Insomnia Pyschopharm Flashcards
What is the difference between insomnia and sleep deprivation?
Insomnia is diagnosed only when an individual has adequate opportunity for sleep; this distinguishes insomnia from sleep deprivation, which has different causes and consequences.
What underlies most cases of insomnia?
Increased neural, physiological, and psychological arousal, together with perpetuating behavioral factors (such as excessive time in bed) are thought to underlie most cases of chronic insomnia
Difficulty falling asleep may signal _____
delayed sleep phase syndrome, restless legs syndrome, or anxiety
Difficulty maintaining sleep can result from ____
sleep apnea, nocturia, or pain
Early morning awakening is associated with ______
advanced sleep phase syndrome and depression
What are a couple of good sleep questionnaires? How long do they take?
The Insomnia Severity Index and Consensus Sleep Diary
They are pretty sensitive and take 2-3 minutes.
What does the ACP recommend as first-line treatment for insomnia?
CBT-I
Online CBT
Several great apps/programs, check out: SHUTi, Sleepio
What has CBT-I been shown to improve?
moderate to large effect sizes on outcomes of interest, including
- time to fall asleep,
- continuity,
- restfulness, and
- duration of sleep
Brief behavioral treatment for insomnia (BBTI)
an evidence-based, easily administered approach derived from CBT-I, can also be used in a variety of treatment settings.
BBTI is delivered in a single initial session with 2 to 3 brief follow-up visits in person or by telephone.
BBTI includes
BBTI includes 4 behavioral interventions that improve sleep consolidation by increasing sleep “drive,” reinforcing sleep regularity, reducing arousal, and increasing associations between bed and sleep:
- (1) reduce time in bed to match actual sleep duration,
- (2) get up at the same time every day, regardless of sleep duration,
- (3) do not go to bed unless sleepy, and
- (4) do not stay in bed unless asleep.
The patient’s progress should be monitored through daily sleep diaries and weekly telephone calls or electronic communications. As sleep becomes more consolidated, the patient can gradually increase time in bed to find the optimal balance between sleep continuity and sleep duration.
Who is pharmacological treatment most appropriate for?
most appropriate for patients with acute insomnia (<3 months) and should be considered as an adjunct to cognitive behavioral treatment for patients with chronic insomnia disorder.
What is the level of evidence for insomnia medications?
evidence for all drugs in the management of insomnia disorder is weak, with almost all studies rated as having a lower level of evidence because of industry sponsorship and other risks of bias related to issues such as small sample sizes, limited duration of follow-up, and limited clinical relevance (eg, comparison with placebo rather than an active pharmacologic or intervention).
Changes in numerical indicators of efficacy (eg, changes in sleep latency) are consistent but not large.
What are the FDA approved meds for insomnia?
- benzodiazepines
- benzodiazepine receptor agonists (BzRAs),
- the melatonin receptor agonist ramelteon,
- the tricyclic drug doxepin, and the
- orexin receptor antagonist suvorexant.
Common meds used to treat insomnia that are not FDA approved and have not been rigorously evaluated for safety and efficacy
- Low doses of sedating antidepressant drugs (eg, trazodone, mirtazapine).
- Sedating antipsychotic drugs (eg, olanzapine, quetiapine) are recommended only for patients with appropriate psychiatric diagnoses because of their potential metabolic, neurologic, and cardiovascular effects.
- Complementary and alternative agents, including melatonin and valerian, also lack sufficiently rigorous efficacy and safety data to recommend their use.
