Sleep Disoders Flashcards
key NTs for sleep
GABA, melatonin
NTs for wakefulness
NE, histamine, ACh
NTs for cycle regulation
serotonin, orexin, hypocretin
younger adults are more likely to have sleep issues like _________ while older are more likely to _______
younger = difficulty falling asleep
older = awakenings night/ early morning
younger adults are more likely to have sleep issues like _________ while older are more likely to _______
younger = difficulty falling asleep
older = awakenings night/ early morning
normal sleep latency is
<30min
normal sleep quantity is
7-9hrs
what are dyssomnias
problems getting to sleep or staying asleep (most common)
Insomnia, RLS, sleep apnea, narcolepsy
what are parasomnias
disorders of arousal (sleep-wake transition)
Night terrors, sleep walking/ talking, bruxism (body doesn’t adjust to REM cycles as it should)
disorders of arousal (sleep-wake transition)
Night terrors, sleep walking/ talking, bruxism (body doesn’t adjust to REM cycles as it should)
parasomnias
problems getting to sleep or staying asleep (most common)
Insomnia, RLS, sleep apnea, narcolepsy
dyssomnia
what are circadian rhythm disorders
a loss of synchronization between internal biological clock and external environment
delayed/ advanced sleep phase syndrome where your internal clock makes you sleep earlier or later- jet leg
a loss of synchronization between internal biological clock and external environment
delayed/ advanced sleep phase syndrome where your internal clock makes you sleep earlier or later- jet leg
circadian rhythm disorders
insomnia is a complained of dissatisfaction with sleep quantity/ quality, associated with =>1 of
Difficulty initiating sleep
Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
Early morning awakening with inability to return to sleep
must be clinically significant distress + impair functioning
insomnia occurs at least ___/wk for at least ___
3x/wl for 3 mths
most common causes of insomnia include
not enough bours, not refreshing/ restorative, poor QoL
what is defined as acute insomnia
Acute (<3mths): stress, environment, jetleg
what is defined as secondary insomnia
insomnia from another cause- ex drugs
what is secondary insomnia
attributed to some other cause
how are insomnia assessments done?
sleep diary- record things like time to bed, total duration of sleep, awakenings, etc
rule out other causes: meds, psych conditions, sleep disorders
what is the only movement disorder in sleep
periodic limb movement disorder
what is the 3P model of insomnia
predisposing factors
precipitating factors
perpetuating factors
what are predisposing factors to insomnia
factors increasing risk of developing insomnia (Ex- anxious predisposition, circular thinking, generalized hyperarousal)
what are precipitating factors to insomnia
(cause of initial onset): emotional distress, onset of medical or psychiatric disorder
what are perpetuating factors for insomnia
learned negative sleep behaviors and cognitive distortions
The longer acute insomnia goes unmanaged, the ___ chance of it becoming chronic from the learned negative relationship
↑
what is polysomnography
sleep studies
sleep studies are indicated for
diagnosis of sleep disorders
eval of sleep related systems
treatment of sleep related breathing disorders
describe a level 1 sleep study
done in lab with equipment to monitor brainwave activity, muscle movements, HR, volume of snoring, etc
describe a level 2 sleep study
done at home with equipment to monitor brainwave activity, muscle movements, HR, volume of snoring, etc
describe a level 3 sleep study
done at home to get info about sleep apnea, not as comprehensive as lvl 1 and 2
describe a level 4 sleep study
done at home, only measures O2 levels in sleep for sleep apnea diagnosis
5 components of CBT-I
stimulus control
sleep hygeine
sleep restriction
relaxation techniques
cognitive therapy
acute insomnia should be treated if
substantial negative impact on daytime performance
when to follow up if meds are given for acute insomnia
q2-4wks
when should you consider LT tx for insomnia
if sig troubled by inadequate sleep
Concerned about deleterious impact of inadequate sleep on pt’s health, safety, wellbeing
CBT and/or nonpharm options have already been tried
Comorbidities have been ruled out or treated maximally
treatments of chronic insomnia include
nonpharm-CBTI and pharm F1-2wks
T or F: Do not suggest OTC sleep aids or OTC meds with drowsiness as a SE
T
1st line meds for insomnia include
BZs and Z drugs (zopiclone and zolpidem
BZs ↓ sleep latency by ____min, ↓ nocturnal awakenings, ↑ total sleep time by ____min
10-19
30-50
BZs decrease what kind of sleep?
REM and delta sleep = less restorative sleep
caution with BZs in older adults because
they have lower phase 1 metabolism = choose drugs that only undergo phase 2 met
what sleep drugs only undergo phase 2 metabolism
lorazepam, oxazepam, tempazepam
Zopiclone and zolpidem MOA
Binds to a1 subunit of GABA receptor (selective binding = ↓ anxiolytic eff comp BZs)
alpha 3 binding plays a role in
sleep regulation
T or F: Z like drugs have lses hangover eff and faster sleep induction comp BZs
T- more selective binding
T or F: Z lke drugs affect sleep architecture
F does not
zopiclone onset and half life
onset <1hr, t1/2 5hrs
zolpidem onset and half life
onset 20min, t1/2 2.6h
which is better for night time awakenings to go back to bed
1. zopiclone
2. zolpidem
zolpidem
2nd line pharm for insomnia
melatonin
L tryptophan
valerian
melatonin has some evidence of
↑ eff in older pts but ↑ risk of AEs like daytime sleepiness in >4mg, shift workers, jet lag, delayed sleep phase
if using melatonin to shift the circ rhythm, how should you take it?
take lower dose 4-5hrs before bed
if using melatonin as a hypnotic, how should you take it
take 30-90min before bed
which of the following has no physical tolerance and dependence
1. zopiclone
2. melatonin
3. lorazepam
4. zopidem
2
zopiclone AE
metallic taste
complex sleep related behaviours
tolerance and dependence
zopidem benefits
less chance of morning hangover eff due to short half life
rapid onset of action
zolpidem AEs
Complex sleep related behaviours can be induced
Risk of physical tol and dep
at least ____ should be allowed for sleep if taking zopiclone and zolpidem
8hrs
doxepin is indicated for
sleep maintennace
temazepam is a
BZ, nonspec GABAa agonsit
dozepin is a
TCAA, H1 antagonist
trazodone and mirtazapine are
phenylpiperazine, 5HT2/H1 antagonist
trazodone and mirtazapine SEs
Risk of OH
Rare risk of priapism and cardiac conduction issues
trazodone and mirtazapine use should be limited to pts with
depression
T or F: mirtazapine preserves sleep structure
T
what are orexins
hypocretins that are neuropeptides which stimulate wake promoting system in cycle
dependence to sleep drugs form after _______ of regularuse
2wks-1mth
what drugs have less tolerance and and withdrawal due to receptor selectivity
Z drugs
which sleep drugs have minimal dependence
eszopiclone, ramelteon, and temazepam (6mths nightly use)
which has higher misuse potential
1. BZs
2 .nonBZs
BZs
how can you reduce risk of dependence and misuse with sleep aids
use intermitent dosing
dispense smallest effective dose + shortest period of time
Taper dose → intermediattent use → trial d/c q3-6mths
