Insomnia

Question 1

Define insomnia

Answer 1

Difficulty falling OR staying asleep

Question 2

What’s primary insomnia?

Answer 2

insomnia w/o cause

Question 3

what’s 2ndary insomnia?

Answer 3

insomnia caused by a condition/drug

Question 4

NTs assoc w/ non-REM sleep

Answer 4

GABA and adenosine

Question 5

NTs/substances assoc w/ wakefulness

Answer 5

1. ACh
2. NE
3. DA
4. substance P
5. corticotropin releasing factor
6. histamine

Question 6

How do lower levels of DA affect sleep?

Answer 6

Lower DA levels PROMOTE sleep

Question 7

How many hours of sleep are assoc w/ poor health outcomes?

Answer 7

≤ 6h

Question 8

What is the MOST COMMON med that promotes insomnia? Why?

Answer 8

Levodopa > increases CNS DA levels > promotes wakefulness

Question 9

5 most common meds likely to disrupt sleep

Answer 9

levodopa, prednisone, venlafaxine, fluvoxamine, rotigotine

Question 10

How frequently must sleep difficulty occur for insomnia to be dx’ed?

Answer 10

at least 3 nights per week

Question 11

How long must sleep difficulty be present for insomnia to be dx’ed?

Answer 11

at least 3 mths

Question 12

Insomnia: sleep onset latency goal?

Answer 12

< 30mins

Question 13

Insomnia: wake after sleep onset goal?

Answer 13

< 30 mins

Question 14

Insomnia: total sleep time goal?

Answer 14

> 6h

Question 15

T or F: Pharmacotx is NOT great for insomnia usually.

Answer 15

T

Question 16

1st line tx for insomnia

Answer 16

CBT for insomnia (CBTi)

Question 17

T or F: CBTi improves sleep, but not total sleep time.

Answer 17

T

Question 18

Non-pharm tx’s for insomnia

Answer 18

1. sleep hygiene
2. sleep restriction
3. stimulus ctrl
4. cognitive tx
5. relaxation tx

Question 19

T or F: Drugs are last line for insomnia tx

Answer 19

T

Question 20

Pharmacotx should not be used longer than ____ for insomnia tx.

Answer 20

1 month

Question 21

How much time can sedative hypnotics increase total sleep time by (according to studies)?

Answer 21

25 minutes (not sig)

Question 22

Classes of drugs for used for insomnia

Answer 22

Z-drugs
antidepressants
BZDs
OTCs

Question 23

Z-drugs used for insomnia? Which one is most common?

Answer 23

Zopiclone - more common

Zolpidem

Question 24

Which antidepressants are used for insomnia? Which one has evidence?

Answer 24

Doxepin
Trazodone
L-tryptophan

Question 25

Which BZDs are used for insomnia?

Answer 25

Temazepam

Question 26

BZDs should be avoided in…

Answer 26

elderly

Question 27

Which OTC products are used for insomnia?

Answer 27

melatonin

valerian root

Question 28

Which two classes of insomnia drugs should be tapered before d/c?

Answer 28

Z-drugs, BZDs

Question 29

What issues are there with using Z-drugs in pregnant women?

Answer 29

May cause low birth wt, preterm deliveries, C-sections

Question 30

Which BZD is recommended in pregnant women if one is absolutely necessary? Why?

Answer 30

Lorazepam > no active metabolites and low levels in breast milk

Question 31

Which drug is safe in pregnancy during the 1st trimester?

Answer 31

Trazodone

Question 32

T or F: Melatonin is safe during pregnancy

Answer 32

F

Not enough evidence/studies

Question 33

Safest drugs for insomnia in elderly:

Answer 33

doxepin ≤ 6 mg/day
melatonin
zolpidem

Question 34

What should we inform elderly pts if they complain about insomnia?

Answer 34

Tell them it’s normal to sleep less as ppl age

Question 35

Strategies for night shift workers to deal with/avoid insomnia

Answer 35

1. Eat enough to manage hunger (don’t eat too much during shift)
2. avoid screens (tv, phone)
3. wear ear plugs, eye masks, use blinds
4. avoid stimulants/caffeine
5. Perform relaxing activities (read, bath, etc.)