Sleep Disorder and Pharmacology Flashcards
Define Dysomnias
Abnormality in the amount, quality or timing of sleep
Examples of Dyssomnias
Insomnia disorder Hypersomnia Narcolepsy Obstructive or central sleep apnea and sleep related hypoventililation Circadian rhythm sleep disorders Restless leg syndrome REM sleep behavior disorder
REM sleep behavior disorder =
Act out their dreams (yelling, kicking, fighting)
Define Parasomnias
Abnormal behaviors or events associated with sleep
Examples of Parasomnias
Nightmare disorder
Sleep terror disorder
Sleepwalking disorder
Insomnia in the population
50% of population complains of it
9-12% of adults have chronic insomnia
20% of elderly
Insomnia is a disorder:
characterized by difficulty in initiating and maintaining sleep
Effects of Sleep deprivation
2 hours lost = 2-3 beers
4 hours lost = 5-6 beers
6 hours lost = 7-8 beers
8 hours lost/no sleep = 10-11 beers (drunk)
The shorter time it takes you to fall asleep (latency) =
The sleepier you are
If less than 5 minutes latency, you are excessively sleepy
Sleep apnea is characterized by:
Repetitive episodes of breathing cessation followed by arousal to restart breathing
Central Sleep Apnea is due to
Impaired CNS respiratory drive
Occurs in 30% of men over 60 years of age
Associated with CHF and advanced age
Narcolepsy is characterized by
Sleep attacks
Cataplexy
Hypnagogic hallucinations
Sleep paralysis
Define Cataplexy
Loss of muscle tone without loss of consciousness
Brought on by extremes in emotions
Narcolepsy most likely involves what system:
Orexin/hypocretin peptide system (75% of narcoleptic patients, this system is undetectable) in CSF
Advanced sleep phase syndrone
Circadian Rhythm Disorder
Falling asleep early (6-8 pm) and waking up early (3 am)
Irregular sleep-wake type
Circadian Rhythm Disorder
Numerous naps during the day, no main nighttime sleep
Normal total sleep
Non-24-hour sleep-wake type
Circadian Rhythm Disorder
Abnormal synchronization between dark/light cycle and endogenous circadian rhythm
50% of blind people
Restless Leg Syndrome is:
uncomfortable feelings (burning, itching, or tingling sensation) of muscles in legs or body, compelling desire to move affected limb) Probably due to dopamine and iron
Restless Leg Syndrome Diagnosis
Desire to move limb based upon paresthesias
Worse in evening or at night
Worsened by inactivity and improved by movement of affect limb
Accompanying motor restlessness
Pharmacologic Therapy of Insomnia
Benzodiazepines
Non-benzodiazepine GABA(A) agents (Z drugs)
Benzodiazepine receptor agents MOA
binding to GABA(A) receptors causing increase in GABAergic neurotramission and hyperpolariztion of neuronal membrane
Traditional BZDs Use
Reduce sleep latency and increase total sleep time
Traditional BZDs side effects
Daytime sedation, performance impairment, drowsiness, amnesia, rebound insomnia
- Half life prolong in elderly
Traditional BZD drugs
Estazolam
Triazolam
Temazepam
Flurazepam
Non-BZDs drugs
Zolpidem, zaleplon, eszopiclone
Non-BZDs Use
Reduce sleep latency and nocturnal awakenings
Induce sleepiness
Non-BZDs Side effects
Drowsiness, amnesia, dizziness, GI
Zolpidem: sleep weight and sleepwaking, sleep driving
Antihistamines Use and drugs
OTC sleep drugs
Mild insomnia
Diphenhydramine, doxylamine
Antidepressants Use and drugs
Insomnia + Depression or pain
Amitryptiline, doxepin and nortriptyline (day time sedation)
Mirtazapine, nefazodone
Trazadone
Melatonin Receptor Agonists Use and Drug
Insomnia- induces sleep
Ramelteon
Valerian use and Drug
Insomnia
Herbal
Orexin receptor antagonists Use and Drug
Suvorexant (Belsomra)
SE: sleep driving
Non-pharm treatment for Obstructive Sleep Apnea
Positive Airway pressure (PAP)
Weight reduction
Surgery
Pharm treatment for Obstructive Sleep Apnea
Avoidance of alcohol and other CNS depressants
Modafinil (Provigil) and Armodafinil (R-isomer)
Modafinil (Provigil) and Armodafinil (R-isomer) Use
Promote wakefulness in patients with residual daytime sleepiness
Treatment of Narcolepsy Drugs
Modafinil (Provigil)
Antidepressants for catelepsy
Sodium Oxybate (Xyrem)
Modafinil (Provigil) MOA and SE
Leads to increased histaminergic transmission
AE: Headache, N, anxiety, insomnia
Antidepressants for catelepsy MOA
Blocks 5HT and NE reuptake to suppress REM sleep
Sodium oxybate (Xyrem) MOA, Use, AE
Gamma hydroxybutyric acid (GHB)
MOA: Potent sedative hypnotic CNS depressant, exact unknown
Use: increases slow-wave sleep, decreases awakenings, increases REM efficiency
AE: Nausea, somnolence, confusion, dizziness, incontinence
Sodium Oxybate Dosing
Oral solution
Taken at bedtime and then 2-4 hours later
Primary Therapy for RLS
DA agonists (ropinirole, pramipexol) Iron Replacement Levodopa
Secondary Therapy for PLS
Gabapentin/pregabalin esp if painful
Opiotes (codeine)
BDZ or Z drugs
