Insomnia Flashcards
Define insomnia
Difficulty falling OR staying asleep
What’s primary insomnia?
insomnia w/o cause
what’s 2ndary insomnia?
insomnia caused by a condition/drug
NTs assoc w/ non-REM sleep
GABA and adenosine
NTs/substances assoc w/ wakefulness
- ACh
- NE
- DA
- substance P
- corticotropin releasing factor
- histamine
How do lower levels of DA affect sleep?
Lower DA levels PROMOTE sleep
How many hours of sleep are assoc w/ poor health outcomes?
≤ 6h
What is the MOST COMMON med that promotes insomnia? Why?
Levodopa > increases CNS DA levels > promotes wakefulness
5 most common meds likely to disrupt sleep
levodopa, prednisone, venlafaxine, fluvoxamine, rotigotine
How frequently must sleep difficulty occur for insomnia to be dx’ed?
at least 3 nights per week
How long must sleep difficulty be present for insomnia to be dx’ed?
at least 3 mths
Insomnia: sleep onset latency goal?
< 30mins
Insomnia: wake after sleep onset goal?
< 30 mins
Insomnia: total sleep time goal?
> 6h
T or F: Pharmacotx is NOT great for insomnia usually.
T
1st line tx for insomnia
CBT for insomnia (CBTi)
T or F: CBTi improves sleep, but not total sleep time.
T
Non-pharm tx’s for insomnia
- sleep hygiene
- sleep restriction
- stimulus ctrl
- cognitive tx
- relaxation tx
T or F: Drugs are last line for insomnia tx
T
Pharmacotx should not be used longer than ____ for insomnia tx.
1 month
How much time can sedative hypnotics increase total sleep time by (according to studies)?
25 minutes (not sig)
Classes of drugs for used for insomnia
Z-drugs
antidepressants
BZDs
OTCs
Z-drugs used for insomnia? Which one is most common?
Zopiclone - more common
Zolpidem
Which antidepressants are used for insomnia? Which one has evidence?
Doxepin
Trazodone
L-tryptophan
Which BZDs are used for insomnia?
Temazepam
BZDs should be avoided in…
elderly
Which OTC products are used for insomnia?
melatonin
valerian root
Which two classes of insomnia drugs should be tapered before d/c?
Z-drugs, BZDs
What issues are there with using Z-drugs in pregnant women?
May cause low birth wt, preterm deliveries, C-sections
Which BZD is recommended in pregnant women if one is absolutely necessary? Why?
Lorazepam > no active metabolites and low levels in breast milk
Which drug is safe in pregnancy during the 1st trimester?
Trazodone
T or F: Melatonin is safe during pregnancy
F
Not enough evidence/studies
Safest drugs for insomnia in elderly:
doxepin ≤ 6 mg/day
melatonin
zolpidem
What should we inform elderly pts if they complain about insomnia?
Tell them it’s normal to sleep less as ppl age
Strategies for night shift workers to deal with/avoid insomnia
- Eat enough to manage hunger (don’t eat too much during shift)
- avoid screens (tv, phone)
- wear ear plugs, eye masks, use blinds
- avoid stimulants/caffeine
- Perform relaxing activities (read, bath, etc.)
