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PMHNP > Interactive Insomnia Lecture > Flashcards

Interactive Insomnia Lecture Flashcards

1
Q

sleep is primarily regulated by 2 neural systems

A

Homeostatic process
- proportion of sleep vs wake

Circadian clock
- timing of sleep/wake cycles

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2
Q

Wake promoters

A

Acetylcholine
Corticotropin-releasing factor
Dopamine
Histamine
Norepinephrine
Orexin
Substance P

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3
Q

Sleep promoters

A

Adenosine
y-aminobutyric acid (GABA)
Melatonin

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4
Q

healthy sleep cycle

A

4 stages of NREM prior to first REM

most adults go through 4-6 cycles of 70-120 min

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5
Q

Insomnia epidemiology

A

1/3

onset early to middle adulthood
rare in childhood or adolescence

2:1 F:M

40% have concurrent psychiatric disorder

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6
Q

insomnia DSM

A

A complaint of dissatisfaction of sleep quantity or quality: 1+:
-difficulty falling asleep
-difficulty maintaining sleep
-early-morning awakening w/inability to return to sleep

Causes clinical distress

Occurs at least 3 nights/week and present at least 3 months

Not explained by:
-medical or psychiatric conditions
-substance use
-another sleep-wake disorder

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7
Q

Transient, short term, chronic insomnia

A

transient: <1 wk

Short term: 1-3 wks

Chronic >3 wks

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8
Q

1st line tx for insomnia

A

CBT-I

combo with sleep hygeine (insuff for on its own)

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9
Q

2nd line tx for insomnia

A

other psych/behavioral therapy

combined therapies

consider occult comorbid disorders

combo with sleep hygeine (insuff for on its own)

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10
Q

when to reassess tx

A

every few weeks until stable then every 6 mo as relapse rate is high

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11
Q

non pharm 1st line tx

A

stimulus control

sleep hygeine

part of CBT-I

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12
Q

CBT-I components

A

stimulus control

sleep hygeine

relaxation therapy

sleep consolidation

cognitive behavioral therapy

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13
Q

stimulus control

A

daily journal
sleep when sleepy
avoid blue light
avoid daytime naps
keep worry time during the day
dont force sleep (if no sleep in 20-30 min leave)

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14
Q

Melatonin

MOA
effectiveness
dosing
AE
notes

A

MOA: binds to MT receptors

effectiveness: dec latency, inc quality, jet lag

dosing: 1-12

AE: HA, Dizzy, nausea

notes: well tolerated

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15
Q

Valerian

MOA
effectiveness
dosing
AE
notes

A

MOA: unk, poss inc GABA

effectiveness: dec latency, inc quality

dosing: 300-600

AE: HA, dizzy, GI, hepatotoxicity

notes: limited FDA, mult types

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16
Q

Antihistamines: Diphenhydramine, Doxylamine, Hydroxyzine

MOA
effectiveness
dosing
AE
notes

A

MOA: All block H1

effectiveness: All useful in transient or short term, poor for chronic, less effective than BZD

dosing
- Diphenhydramine: 25-50
-Doxylamine: 25
-Hydroxyzine: 50-100

AE: CNS, cognitive, hangover, delerium, anticholinergic
- precaution in glaucoma. CV, BPH, nursing mothers

notes: mult OTC, tolerance, paradoxical in children, avoid in elderly and men with BPH

17
Q

BZD benefit for insomnia

A
  • Commonly used
  • Highly effective
  • Dec sleep latency
  • Inc total sleep time
  • Inc quality of sleep
18
Q

BZD risks for insomnia

A

CNS
fall
interactions
dependence/abuse

19
Q

BZD rx for insomnia: temazepam, triazolam

Effectiveness
dosing
half life
AE
pearls

A

Effectiveness
- Both dec latency and inc quality
- temazepam dec wake after onset and inc total sleep time

dosing
- Temazepam 15-30
- Triazolam 0.125-0.25

half life
- Temazepam 8.8
- Triazolam 1.5-5.5

AE- Amnesia, rebound insomnia

pearls
- most efficacy for 1 mo
- high dose with longer half life which means more AE
- fall
- Avoid for pregnant, OSA, SUD, with alcohol or opioid
- can worsen depression and SI

20
Q

2 non-BZD GABA-A Agonists

A

Z-drugs

Zolpidem
Eszopiclone
Zalepion

21
Q

Non BZD drugs

effectiveness
AE
pearls

A

effectiveness
- All dec latency, inc quality and inc total sleep time
-Zalepion- sleep aid for middle of the night awakening

AE- amnesia, dizzy, HA, somnolence, complex sleep behaviors

pearls
- less w/d, tolerance, rebound
- no AE for next day psychomotor
- take on empty stomach
- avoid alcohol and other CNS
- can worsen depression and SI

PMHNP (26 decks)

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