Insomnia Therapeutics Flashcards
Who is at highest risk of insomnia?
Women
Elderly
Those with comorbidities
What is insomnia a risk factor of?
Depression
Anxiety
Obesity
Hypertension
What are the causes of secondary insomnia?
Drugs
Life events
The environment
Illnesses
What is insomnia?
Persistent problems falling asleep or staying asleep
What is the difference between transient, short-term and chronic insomnia?
Transient - Usually sleep well, disrupted by circumstances
Short-term - May last for a few weeks; bereavement, illness
Chronic - Majority of nights over 3 months or more, despite adequate opportunity
What are the sleep hygiene approaches to insomnia treatment?
Daily exercise
Stop napping
Make bedroom right light and noise levels and right temperature
Reduce consumption of some substances (e.g. coffee) in evening
Avoid TV, computers, devices in bed
Try relaxation techniques
Develop a sleep routine
If tried sleeping for 30mins, get up and return when sleepy
Avoid pets disturbing sleep
When would hypnotic drugs be used?
If interfering with daily life
How should hypnotics be used?
Shortest period of time (max 4 weeks)
One or two intermittent doses at lowest effective dose
Which agents should be used if the patient is having trouble falling asleep?
Short-acting
Temazepam and Zolpidem
Which agents should be used if the patient is having trouble staying asleep?
Longer acting
Nitrazepam and Zopiclone
What is the downside of using longer acting agents?
Hangover effect
What may happen when using benzodiazepines?
Reduce stage 3 and 4 non-REM sleep
Rebound insomnia
How do Z-drugs work?
Shorten stage 1 sleep but increase stage 2
What are the other possible treatments for insomnia?
Melatonin
Sedating antihistamines
Clomethiazole
OTC preparations
