Sleep Disorder

Question 1

Delayed sleep phase disorder

Answer 1

Most common in adolescents/young adults
“night owl” tendencies delay sleep onset
If allowed to sleep in (around 3pm) person OK
Causes daytime sleepiness
Most are often alert, productive, and creative late at night

Question 2

Advanced sleep phase disorder

Answer 2

Usually seen in elderly
Person has early evening bedtimes (6-9pm) and early morning waking (2-5am)
Are usually sleepy in late afternoon or early evening
“morning larks”

Question 3

Obstructive Sleep Apnea (OSA) Risk factors

Answer 3

Obesity (BMI >30)
Neck circumference > 17 inches
Narrow airway
Large tongue

Question 4

Insomnia common factors

Answer 4

Stress, caffeine, physical discomfort, daytime napping, early bedtimes
Depression & manic disorders
ETOH abuse
Heavy smoking

Question 5

Medications for Insomnia

Answer 5

Benzodiazepine hypnotics:
Lorazepam
Temazepam

Nonbenzodiazepine hypnotics:
Zolpidem (Ambien)
Zaleplon (Sonota)
The above are good choices for the elderly

Antihystamines:
Diphenhydramine
Hydroxyzine

Question 6

Narcolepsy Consists of a tetrad of symptoms:

Answer 6

Lasts for about 15 minutes each, can be longer.
May happen after eating, while driving, talking to someone or during other situations
Most often, person wakes up feeling refreshed.

Question 7

Medications for Narcolepsy

Answer 7

Modafinil (Provigil)
First line treatment (now generic)
Armodafinil (Nuvigil)
Methyphenidate (Ritalin)
Imipramine 75-100mg daily...Effective for cataplexy not narcolepsy

Question 8

Zolpidem (Ambien)

Answer 8

Nonbenzodiazepines
Short-term treatment for insomnia, Central Sleep Apnea
MOA: Interacts with GABA-benzodiazepine receptor complexes
SE: Depression exacerbation
Category B

Question 9

Triazolam (Halcion)

Answer 9

Benzodiazepines…all categoy X
Tx. Insomnia
MOA: Binds to benzodiazepine receptors; enhances GABA effects
SE: Angioedema, seizures, respiratory depression

Question 10

Diphenhydramine (Benadryl) OTC

Answer 10

Antihistamines
Insomnia
MOA: Antagonist of the central H1 receptor
SE: Hemolytic anemia, thrombocytopenia
Category B

Question 11

Trazodone (Desyrel)

Answer 11

Antidepressant
Tx. Insomnia
MOA: Antagonizes serotonin 5-HT2A/C and alpha-1 adrenergic receptors; inhibits serotonin reuptake
SE: Suicidality, depression exacerbation, serotonin syndrome
Caution post MI and under 24 yo
Category C

Question 12

Ramelteon (Rozerem)

Answer 12

Melatonin Receptor Agonist
MOA: Binds to melatonin MT1 and MT2 receptors, inducing sleep (melatonin receptor agonist)
Category C

Question 13

Melatonin OTC

Answer 13

Tx. Insomnia
MOA: Prepares the body for sleep
SE: May affect BP, blood sugar levels, clotting