Respiratory & Sleep Medicine_ Insomnia and Sleep Disorders Flashcards
What is the definition of insomnia?
Unsatisfactory sleep that impairs daytime functioning
What are three criteria for diagnosing insomnia?
- Presents with difficulty initiating sleep or maintaining sleep, or with sleep that is nonrestorative for at least 1 month
- Occurs despite adequate opportunity and circumstances for sleep
- Impaired sleep causes deficits in daytime activity
What groups of people have higher rates of insomnia?
- Adult women
- persons who are unemployed
- divorced
- widowed
- or of lower SES
What are symptoms of impaired daytime function?
- Fatigue
- headaches
- GI symptoms
- sleepiness
- poor attention/concentration
- increased errors/accidents
- reduced motivation
- mood disturbance
- or social dysfunction
What are common causes of acute insomnia (<30 days)?
- Situation stress
- environmental stressors
- or death of a loved one
What are the initial categories of treatment options for insomnia?
- Behavioral therapies including relaxation and cognitive therapy
- exercise
- sleep hygiene instruction
- stimulus control therapy
- sleep restriction therapy
- medications
What are reasons to avoid the use of over-the-counter antihistamines for insomnia?
- Residual drowsiness
- reduced sleep quality
- anticholinergic side effects
- minimal effectiveness
What are examples of good sleep hygiene actions?
- 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
What are the contraindications to medications used to treat insomnia?
- Pregnancy
- excess alcohol consumption
- renal or hepatic disease
- pulmonary disease or sleep apnea
- adults over 75
What classes of medications target GABA receptors and can be used to promote sleep?
- Long-acting benzodiazepines
- nonbenzodiazepines
- melatonin agonists
Examples of non-benzodiazepines
- eszopiclone
- zaleplon
- zolpidem
What is the advantage of nonbenzodiazepines (eszopiclone, zaleplon, zolpidem) over benzodiazepines for the treatment of chronic insomnia?
- Fewer adverse effects
- decreased risk of dependency
What are common side effects of medications used to treat insomnia?
- daytime sedation
- drowsiness
- lightheadedness
- cognitive impairment
- dependence
- night wandering
Patients with insomnia due to a circadian rhythm disorder may benefit from what therapies?
- melatonin
- phototherapy or
- chronotherapy
Before considering medication or treatment of insomnia, what should you do?
treat any condiitons that may be causing the insomnia
- medical conditions
- psychiatric illness
- substance abuse, or
- sleep disorder
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?
- Primary psychophysiologic insomnia.
What are the common sleep problems in the following age groups?
- infants and toddlers.
- Night Waking
- bedtime resistance
What are the common sleep problems in the following age group?
preschool aged children
- difficulties falling asleep
- Night awakenings
What are the common sleep problems in the following age groups?
- middle childhood
- bedtime resistance, sleep related anxiety
Common sleep problems in adolescents
insomnia.
What behavioural interventions are advised for the treatment of behavioural in children?
- consistent bedtime routines
- systemic ignoring
- counseling
- bedtime fading
- positive reinforcement
- parent education
What are some common examples of circadian rhythm sleep disorders?
- Jet lag and shift work
What common medical conditions are associated with insomnia?
- Pulmonary disease
- IHD
- heartfailure
- GORD
- BPH
- Menopause
- rheumatologic disease
- Pain
- PTSD
- Hypothyroidism
- diabetes mellitus
- neurologic disease
Early morning awakening is a hallmark symptom of what condition?
depression
What psychiatric conditions are associated with insomnia?
- depression
- substance abuse
- anxiety
- post traumatic stress disorder.
What medications commonly cause insomnia?
- Caffeine
- appetite suppressant
- calcium channel blockers
- some antidepressants
- Prednisone
shift to work sleep disorder has been associated with what medical and psychiatric problems?
- gastrointestinal symptoms
- cardiovascular symptoms
- depression
- substance abuse.
What is a name for a sleep-wake cycle longer than 24 hours , accompanied by difficulty falling asleep?
- Delayed sleep phase syndrome
An older adult complains of falling asleep and waking up before the desired clock time. What is the diagnosis?
- Advanced sleep phase syndrome.
What is the difference between a patient with advanced sleep phase syndrome and depression?
- Depression has decreased latency (longer time) to REM sleep.
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?
- Restless Leg Syndrome (RLS)
What lab tests should you do to identify possible secondary causes of restless leg syndrome?
- Serum ferritin
- pregnancy test
- serum chemistry to rule out uremia and diabetes.
What is the differential diagnosis of RLS?
- nocturnal leg cramps.
- akathisia
- Peripheral neuropathy
- vascular disease.
What class of medications are first line for the treatment of restless leg syndrome?
- dopaminergic agents such as pramiprexole, ropinirole and pergolide.
This disorder is characterized by rhythmic limp movement, usually lower legs during sleep, causing fragmentation of sleep.
- Periodic leg movement disorder (nocturnal myoclonus)
pauses in respiration during sleep, accompanied by brief arousals in nocturnal hypoxemia, along with daytime deficits should suggest what diagnosis?
Obstructive sleep apnea.
OSA diagnosis can be confirmed by what study?
- Polysomnography (sleep study)
What are risk factors for obstructive sleep apnea?
- condition causing narrowing of the airways
- obesity
- male sex
- smoking
- nighttime nasal congestion
- familiar history of OSA
- menopause
OSA increases the risk of what other problems?
- motor vehicle collisions
- hypertension
- cardiovascular disease
- impaired neurocognitive function
Define apnea.
Absence of airflow at the nose and mouth for 10 seconds or more
hypopnea Is ….
- greater than 50% reduction airflow at nose and mouth for at least 10 seconds.
What is the treatment of choice in obstructive sleep apnea?
Nasal continuous positive airway pressure, CPAP
