Insomnia (Exam 3) Flashcards
Insomnia
difficulty falling/staying asleep, waking up too early, not feeling rested after sleeping
Transient Insomnia
< 7 days
Short-term Insomnia
1-3 weeks
Chronic Insomnia
> 3 weeks
Insomnia symptoms
fatigue, drowsiness, anxiety, irritability, depression, decreased cognition/memory
Drugs that cause insomnia
CNS stimulants and depressants
ex. beta blockers, decongestants
Drugs that produce withdrawal insomnia
alcohol, amphetamines, benzos, opiates
(drugs that have tolerance to)
Non Pharm Therapy for Insomnia
Melatonin
Valerian root
Valerian root is NOT useful for ____ insomnia
acute
Long term use of valerian root may predispose to
benzodiazepine side effects/withdrawal
Pharmacological Tx for Insomnia
Diphenhydramine
Doxylamine
Diphenhydramine indications
transient and short-term
Diphenhydramine dosing
25-50 mg QHS PRN
No more than 7-10 days
Tolerance develops quickly with ______
diphenhydramine
Diphenhydramine metabolism
CYP2D6
CYP2D6 inhibitor (metoprolol, venlafaxine, codeine, propranolol)
Diphenhydramine max absorption at _____ and max sedation at _____
1-4 hours
3-6 hours
Diphenhydramine contraindications
BPH
Urinary retention disorder
Glaucoma
Cardio diseases
Dementia
Diphenhydramine Products
Unisom SleepGels
Sominex Nighttime Sleep Aid
ZzzQuil
Advil PM
Insomnia Exclusions
< 12 years old
> 65 years old
Pregnant
Nocturnal/early awakenings
Chronic insomnia
Secondary insomnia
Why can’t we treat children < 12?
Paradoxical excitation
Main Tx for drowsiness and fatigue
caffeine (a nice peach vibe celsius)
Before recommending caffeine, rule out
drug-induced
chronic symptoms
Non pharm therapy for drowsiness/fatigue
Good sleep
Ginseng?
Caffeine dosing
100-200 mg every 3-4 hours
