Insomnia-Gentry Flashcards
How does DSM5 treat insomnia?
used to only be considered a symptom of another disorder
now considered its own disorder
What are the DSM 5 criteria for insomnia disorder?
A) A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
- Difficulty initiating sleep - Difficulty maintaining sleep (i.e., frequent awakening with problems returning to sleep) - Early morning awakening with the inability to return to sleep
B) The sleep disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
C&D) Sleep difficulty occurs at least 3 nights per week and present for at least 3 months.
E. Sleep difficulty occurs despite adequate opportunity to sleep.
F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (i.e. narcolepsy, sleep apnea, parasomnia).
G. Insomnia not attributable to the physiological effects of a substance (i.e. drug abuse, medication).
H. Co-existing mental and medical disorders do not adequately explain the predominant complaint of insomnia.
How prevalent is insomnia?
1/3 US adults some sleep problem
50% of primary care patients
12% chronic insomnia
Which gender, age group is insomnia related to?
women
older adults
What are some chronic medical & psychiatric problems that are associated with insomnia?
Depression, PTSD, substance use
Other sleep disorders (comorbid with sleep apnea)
Chronic pain/medical disorders
The prevalence of sleep disturbances ranges from 50-88%.
How can insomnia be disabling?
difficulties with intellectual, social, vocational functioning
less job satisfaction, lower performance scores, less productivity, higher rates of being absent
pain
What are other conditions that people with insomnia are more likely to suffer from?
Pain conditions Gastrointestinal distress Hypertension Heart disease May be risk factor for diabetes Depression
Describe the overlap of depression & insomnia.
Up to 90% of those with MDD complain of sleep problems.
Depression disturbed sleep is associated with:
Increased symptom severity
Slower and lower rates of remission
Higher treatment dropout rates
Less stable response to treatment
Increase suicide risk
T/F Patients with chronic insomnia are between 2 and 6 times more likely to have new-onset or recurrent episodes of depression as compared to patients w/o chronic insomnia.
True.
T/F Sometimes when depression is resolved, insomnia remains.
True. Then the patient is more susceptible to another bout of depression.
What are some examples of nonbenzodiazepine receptor agonists used for sleep treatment?
Zolpidem (Ambien), Zolpidem ER (Ambien CR), Zaleplon (Sonata), Eszopiclone (Lunesta)
What are the pros to nonbenzos?
Bind to sub-types of GABA receptors that specifically modulate sleep and therefore are thought to have less unwanted side effects.
What are the cons to nonbenzos?
Drowsiness, dizziness, unsteadiness of gait, rebound insomnia and memory impairment have been reported.
What are some benzos used for sleep treatment?
Benzodizepines: Alprazolam (Xanax), Lorazepam (Ativan), Clonazepam (Klonopin), Temazepam (Restoril), Diazpepam (Valium).
What are the pros for benzos for sleep?
Pros: Enhance sleep, decrease anxiety.
What are the cons for benzos for sleep?
Cons: Daytime sedation, unsteadiness of gait (increase fall risk in elderly), higher risk of tolerance, dependence, withdrawal and risk of abuse.
What are the indications for each of the non-benzos for sleep disturbance?
Ambien – approved for falling asleep or sleep onset
Ambien CR for both sleep onset and maintenance
Lunesta –sleep onset and sleep maintenance
Sonata –sleep onset only
What are some antidepressants used for sleep?
Tricyclic antidepressants: Doxepin (Sinequan), Amitriptyline (Elavil).
Second generation antidepressant: Trazadone (Desyrel), Mirtazapine (Remeron).
What are some pros for antidepressants for sleep?
used for insomnia & depression
What are some cons for antidepressants for sleep?
still reported side effects
What are some other meds for sleep disturbances?
Melantonin Receceptor Agonist: Ramelteon (Rozerem)
**Selective agonist at MT1 and MT2 melatonin receptors
Antihistimine: Diphenhydramine (Benadryl), Hydroxine (Vistaril)
Antipsychotics: Quetiapine (Seroquel), Chlorpromazine (Thorazine), Risperidone (Risperdal), Olanzapine (Zyprexa), and Ziprasidone (Geodon)
Which sleep medications are FDA approved?
Ambien, sonata, Lunesta, Rozerem, Temazepam and low dose doxepin.
What are the indication for ambien, sonata, rozerem, ER ambien, and lunesta?
ambien: sleep onset insomnia
sonata: sleep onset
rozerem: sleep onset
ER ambien: sleep onset & maintenance
lunesta: sleep onset & maintenance
Why is rozerem awesome?
targets sleep wake cycle, & not the CNS
can be used long term with no evidence of abuse & dependence
