Psychiatric Conditions: Sleep Disorders Flashcards
Diagnosis of chronic insomnia
pt has symptoms of at least 3 times per week for atleast 3 months
natural products for insomnia
melatonin 3-5mg
valerian
kava, not recommended due to hepatotoxicity tho
chamomile tea can help
Cognitive behavioral therapy for insomnia that should be tried first
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
Which drugs help fall asleep
Ramelteon
Zaleplon
Which drugs help stay asleep
Doxepin
Suvorexant
Which drugs help both falling asleep and staying asleep
Esziopiclone
Zolpidem
Hypnotics
Eszopiclone = Lunesta
Zolpidem = Ambien
Zaleplon = Sonata
Hypnotics boxed warnings
complex sleep behavior = sleep walking, sleep driving, other stuff while not fully awake
Hypnotics warnigns
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
Hypnotics side effects
Somnolence
dizziness
ataxia
headache
unusual actions while sleeping pt unaware of
Orexin receptor antagonists
Daridorexant = Quviviq
Lemborexant = DayVigo
Suvorexant = Belsomra
take on empty stomach
Orexin receptor antagonist Contraindications
Narcolepsy
Orexin Receptor antagonist warnings
worsening depression, suicidal ideation
sleep paralysis
hallucinations
Orexin Receptor antagonist side effects
somnolence
headache
dizziness
abnormal dreams
Melatonin Receptor Agonists
Ramelteon = Rozerem
Tasimelteon = Hetlioz
Melatonin Receptor Agonists info
Side effects: Somnolence, dizziness
Notes: not controlled substance, dont take with fatty food
TCA for insomnia
Doxepein = Silenor
Doxepin (Silenor) boxed warnings & notes
inc risk of suicidal ideation
used off-label, along with trazodone and mirtazepine
Doxepin (Silenor) Contraindications
Requires 2 week washout of MAOi
Temazepam brand name
Restoril
Benzodiazepine side effects
drowsiness
dizziness
inc fall risk
cognitive impairment
Benadryl and Unisom (Doxylamine) side effects
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
Restless Leg Syndrome txm
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
Stimulants for wakefulness
Modafinil = Provigil
Armodafinil = Nuvigil
Modafinil/Armodafinil side effects
severe rash, can be life threatening, headache, insomnia, anxiety, nausea
Sodium Oxybates
indicated for narcolepsy with cataplexy
Sodium oxybate = Xyrem
Calcium, magnesium, potassium and sodium oxybates = Xywav
Xyrem and Xywav boxed warning
REMS program du to active moiety being GHB which is used for sexual assaults
