Psychiatric Conditions: Sleep Disorders

Question 1

Diagnosis of chronic insomnia

Answer 1

pt has symptoms of at least 3 times per week for atleast 3 months

Question 2

natural products for insomnia

Answer 2

melatonin 3-5mg
valerian
kava, not recommended due to hepatotoxicity tho
chamomile tea can help

Question 3

Cognitive behavioral therapy for insomnia that should be tried first

Answer 3

keep bedroom dark, comfy and quiet
keep regular sleep schedule
avoid naps, limit to 30min
only sleep in bedroom
turn clock away so no anxiety about sleep
dont eat heavy before bed
avoid exercise before bed
no caffeine afternoon
pre-bedtime ritual

Question 4

Which drugs help fall asleep

Answer 4

Ramelteon
Zaleplon

Question 5

Which drugs help stay asleep

Answer 5

Doxepin
Suvorexant

Question 6

Which drugs help both falling asleep and staying asleep

Answer 6

Esziopiclone
Zolpidem

Question 7

Hypnotics

Answer 7

Eszopiclone = Lunesta
Zolpidem = Ambien
Zaleplon = Sonata

Question 8

Hypnotics boxed warnings

Answer 8

complex sleep behavior = sleep walking, sleep driving, other stuff while not fully awake

Question 9

Hypnotics warnigns

Answer 9

inc risk of CNS depression and next-day impairment with 7-8hrs of sleep

abnormal thinking and behavioral changes
respiratory depression

potential for abuse and dependence, withdrawal if used more than 2 wks

Question 10

Hypnotics side effects

Answer 10

Somnolence
dizziness
ataxia
headache
unusual actions while sleeping pt unaware of

Question 11

Orexin receptor antagonists

Answer 11

Daridorexant = Quviviq
Lemborexant = DayVigo
Suvorexant = Belsomra

take on empty stomach

Question 12

Orexin receptor antagonist Contraindications

Answer 12

Narcolepsy

Question 13

Orexin Receptor antagonist warnings

Answer 13

worsening depression, suicidal ideation
sleep paralysis
hallucinations

Question 14

Orexin Receptor antagonist side effects

Answer 14

somnolence
headache
dizziness
abnormal dreams

Question 15

Melatonin Receptor Agonists

Answer 15

Ramelteon = Rozerem
Tasimelteon = Hetlioz

Question 16

Melatonin Receptor Agonists info

Answer 16

Side effects: Somnolence, dizziness

Notes: not controlled substance, dont take with fatty food

Question 17

TCA for insomnia

Answer 17

Doxepein = Silenor

Question 18

Doxepin (Silenor) boxed warnings & notes

Answer 18

inc risk of suicidal ideation

used off-label, along with trazodone and mirtazepine

Question 19

Doxepin (Silenor) Contraindications

Answer 19

Requires 2 week washout of MAOi

Question 20

Temazepam brand name

Answer 20

Restoril

Question 21

Benzodiazepine side effects

Answer 21

drowsiness
dizziness
inc fall risk
cognitive impairment

Question 22

Benadryl and Unisom (Doxylamine) side effects

Answer 22

sedation, tolerance to affects can occur after 10 days

peripheral anticholinergic side effects: dry mouth, dry/blurry vision, urinary retention (hard for males with BPH to urinate) = best to avoid in BPH and in glaucoma

Question 23

Restless Leg Syndrome txm

Answer 23

dopamine agonists
1-3 hours before bedtime

Pramipexole, ropinirole, rotigotine
Gabapentin enacarbil = approved for RLS = ER formulation
IR gabapentin = used too, off label and cheaper

Question 24

Stimulants for wakefulness

Answer 24

Modafinil = Provigil
Armodafinil = Nuvigil

Question 25

Modafinil/Armodafinil side effects

Answer 25

severe rash, can be life threatening, headache, insomnia, anxiety, nausea

Question 26

Sodium Oxybates

Answer 26

indicated for narcolepsy with cataplexy

Sodium oxybate = Xyrem
Calcium, magnesium, potassium and sodium oxybates = Xywav

Question 27

Xyrem and Xywav boxed warning

Answer 27

REMS program du to active moiety being GHB which is used for sexual assaults