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445- Pain and Mental Health > Sleep Disoders > Flashcards

Sleep Disoders Flashcards

1
Q

key NTs for sleep

A

GABA, melatonin

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2
Q

NTs for wakefulness

A

NE, histamine, ACh

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3
Q

NTs for cycle regulation

A

serotonin, orexin, hypocretin

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4
Q

younger adults are more likely to have sleep issues like _________ while older are more likely to _______

A

younger = difficulty falling asleep
older = awakenings night/ early morning

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4
Q

younger adults are more likely to have sleep issues like _________ while older are more likely to _______

A

younger = difficulty falling asleep
older = awakenings night/ early morning

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5
Q

normal sleep latency is

A

<30min

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6
Q

normal sleep quantity is

A

7-9hrs

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7
Q

what are dyssomnias

A

problems getting to sleep or staying asleep (most common)
Insomnia, RLS, sleep apnea, narcolepsy

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8
Q

what are parasomnias

A

disorders of arousal (sleep-wake transition)
Night terrors, sleep walking/ talking, bruxism (body doesn’t adjust to REM cycles as it should)

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9
Q

disorders of arousal (sleep-wake transition)
Night terrors, sleep walking/ talking, bruxism (body doesn’t adjust to REM cycles as it should)

A

parasomnias

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10
Q

problems getting to sleep or staying asleep (most common)
Insomnia, RLS, sleep apnea, narcolepsy

A

dyssomnia

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11
Q

what are circadian rhythm disorders

A

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

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12
Q

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

circadian rhythm disorders

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13
Q

insomnia is a complained of dissatisfaction with sleep quantity/ quality, associated with =>1 of

A

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

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14
Q

insomnia occurs at least ___/wk for at least ___

A

3x/wl for 3 mths

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15
Q

most common causes of insomnia include

A

not enough bours, not refreshing/ restorative, poor QoL

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16
Q

what is defined as acute insomnia

A

Acute (<3mths): stress, environment, jetleg

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17
Q

what is defined as secondary insomnia

A

insomnia from another cause- ex drugs

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18
Q

what is secondary insomnia

A

attributed to some other cause

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19
Q

how are insomnia assessments done?

A

sleep diary- record things like time to bed, total duration of sleep, awakenings, etc
rule out other causes: meds, psych conditions, sleep disorders

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20
Q

what is the only movement disorder in sleep

A

periodic limb movement disorder

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21
Q

what is the 3P model of insomnia

A

predisposing factors
precipitating factors
perpetuating factors

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22
Q

what are predisposing factors to insomnia

A

factors increasing risk of developing insomnia (Ex- anxious predisposition, circular thinking, generalized hyperarousal)

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23
Q

what are precipitating factors to insomnia

A

(cause of initial onset): emotional distress, onset of medical or psychiatric disorder

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24
Q

what are perpetuating factors for insomnia

A

learned negative sleep behaviors and cognitive distortions

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25
Q

The longer acute insomnia goes unmanaged, the ___ chance of it becoming chronic from the learned negative relationship

A

↑

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26
Q

what is polysomnography

A

sleep studies

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27
Q

sleep studies are indicated for

A

diagnosis of sleep disorders
eval of sleep related systems
treatment of sleep related breathing disorders

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28
Q

describe a level 1 sleep study

A

done in lab with equipment to monitor brainwave activity, muscle movements, HR, volume of snoring, etc

29
Q

describe a level 2 sleep study

A

done at home with equipment to monitor brainwave activity, muscle movements, HR, volume of snoring, etc

30
Q

describe a level 3 sleep study

A

done at home to get info about sleep apnea, not as comprehensive as lvl 1 and 2

31
Q

describe a level 4 sleep study

A

done at home, only measures O2 levels in sleep for sleep apnea diagnosis

32
Q

5 components of CBT-I

A

stimulus control
sleep hygeine
sleep restriction
relaxation techniques
cognitive therapy

33
Q

acute insomnia should be treated if

A

substantial negative impact on daytime performance

34
Q

when to follow up if meds are given for acute insomnia

A

q2-4wks

35
Q

when should you consider LT tx for insomnia

A

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

36
Q

treatments of chronic insomnia include

A

nonpharm-CBTI and pharm F1-2wks

37
Q

T or F: Do not suggest OTC sleep aids or OTC meds with drowsiness as a SE

A

T

38
Q

1st line meds for insomnia include

A

BZs and Z drugs (zopiclone and zolpidem

39
Q

BZs ↓ sleep latency by ____min, ↓ nocturnal awakenings, ↑ total sleep time by ____min

A

10-19
30-50

40
Q

BZs decrease what kind of sleep?

A

REM and delta sleep = less restorative sleep

41
Q

caution with BZs in older adults because

A

they have lower phase 1 metabolism = choose drugs that only undergo phase 2 met

42
Q

what sleep drugs only undergo phase 2 metabolism

A

lorazepam, oxazepam, tempazepam

43
Q

Zopiclone and zolpidem MOA

A

Binds to a1 subunit of GABA receptor (selective binding = ↓ anxiolytic eff comp BZs)

44
Q

alpha 3 binding plays a role in

A

sleep regulation

45
Q

T or F: Z like drugs have lses hangover eff and faster sleep induction comp BZs

A

T- more selective binding

46
Q

T or F: Z lke drugs affect sleep architecture

A

F does not

47
Q

zopiclone onset and half life

A

onset <1hr, t1/2 5hrs

48
Q

zolpidem onset and half life

A

onset 20min, t1/2 2.6h

49
Q

which is better for night time awakenings to go back to bed
1. zopiclone
2. zolpidem

A

zolpidem

50
Q

2nd line pharm for insomnia

A

melatonin
L tryptophan
valerian

51
Q

melatonin has some evidence of

A

↑ eff in older pts but ↑ risk of AEs like daytime sleepiness in >4mg, shift workers, jet lag, delayed sleep phase

52
Q

if using melatonin to shift the circ rhythm, how should you take it?

A

take lower dose 4-5hrs before bed

53
Q

if using melatonin as a hypnotic, how should you take it

A

take 30-90min before bed

54
Q

which of the following has no physical tolerance and dependence
1. zopiclone
2. melatonin
3. lorazepam
4. zopidem

A

2

55
Q

zopiclone AE

A

metallic taste
complex sleep related behaviours
tolerance and dependence

56
Q

zopidem benefits

A

less chance of morning hangover eff due to short half life
rapid onset of action

57
Q

zolpidem AEs

A

Complex sleep related behaviours can be induced
Risk of physical tol and dep

58
Q

at least ____ should be allowed for sleep if taking zopiclone and zolpidem

A

8hrs

59
Q

doxepin is indicated for

A

sleep maintennace

60
Q

temazepam is a

A

BZ, nonspec GABAa agonsit

61
Q

dozepin is a

A

TCAA, H1 antagonist

62
Q

trazodone and mirtazapine are

A

phenylpiperazine, 5HT2/H1 antagonist

63
Q

trazodone and mirtazapine SEs

A

Risk of OH
Rare risk of priapism and cardiac conduction issues

64
Q

trazodone and mirtazapine use should be limited to pts with

A

depression

65
Q

T or F: mirtazapine preserves sleep structure

A

T

66
Q

what are orexins

A

hypocretins that are neuropeptides which stimulate wake promoting system in cycle

67
Q

dependence to sleep drugs form after _______ of regularuse

A

2wks-1mth

68
Q

what drugs have less tolerance and and withdrawal due to receptor selectivity

A

Z drugs

69
Q

which sleep drugs have minimal dependence

A

eszopiclone, ramelteon, and temazepam (6mths nightly use)

70
Q

which has higher misuse potential
1. BZs
2 .nonBZs

A

BZs

71
Q

how can you reduce risk of dependence and misuse with sleep aids

A

use intermitent dosing
dispense smallest effective dose + shortest period of time
Taper dose → intermediattent use → trial d/c q3-6mths

445- Pain and Mental Health (21 decks)

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