sleep Flashcards
insomnia 1st line
CBT
insomnia short term ttx
benzos 4-8 wks
benzo on sleep
lower sleep latency
lower nighttime awakenings
benzo se
rebound insomnia dependence tolerance daytime sleepiness elderly confusionn/dizzy/fall
sleep med for shorterm, and lower daytime sleepiness and lower orthohypotension
nonbenzo
zolpidem,zaliplone,ezoplicolone,melatonin,suvorexant
causes falls/cognitive impairment in elderly and cognitive impairment in women at higher dose than 10mg
zolpiDEM
off-label used for sleep
trazadone, mirtazepine, doxepin
mc used depression + sleep prob
trazadone
causes of hyper somnolence disorder
viral-IM,GB,Pneumonia,HIV
head trauma
AD genetics
ttx of hypersomnolence disorder
first line: modafinil, methylphenidate
2nd line: atomoxetine,
pitolisant
sodium oxybate
scheduled napping
least addictive of drugs to help stay awake
atomoxetine
moa modafinil
increase dopamine–>more orexin+histamine–>more wakefulnes
moa sodium oxybate
GHB (ghb–>gaba) unknown why
moa methylphenidate
stop net dat
moa pitolisant
h3 –>increased histamine–>wakefulness
what leads to wakefulness
dopamine seratonin-raphe ne -lc cholinergic- pontine tegmentum glutamate (ARAS)
histamine-posterior hypothal, tuberomammilary nucleus
orexin/hypocretin-lateral hypothalamus
narcolepsy CSF
low orexin/hypocretin
narcolepsy polysomnograph
reduced rem sleep latency
narcoleptic catalepsy ttx
1st line: sodium oxybate
others: pitolisant, atomoxetine, dulox, venlafax, fluox
tca-imipramine, desipramine, clomipramine
REM suppression drugs
ssri, snri: fluoxetine, duloxetine, venlafaxine
central sleep apnea breathing pattern
chyne stokes crescendo descrescendo
central sleep apnea cause
idopathic
or
opioid use
ttx obstructive sa vs central sa
osa: cpap/bipap, tonsilelctomy, stimulation
csa: cpap/bipap, o2 supp, acetazolamide, theophyline
ttx for delayed sleep phase disorder (of circadian rhythm disorders)
melatonin
bright light
chronotherapy
ttx advanced sleep phase
phototherapy
ttx shiftwork
modafinil
phototherapy
medications that can cause SLEEPWALKING
anticholinergics, sedative hypnotics, lithium
other causes=family history, Obstructive sleep apnea, nocturnal seizures
association with REM sleep behavior disorder
PARKINSONS
LEWY BODY DEMENTIA
ssri, snri, beta blockers,tca
narcolepsy
ttx of rem sleep behavior disorder
clonazepam
melatonin
Restless leg syndrome causes
iron def anemia dopamine blocking antiemetics antipsychotics antidepressnats antihistamine
ttx restless leg syndrome
dopamine agonist + benzo = 1st line
gabapentin, pregabalin
low potency opioids
