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Therapeutics Module 3 > Insomnia (Redo) > Flashcards

Insomnia (Redo) Flashcards

1
Q

Sleep Latency is?

A

Time to fall asleep following bedtime

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2
Q

WASO is?

A

Wake after sleep, sum of wake times from sleep onset to final awakening

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3
Q

TIB is?

A

Time in bed

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4
Q

TST is?

A

Total sleep time (TIB-SL-WASO)

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5
Q

Sleep Efficiency percent is?

A

Determines how well that person is sleeping

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6
Q

What are the 2 basic types of sleep?

A

REM
Non-REM (3 stages 75% of time)

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7
Q

When does REM sleep generally occur?

A

Generally the latter half is longer as compared to the earlier in night

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8
Q

How many REM sleeps do we generally have in a night?

A

4-5

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9
Q

What are the 7 wake promoting neurotransmitters?

A
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10
Q

What are the NREM neurotransmitters during sleep?

A
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11
Q

What are the REM neurotransmitters during sleep?

A
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12
Q

What is insomnia?

A

Difficulty falling asleep or remaining alseep

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13
Q

What are the DSM criteria?

A

Predominant complain is sleep quantity or quality

Report of one of the following symptoms (Sleep related stuff)

Sleep complain is accompanied by great distress or impairment in the day

Sleep difficulty 3 nights per week
Sleep difficulty is for at least 3 months

Sleep difficulty occurs despite adequate opportunity for sleep

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14
Q

What is primary insomnia?

A

Absence of any causes

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15
Q

What is secondary insomnia?

A

Medical condition or medication adverse effects

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16
Q

What is important in terms of screening for insomnia?

A

We want to screen for other sleep disorders. Underlying other sleep disorders is important to rule out.

17
Q

What are some insomnia severity scales we can use?

A

Insomnia severity index
Epworth sleepiness scale

18
Q

What is the general epidemiology of sleep?

A

Age (increased)
Gender (Women)
Comorbidity (Any comorbid conditions that affect people trying to sleep

19
Q

Risk factors of sleep/

A

Stress
Increased age
Gemale sex
Comborbid conditions
Social issues
Shift workers

20
Q

Most common medications that likely to disrupt sleep

A
21
Q

What is first line treatment for sleep?

A

CBTi management first

22
Q

Where do benzodiazepines work?

A

Binds to GABA site to potentiate the effect. Slow down the nervous system

23
Q

What are the short acting Benzos?

A

Alprazolam, midazolam, Triazolam

24
Q

What are the medium acting benzos?

A

Lorazepam, oxazepam, temazepam, clonazepam

25
Q

What are the long acting benzos

A

Bromazepam, diazepam, chlordiazepoxide

26
Q

What is the benz duration that is the most addictive?

A

Short acting.

27
Q

What is high NNH or NNT with respect to the Benzo/Z-drugs

A
28
Q

What is important about benzodiazepine counselling points?

A

Be realistic about the risks and benefits (25 minutes, 10 minutes)

29
Q

What is Diphenhydramine and hydroxyzine?

A

Antihistamines
Paradoxical syndrome
NOT RECOMNEDED

30
Q

What is melatonin?

A

Secreted by pineal gland and is influenced by light and dark environment

8 minute, but benefit is not highly beneficial

31
Q

What is TCAs

A

Amitriptyline and nortriptyline.

Dirty meds

32
Q

What is Doxepin?

A

Histamine blockers

Increases sleep quality/efficiency but has risk of anticholinergic effects

33
Q

What is trazodone?

A

Mixed serotonin and alpha 1 blocking

Helps with sleep initiation and less S/E

Hypotension

34
Q

What is Lemborexant?

A

Orexin receptor antagonist

Orexin promotes wakefullness and thes meds block it

S/E especially mood

Less rebound insomnia and better for possible sleep maintenance

LONG duration of effect >7 hours

35
Q

What is Daridorexant?

A

Orexin receptor antagonist

Not available in Canada yet

36
Q
A

Therapeutics Module 3 (6 decks)

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