insomnia/drowsiness/fatigue Flashcards
stage 1 of sleep
transitional, occurs as one falls asleep
stage 2 of sleep
light sleep, about 50% of sleep time
stage 3 and 4 of sleep
deep sleep
REM
not light or deep, characterized by eyes move rapidly from side to side
cycle of sleep repeats every
70-120 minutes
transient insomnia
lasts < 1 week; self-limiting
short term insomnia
1-3 weeks (can progress to long term)
chronic/long term insomnia
lasts > 3 weeks, often result of medical problem, psychiatric disorder or substance abuse
primary insomnia definition
sleep difficulty lasting at least one month, but is not cause by another sleep disorder, medical condition, psychiatric condition, or medication
exclusions for self treatment of insomnia
- < 12 years of age
- > or equal to 65
- pregnancy
- frequent nocturnal awakenings or early morning awakenings
- chronic insomnia
- sleep disturbances secondary to psychiatric or general medical disorder
non pharm treatment of insomnia
- bed for sleeping
- regular sleep pattern
- avoid electronic devices
- exercise regularly
- avoid large meals two hours before bed
- avoid daytime napping
- avoid caffeine, alcohol, nicotine within 4-6 hours of bed
- do not watch clock
- relaxing activity
non prescription options
antihistamines and ethanol
antihistamine usage in insomnia
indicated for transient and short term use, poor for long term bc tolerance develops
dosing of antihistamines
typically 50 mg, can be 25 mg
duration of antihistamines
use no more than 7-10 consecutive nights
adverse effects of antihistamines
additive sedation if used in combo with other medication that has other anticholinergic effects, dry mouth, constipation, blurry vision
do not use antihistamines in patients with these conditions
BPH, arrhythmias, or dementia
cessation of ethanol
can cause rebound insomnia
complementary therapies for insomnia
melatonin and valerian
melatonin regulates
sleep and circadian rhythm
melatonin improves
attempts at sleeping, but doesn’t cause drowsiness
dosing of melatonin
0.3-0.5 mg 30-60 min before bed time
dosing of melatonin for jetlag
2-5 mg in the evening of arrival day at destination and at bedtime for 2-5 days
pregnancy considerations
doxylamine approved in combo with pyridoxine for NV but not insomnia
children considerations
encourage nonpharm measures first, antihistamines are not indicated in less than 12 years
fatigue caused by
insufficient duration of poor quality of sleep
can be impacted by CNS depressants or chronic conditions
exclusions for fatigue
- less than 12
- pregnancy
- breastfeeding
- heart disease
- anxiety disorders
- medication-induced drowsiness
- chronic fatigue
pharm therapy for fatigue
caffeine
moa of caffeine
nonselective adenosine antagonist at A1 and A2A receptors; adenosine acts centrally to promote sleep; secondary effect on dopamine and acetylcholine may increase alertness also
low-moderate doses of caffeine can
increase arousal, fatigue, and elevate mood
higher doses of caffeine can cause
anxiety, nausea, nervousness, increased BP/HR
dose of caffeine
100-200 mg every 3-4 hours prn
smoking increases clearance of caffeine by
about 56%
DDI with caffeine
MAOIs, CHA, uncontrolled HTN, or arrhythmias
complementary therapy for fatigue
ginseng is used to boost physical and mental energy and enhance sense of wellbeing
pregnancy and caffeine
limit intake to < 200 mg/day
nursing mothers and caffeine
only small-moderate amounts per day immediately after breastfeeding
children and caffeine
not indicated in less than 12
elderly and caffeine
elimination is prolonged in elderly, thus have more interference with sleep
