Insomnia and Sleepiness Flashcards
What classifies a person as having insomnia
Difficulty initiating sleep
difficulty maintaining sleep
waking up too early
sleep difficulty despite adequate sleep opportunity
daytime consequences(sleepiness, irritability)
absence of other underlying sleep disorder or problem
HAS to occur at east 3 times/week for 3 months
What are some causes of sleep impairment
medical
psychiatric
drug induced/related
environmental
social
What are some non-pharmacological therapy options
keeping a regular sleep/wake sched
exercise frequently(but not immediately before bedtime)
avoid alcohol and stimulants in the late afternoon to evening
avoid blue light prior to bedtime
maintain comfortable sleep environment
What should be considered when using drug options to treat insomnia
indicated for transient or short-term insomnia
OTC options should not be used in patients with chronic insomnia
indicated only for difficulty initiating sleep
max duration of use is 2 weeks
What are exclusions to self-treatment
less than 12 years of age
older than 65 years of age
pregnant/breastfeeding
frequent nocturnal or early morning awakenings
chronic insomnia
sleep disruption secondary to psychiatric or medical condition
What antihistamine can be used to treat insomnia
Diphenhydramine
What are the salt forms and corresponding mg available
Citrate=38mg
HCl=25mg
How fast can you develop a tolerance to diphenhydramine once you start taking it
4-7 days
What are precautions that should be taken when using diphenhydramine
do not use for more than 14 nights
not be used in children younger than 12
avoid alcohol and other CNS depressants
caution of combination products
contraindicated for chronic bronchitis or emphysema
elderly more susceptible to adverse effects
Why should you avoid diphenhydramine when pregnant and lactating
May increase uterine activity
may reduce milk production
Who should not take melatonin
those with renal and or hepatic impairment
What drug interactions exist with melatonin
warfarin: increased risk or bleeding
nifedipine: increased blood pressure
fluvoxamine: increased CNS depression
corticosteroids: reduced efficacy of steroids
How does valerian root affect insomnia
Increases GABA release to induce sleepiness
How does alcohol affect sleep
decreases sleep latency, disrupts sleep cycle, glutamine rebound
How is central fatigue classified
described as mental exhaustion with impaired concentration or thinking ability that occurs as a result of intellectually demanding activities
How is physical fatigue classified
a sense of physical exhaustion or depletion of energy as a result of physical effort
How is sleepiness characterized
a person feels the urge to return to sleep in the absence of central or physical fatigue
What are some causes of fatique
depression and anxiety and other psych conditions
everyday stress
medical conditions
medications
Does fatigue respond to caffeine
NO, only sleepiness will respond to caffeine
What is an OTC therapy that can be used to treat sleepiness
Caffeine: 100-200mg every 3-4 hours. MDD 600mg daily
What are exclusions to self-treatment of fatigue/sleepiness
younger than 12 years old
taking medications
chronic fatigue
have heart disease or high blood pressure
women who are pregnant or breastfeeding
anxiety disorders
medication-induced drowsiness
When does tolerance start to develop with caffeine
After 4-5 days
What are some adverse effects that occur with caffeine
caffeinism
insomnia
tremor/muscle twitching
tachycardia
mild blood pressure increases
