Sleep Disorder Flashcards
1) Stage 1: Beginning of sleep cycle; light stage that is the transition between wakefulness and sleep
2) Stage 2: Become less aware of surroundings; breathing and heart rate becomes more regular; people spend ~50% in this stage
3) Stage 3: Deepest sleep stage; muscles relax and people are less responsive to noise and activity; delta wave sleep
NREM – quiet sleep
Dreams occur in this stage and brain is more active; eyes move rapidly; “paradoxical sleep”
REM
Difficulty initiating or maintaining sleep
(a) Common complaints of poor sleep quality or insufficient quantity due to difficulty
initiating sleep or maintaining sleep
Insomnia clinical features
(a) Alcohol abuse – alcohol decreases REM sleep
(b) Stimulant abuse – preworkout or caffeine
(c) Tobacco abuse
(d) Psychiatric comorbidities
Risk factors that can lead to sleep issues
(a) Fatigue or malaise
(b) Poor attention of concentration
(c) Mood disturbance
(d) Daytime somnolence
(e) Reduced motivation of energy
Compromised daytime function sleep of insomnia
(1) Chronic diagnosis established by history and patient report
(2) Sleep history for 1 week
(a) Detailed description of sleep problems
1) Number of awakening and durations of awakening
2) Sleep time and duration
3) Symptoms of disturbed sleep like daytime somnolence or fatigue
Diagnosis of insomnia
(a) Requires that the 4 following criteria are met
1) Difficulty initiating sleep, maintaining sleep or waking up too early
2) Sleep difficulties occur despite adequate opportunity for sleep
3) Patient has daytime impairment that is attributable to sleep difficulty
4)*** Sleep difficulty is not better explained by another sleep disorder or substance abuse
Diagnostic criteria of insomnia
(1) Restless legs syndrome
(2) Sleep apnea
(3) Depression
Differential diagnosis of insomnia
(1) Shot term insomnia (less than once month in duration)
(a) Usually occurs from psychologic or physiologic stress
(b) Educate and reassurance may be all that is needed
(c) Educate on sleep hygiene
1) Consistent bedtime and wake time
2) Attempt to sleep should only occur if patient is sleepy
3) Avoid napping and dozing during the day
4) Avoid “clock watching”
5) Avoid electronics before bedtime
6) Avoid stimulants, tobacco, alcohol right before bed
Treatment of insomnia
(a) Medications should not be the sole treatment of insomnia
(b) Benzodiazepines have been the most widely prescribed true sedative- hypnotics, being safer than barbiturates though they are best for short term use.
(c) Melatonin
1) Dose: 3-5mg PO qHS
2) Side effects: Vivid dreams and nightmares, daytime somnolence, GI irritability
(d) Trazodone
1) Dose: 50mg PO qHS
2) Side effects: Blurred vision, syncope, edema, weight loss
(e) Vistaril
1) Dose: 25-50mg PO qHS
2) MOA: Competes with histamine for the 5HT2 and dopaminergic receptors in the hippocampus
(f) Diphenhydramine
1) Dose: 25-50mg PO qHS
Medication of insomnia
Depends on the underlying cause of insomnia as well as the prevention of secondary complications such as substance misuse in the context of self-medication.
Prognosis of insomnia
