Lecture 1-Insomnia Flashcards
Deifine Dyssomnia. Give some examples of Dyssomnias.
Dyssomnia = sleep disorder characterized by problems in timing, quality, or amount of sleep
Dyssomnias = insomnia, sleep apnea, narcolepsy
Deifine Parasomnia. Give some examples of Parasomnias.
Parasomnia = sleep disorder characterized by abnormalities in physiology or behavior associated with sleep (around sleep)
Parasomnias = Bruxism, nightmare disorder, sleep terror disorder, sleepwalking disorder
Define insomnia.
Complaint of dissatisfaction with sleep quantity or quality, associated with at least one of the following symptoms:
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Early-morning awakening with inability to return to sleep
Sleep disturbance causes distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning
If any of these neurotransmitters are ___ at night, you will be awake and it will cause you _____ as they are _____: norepi, serotonin, dopamine, histamine.
on; insomnia; excitatory
If any of these neurotransmitters are _____ at night, you will be awake and it will cause you insomnia as these are ______ and cause you to be _____: GABA, melatonin, adenosine.
not on; inhibitory; tired
Name some some of the physical (exogenous) causes of insomnia:
Use of CNS stimulants:
Caffeine
Withdrawal of sedating agents: Alcohol, barbiturates, benzodiazepines
Medical conditions: Chronic pain, Pulmonary disease, Endocrine disorders
Name 4 of the causes of insomnia secondary to a mental disorder:
Major depressive disorder: Short sleep latency, repeated nighttime awakenings, waking too early in the morning
Bipolar disorder: Manic and hypomanic patients have problems falling asleep and maintaining sleep
Generalized anxiety disorder/PTSD: Trouble falling asleep/nightmares
Anxiety symptoms that can lead to insomnia. After many nights of insomnia, some may experience anxiety about the possibility of not being able to sleep. Anxiety causes more norepi & DA.
What are some of the effects of insomnia?
Decreased quality of life
Complaints of impaired daytime performance and more accidents, absenteeism and presenteeism (being there but being inefficient)
Self-medication and risk of substance abuse occurs (alcohol)
Association between insomnia and psychiatric disorders
How do we manage a patient who is complaining of symptoms consistent with insomnia?
1st Step and Initial management strategy is make diagnosis, informed consent and education
2nd Step is Behavioral counseling
Sleep hygiene/Stimulus control
3rd step = sleep restriction therapy, cognitive therapy, behavioral therapy
4th step: pharmacological interventions (stepwise)
Always address underlying medical, psychiatric or environmental causes of insomnia and treat those _____.
1st
What is the best way to diagnose insomnia?
a. Electroencephalography
b. Polysomnography (sleep study)
c. Detailed clinical history
d. Blood test looking at serum neurotransmitter levels
c. Detailed clinical history
Always take a good history first
A 48 year old male comes to your office with a complaint of insomnia. What is the best first initial treatment?
a. Start 30 minutes of aerobic exercise before bed
b. Inform and educate the patient about insomnia
c. Drink One glass of wine before dinner
d. Start Zolpidem as needed
b. Inform and educate the patient about insomnia
A 34 year old female patient has well diagnosed insomnia and she ultimately is cured after she is taught to keep a sleep diary, to analyze her number of hours asleep and she determines she has no daytime consequences and no longer worries about random insomnia nights? What treatment has she used?
a. Stimulus control
b. Sleep restriction
c. Behavioral therapy
d. Freudian psychoanalysis
c. Behavioral therapy
Once you say sleep diary or sleep logs you are doing cognitive or behavioral therapy.
