Insomnia Flashcards
Secondary causes of insomnia
drugs, life events, environment, illness
Three types of insomnia?
Transient, acute, chronic
What is transient insomnia?
sleep well usually. Jet lag, shift work, noise/light disturbance
What is acute insomnia?
may last for a few weeks, bereavement, physical illness
What is chronic insomnia?
inability to achieve or maintain sleep satisfactorily on the majority of nights over a period of at least three months, despite adequate opportunity, with subsequent adverse consequences on daily functioning
Symptoms of insomnia?
- difficulty falling asleep
- frequent waking
- early morning wakening
- daytime sleepiness
- general loss of wellbeing due to sleep loss
Things to consider when treating insomnia?
- try to treat underlying cause first
- hypnotics only used in severe insomnia interfering with life
- consider sleep hygiene first unless urgent treatment required (then do both) - habits are v important
Principles of using hypnotics for insomnia?
For the shortest time period (usually 2 weeks, max 4 weeks, see SmPCs)
For one or two doses, or intermittently if possible
At the lowest effective dose
for short term/transient, a few doses may be enough.
- additive sedative effects from other drugs or alcohol
- prescribe agent w lowest acquisition cost as efficacy is the same
When to use short acting agent for insomnia?
difficulty falling asleep
higher risk of dependence and late night rebound insomnia
When to use lon-acting agent for insomnia?
early morning wakening
less likely to cause rebound insomnia, but risk of next day grogginess
Most widely prescribed hynotics?
benzos
can use short or long acting - counsel on use of machinery/driving etc
extreme caution in elderly
Most widely prescribed hynotics?
benzos
can use short or long acting - counsel on use of machinery/driving etc
extreme caution in elderly or previous addiction
reduce stage 3 and 4 non-REM sleep
What are the Z drugs?
Zolpidem (short), zopiclone (long)
shorten stage 1, increase stage 2, little effect on 3 nad 4
similar to BZDs for cautions
withdraw gradually in prolonged use
Other drugs available for insomnia?
Melatonin
Sedating antihistamines
Clomethiazole
OTC preps
Place of melatonin in insomnia treeatment?
Mimics natural melatonin: not addictive and well tolerated, does not cause tolerance
Usual dose 2mg daily, licensed as monotherapy for over 55’s, very short acting (often appears as MR prep) – promotes sleep initiation and uninterrupted sleep
