Insomnia Flashcards

1
Q

How is the duration of insomnia classified as?

A

transient - few days
short-term - up to 3 weeks
chronic - greater than 3 weeks

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2
Q

What is insomnia?

A

disturbed sleep -waking in the middle of the night
trouble getting to sleep
waking up too early or feeling tired throughout the day despite sleeping early

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3
Q

what questions would you ask a pt with insomnia?

A
  • pattern of sleep - emotional disturbance
  • daily routine - shift patterns, more workload
  • underlying medical conditions - GORD, pregnancy, asthma
  • recent travel - time zones
  • daytime sleeping - naps throughout the day
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4
Q

what medicines can induce insomnia?

A
  • Stimulants: caffeine - more than 4 cups can cause insomnia, theophylline MAOIs
  • antiepileptics
  • alcohol
  • BB
  • SSRIs
  • diuretics - must take in the morning
  • griseofulvin
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5
Q

When to refer a pt with insomnia?

A
  1. Duration longer than 3 weeks - chronic insomnia
  2. children under 12
  3. suspected adverse events from medication like fluoxetine, MAOI’s
  4. suspected depression
  5. prostatic hypertrophy and closed angle glaucoma are C/I to antihistamine therapy
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6
Q

what are key steps to good sleep hygiene?

A
maintain a regular routine 
food snacks and alcoholic/caffeine should be avoided 
avoid stimulants and alcohol 
no naps 
associate bed with sleep 
recommend ways to prevent snoring
lavendar oil
light exercise in the evening
warm bath
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7
Q

What tx options are available for pts with insomnia?

A

first generation antihistamines (diphenhydramine, promethazine)

melatonin - reduces jet lag, taken at night

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8
Q

What are the age restrictions of first generation antihistamines? side effects? Interaction?

A

> 16 years
dry mouth, sedation
glaucoma, prostrate enlargement

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9
Q

when should diphenhydramine and promethazine be taken?

A

DPH: 20 mins before bed
Promethazine: one hour before bed

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10
Q

what are branded names of antihistamines used for insomnia?

A

Nytol

Nightcalm

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