Insomnia & Sleep Disorders Flashcards
how many cycles of REM & NREM occur throughout the night
4-6 cycles with each cycle being 70-120 minutes
describe generally the stages of sleep
1 NREM: transition between awake/sleep
2 NREM: light sleep, HR, RR slow down
3-4 NREM: delta sleep/deep sleep
REM: eye movements, dreaming occurs
how long after falling asleep does REM occur
90 minutes
changes in sleep from infant to older adult
infant: 20 hours/day, differentiation btwn REM/NREM occurs at 3-6 months, circadian patterns by age 3
child: delta sleep declines & REM increases
midlife: gradual decline in sleep efficiency & time
older: lighter, fragmented sleep, intermittent wakeups
what are the transmitters that promote WAKEFULNESS
how do we target them to treat sleep disorders
norepinephrine
orexin
dopamine
histamine
substance P
target with antagonists
what are the transmitters that promote SLEEPINESS
how do we target them to treat sleep disorders
GABA
adenosine
melatonin
target with agonists
diagnostic criteria of insomnia
occurs at least 3 nights per week
present for at least 3 months
not better explained by another sleep disorders
definition of sleep onset insomnia
sleep latency 20-30 minutes
definition of sleep maintenance insomnia
inability to stay asleep through the night, struggling to get back to sleep for 20-30 minutes
who has a higher incidence of insomnia
women, elderly, unemployed, widowed, low socioeconomic status
who rarely has insomnia
kids
which type of insomnia is more common in younger adults
sleep onset insomnia
which type of insomnia is more common in older adults
sleep maintenance insomnia
which medications can cause insomnia
narcotics: opioids
CV meds: BBs, statins, diuretics, alpha ags/antags
antidepressants: SSRI, MAOI,SNRI
steroids
stimulants: caffeine, MPH, adderall, cocaine
decongestants: sudafed
respiratory meds: albuterol, theophylline
alcohol
define short term insomnia
persisting <3 months
define chronic insomnia
persisting>3 months
nonpharmacologic options for insomnia
CBT, sleep hygiene
name 5 classes of drugs that can be used for insomnia
benzodiazepines
z drugs
melatonin receptor agonist
orexin receptor antagonist
TCA (doxepin)
which prescription drugs are NOT recommended for insomnia
trazodone
mirtazapine
TCAs
atypical antipsychotics
which OTC drugs are NOT recommended for insomnia
diphenhydramine, doxylamine
melatonin, valerian, chamomile
which benzos are used for sleep
quazepam
estazolam
flurazepam
temazepam
triazolam
what are the z drugs
zolpidem
eszopiclone
zaleplon
which drug is a melatonin receptor agonist
ramelteon
which drugs are orexin receptor antagonists
suvorexant
lemborexant
daridorexant
when are orexin receptor antagonists contraindicated
narcolepsy
they can cause sleep paralysis, cataplexy, narcolepsy-like symptoms
doxepin pearls
a TCA unique in having H1 antihistaminic activity that can be used for sleep maintenance
define obstructive sleep apnea
collapse or obstruction of upper airway, repetitive episodes of cessation of breathing during sleep following by blood oxygen desaturation & brief arousal from sleep to restart breathing
obstructive sleep apnea risk factors
male, obese, CHF, AFib, HTN, T2DM, stroke, neck circumference
questionnaire used for obstructive sleep apnea
STOP BANG
snoring, tired, observed, blood Pressure, BMI, age, neck circumference, gender
symptoms of sleep apnea
loud disruptive snoring, witnessed apneas during sleep, excessive daytime sleepiness
nonpharm treatments for sleep apnea
weight reduction, surgery, positional therapy, oropharyngeal exercise, palatal implants, CPAP or BiPAP
what is the standard treatment for obstructive sleep apnea
positive airway pressure (PAP)
pharm treatment for obstructive sleep apnea
none
medications to avoid with obstructive sleep apnea
CNS depressants, agents that promote weight gain, medications that cause rhinopharyngeal inflammation or cough
risk factors for restless legs syndrome
female, family, genetics
common cause of secondary restless legs syndrome
iron deficiency
nonpharm for restless legs syndrome
correct iron deficiency if applicable
avoid caffeine/alcohol
exercise
warm or cool packs
foot wrap or vibrating pad
pharm options for restless legs syndrome
dopamine agonists: ropinirole, pramipexole, rotigotine
gabapentin enacarbil
off label: opioids, pregabalin, carbamazepine, clonidine
iron supplements only in those with iron deficiency
meds for sleep onset only
ramelteon
triazolam
zaleplon
meds for sleep maintenance only
doxepin
