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General Medicine & Family Medicine > Respiratory & Sleep Medicine_ Insomnia and Sleep Disorders > Flashcards

Respiratory & Sleep Medicine_ Insomnia and Sleep Disorders Flashcards

1
Q

What is the definition of insomnia?

A

Unsatisfactory sleep that impairs daytime functioning

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2
Q

What are three criteria for diagnosing insomnia?

A
  1. Presents with difficulty initiating sleep or maintaining sleep, or with sleep that is nonrestorative for at least 1 month
  2. Occurs despite adequate opportunity and circumstances for sleep
  3. Impaired sleep causes deficits in daytime activity
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3
Q

What groups of people have higher rates of insomnia?

A
  • Adult women
  • persons who are unemployed
  • divorced
  • widowed
  • or of lower SES
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4
Q

What are symptoms of impaired daytime function?

A
  • Fatigue
  • headaches
  • GI symptoms
  • sleepiness
  • poor attention/concentration
  • increased errors/accidents
  • reduced motivation
  • mood disturbance
  • or social dysfunction
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5
Q

What are common causes of acute insomnia (<30 days)?

A
  • Situation stress
  • environmental stressors
  • or death of a loved one
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6
Q

What are the initial categories of treatment options for insomnia?

A
  • Behavioral therapies including relaxation and cognitive therapy
  • exercise
  • sleep hygiene instruction
  • stimulus control therapy
  • sleep restriction therapy
  • medications
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7
Q

What are reasons to avoid the use of over-the-counter antihistamines for insomnia?

A
  • Residual drowsiness
  • reduced sleep quality
  • anticholinergic side effects
  • minimal effectiveness
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8
Q

What are examples of good sleep hygiene actions?

A
  • Maintain regular sleep schedule
  • avoid caffeine after lunch
  • avoid alcohol near bedtime
  • avoid smoking
  • decrease light and stimuli in bedroom
  • exercise for 20 minutes daily more than 4 hours prior to bedtime
  • avoid daytime naps
  • avoid large meals before bed
  • maintain same sleep and wake time
  • avoid excessive time in bed
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9
Q

What are the contraindications to medications used to treat insomnia?

A
  • Pregnancy
  • excess alcohol consumption
  • renal or hepatic disease
  • pulmonary disease or sleep apnea
  • adults over 75
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10
Q

What classes of medications target GABA receptors and can be used to promote sleep?

A
  • Long-acting benzodiazepines
  • nonbenzodiazepines
  • melatonin agonists
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11
Q

Examples of non-benzodiazepines

A
  • eszopiclone
  • zaleplon
  • zolpidem
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12
Q

What is the advantage of nonbenzodiazepines (eszopiclone, zaleplon, zolpidem) over benzodiazepines for the treatment of chronic insomnia?

A
  • Fewer adverse effects
  • decreased risk of dependency
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13
Q

What are common side effects of medications used to treat insomnia?

A
  • daytime sedation
  • drowsiness
  • lightheadedness
  • cognitive impairment
  • dependence
  • night wandering
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14
Q

Patients with insomnia due to a circadian rhythm disorder may benefit from what therapies?

A
  • melatonin
  • phototherapy or
  • chronotherapy
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15
Q

Before considering medication or treatment of insomnia, what should you do?

A

treat any condiitons that may be causing the insomnia

  • medical conditions
  • psychiatric illness
  • substance abuse, or
  • sleep disorder
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16
Q

In this type of insomnia, the person has conditioned anxiety around falling asleep or staying asleep and often has a genetic vulnerability, medication disorders, psychiatric conditions or acute stress?

A
  • Primary psychophysiologic insomnia.
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17
Q

What are the common sleep problems in the following age groups?
- infants and toddlers.

A
  • Night Waking
  • bedtime resistance
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18
Q

What are the common sleep problems in the following age group?

preschool aged children

A
  • difficulties falling asleep
  • Night awakenings
19
Q

What are the common sleep problems in the following age groups?

  • middle childhood
A
  • bedtime resistance, sleep related anxiety
20
Q

Common sleep problems in adolescents

A

insomnia.

21
Q

What behavioural interventions are advised for the treatment of behavioural in children?

A
  • consistent bedtime routines
  • systemic ignoring
  • counseling
  • bedtime fading
  • positive reinforcement
  • parent education
22
Q

What are some common examples of circadian rhythm sleep disorders?

A
  • Jet lag and shift work
23
Q

What common medical conditions are associated with insomnia?

A
  • Pulmonary disease
  • IHD
  • heartfailure
  • GORD
  • BPH
  • Menopause
  • rheumatologic disease
  • Pain
  • PTSD
  • Hypothyroidism
  • diabetes mellitus
  • neurologic disease
24
Q

Early morning awakening is a hallmark symptom of what condition?

A

depression

25
Q

What psychiatric conditions are associated with insomnia?

A
  • depression
  • substance abuse
  • anxiety
  • post traumatic stress disorder.
26
Q

What medications commonly cause insomnia?

A
  • Caffeine
  • appetite suppressant
  • calcium channel blockers
  • some antidepressants
  • Prednisone
27
Q

shift to work sleep disorder has been associated with what medical and psychiatric problems?

A
  • gastrointestinal symptoms
  • cardiovascular symptoms
  • depression
  • substance abuse.
28
Q

What is a name for a sleep-wake cycle longer than 24 hours , accompanied by difficulty falling asleep?

A
  • Delayed sleep phase syndrome
29
Q

An older adult complains of falling asleep and waking up before the desired clock time. What is the diagnosis?

A
  • Advanced sleep phase syndrome.
30
Q

What is the difference between a patient with advanced sleep phase syndrome and depression?

A
  • Depression has decreased latency (longer time) to REM sleep.
31
Q

An urge to move the legs, accompanied by painful, itching, or creeping sensation in the legs, when a patient lies down to fall asleep is suggestive of what syndrome?

A
  • Restless Leg Syndrome (RLS)
32
Q

What lab tests should you do to identify possible secondary causes of restless leg syndrome?

A
  • Serum ferritin
  • pregnancy test
  • serum chemistry to rule out uremia and diabetes.
33
Q

What is the differential diagnosis of RLS?

A
  • nocturnal leg cramps.
  • akathisia
  • Peripheral neuropathy
  • vascular disease.
34
Q

What class of medications are first line for the treatment of restless leg syndrome?

A
  • dopaminergic agents such as pramiprexole, ropinirole and pergolide.
35
Q

This disorder is characterized by rhythmic limp movement, usually lower legs during sleep, causing fragmentation of sleep.

A
  • Periodic leg movement disorder (nocturnal myoclonus)
36
Q

pauses in respiration during sleep, accompanied by brief arousals in nocturnal hypoxemia, along with daytime deficits should suggest what diagnosis?

A

Obstructive sleep apnea.

37
Q

OSA diagnosis can be confirmed by what study?

A
  • Polysomnography (sleep study)
38
Q

What are risk factors for obstructive sleep apnea?

A
  • condition causing narrowing of the airways
  • obesity
  • male sex
  • smoking
  • nighttime nasal congestion
  • familiar history of OSA
  • menopause
39
Q

OSA increases the risk of what other problems?

A
  • motor vehicle collisions
  • hypertension
  • cardiovascular disease
  • impaired neurocognitive function
40
Q

Define apnea.

A

Absence of airflow at the nose and mouth for 10 seconds or more

41
Q

hypopnea Is ….

A
  • greater than 50% reduction airflow at nose and mouth for at least 10 seconds.
42
Q

What is the treatment of choice in obstructive sleep apnea?

A

Nasal continuous positive airway pressure, CPAP

43
Q
A

General Medicine & Family Medicine (150 decks)

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