover’
Can develop tolerance
Describe sleep hygiene considerations.
Increase daily exercise but not within 4 hours of bedtime
Stop daytime naps
Bedroom should be at right noise levels, light and temperature
Reduce consumption of certain substances (nicotine, caffeine, chocolate, alcohol)
Avoid TV, computers etc in bedroom
Develop routine for getting in and out of bed
