Module 12 - Insomnia

Question 1

• Sleep Hygiene

Answer 1

• fixed bedtime and awakening time
• no napping
• no etoh, nicotine, chocolate before bed
• no spicy, heavy, acidic, sugary food before bed
• exercise good but not before bed
• comfortable, cool, dark, quiet
• bedroom reversed for sleep and sex NOT WORK

Question 2

• Brief Behavioral Treatment Plan

Answer 2

THREE STEPS
1. screen positive for possible insomnia
2. assign sleep log and teach how to complete on daily basis for 2 weeks
3. teach how to calculate a daily sleep efficiency score
- ratio = asleep time / time in bed
- higher number indicates higher sleep efficiency

Question 3

• Change Theory

Answer 3

1. Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)
2. Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)
3. Preparation/Determination (Getting ready to change)
4. Action/Willpower (Changing behavior)
5. Maintenance (Maintaining the behavior change) 6. Relapse (Returning to older behaviors and abandoning the new changes)

Question 4

Insomnia Meds *

Answer 4

now those for sleep onset vs sleep maintenance:
-Doxepin: SLEEP MAINTENCE
-Benzos: both (-pams)
-Z Drugs: both (Eszopiclone, Zolpidem )

Which are recommended for the elderly
antidepressant: doxepin (or maybe trazodone)
AVOID BENZOS

Treatment length for acute insomnia:
- Don’t use antihistamines (diphenhydramine)
-7 to 10 days

Major AE of non-BZD:
- anticholinergic affects in SSRI’s