Sleep Disorder and Pharmacology

Question 1

Define Dysomnias

Answer 1

Abnormality in the amount, quality or timing of sleep

Question 2

Examples of Dyssomnias

Answer 2

Insomnia disorder
Hypersomnia
Narcolepsy
Obstructive or central sleep apnea and sleep related hypoventililation
Circadian rhythm sleep disorders
Restless leg syndrome
REM sleep behavior disorder

Question 3

REM sleep behavior disorder =

Answer 3

Act out their dreams (yelling, kicking, fighting)

Question 4

Define Parasomnias

Answer 4

Abnormal behaviors or events associated with sleep

Question 5

Examples of Parasomnias

Answer 5

Nightmare disorder
Sleep terror disorder
Sleepwalking disorder

Question 6

Insomnia in the population

Answer 6

50% of population complains of it
9-12% of adults have chronic insomnia
20% of elderly

Question 7

Insomnia is a disorder:

Answer 7

characterized by difficulty in initiating and maintaining sleep

Question 8

Effects of Sleep deprivation

Answer 8

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)

Question 9

The shorter time it takes you to fall asleep (latency) =

Answer 9

The sleepier you are

If less than 5 minutes latency, you are excessively sleepy

Question 10

Sleep apnea is characterized by:

Answer 10

Repetitive episodes of breathing cessation followed by arousal to restart breathing

Question 11

Central Sleep Apnea is due to

Answer 11

Impaired CNS respiratory drive
Occurs in 30% of men over 60 years of age
Associated with CHF and advanced age

Question 12

Narcolepsy is characterized by

Answer 12

Sleep attacks
Cataplexy
Hypnagogic hallucinations
Sleep paralysis

Question 13

Define Cataplexy

Answer 13

Loss of muscle tone without loss of consciousness

Brought on by extremes in emotions

Question 14

Narcolepsy most likely involves what system:

Answer 14

Orexin/hypocretin peptide system (75% of narcoleptic patients, this system is undetectable) in CSF

Question 15

Advanced sleep phase syndrone

Answer 15

Circadian Rhythm Disorder

Falling asleep early (6-8 pm) and waking up early (3 am)

Question 16

Irregular sleep-wake type

Answer 16

Circadian Rhythm Disorder
Numerous naps during the day, no main nighttime sleep
Normal total sleep

Question 17

Non-24-hour sleep-wake type

Answer 17

Circadian Rhythm Disorder
Abnormal synchronization between dark/light cycle and endogenous circadian rhythm
50% of blind people

Question 18

Restless Leg Syndrome is:

Answer 18

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

Question 19

Restless Leg Syndrome Diagnosis

Answer 19

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

Question 20

Pharmacologic Therapy of Insomnia

Answer 20

Benzodiazepines

Non-benzodiazepine GABA(A) agents (Z drugs)

Question 21

Benzodiazepine receptor agents MOA

Answer 21

binding to GABA(A) receptors causing increase in GABAergic neurotramission and hyperpolariztion of neuronal membrane

Question 22

Traditional BZDs Use

Answer 22

Reduce sleep latency and increase total sleep time

Question 23

Traditional BZDs side effects

Answer 23

Daytime sedation, performance impairment, drowsiness, amnesia, rebound insomnia
- Half life prolong in elderly

Question 24

Traditional BZD drugs

Answer 24

Estazolam
Triazolam
Temazepam
Flurazepam

Question 25

Non-BZDs drugs

Answer 25

Zolpidem, zaleplon, eszopiclone

Question 26

Non-BZDs Use

Answer 26

Reduce sleep latency and nocturnal awakenings | Induce sleepiness

Question 27

Non-BZDs Side effects

Answer 27

Drowsiness, amnesia, dizziness, GI | Zolpidem: sleep weight and sleepwaking, sleep driving

Question 28

Antihistamines Use and drugs

Answer 28

OTC sleep drugs Mild insomnia Diphenhydramine, doxylamine

Question 29

Antidepressants Use and drugs

Answer 29

Insomnia + Depression or pain Amitryptiline, doxepin and nortriptyline (day time sedation) Mirtazapine, nefazodone Trazadone

Question 30

Melatonin Receptor Agonists Use and Drug

Answer 30

Insomnia- induces sleep | Ramelteon

Question 31

Valerian use and Drug

Answer 31

Insomnia | Herbal

Question 32

Orexin receptor antagonists Use and Drug

Answer 32

Suvorexant (Belsomra) | SE: sleep driving

Question 33

Non-pharm treatment for Obstructive Sleep Apnea

Answer 33

Positive Airway pressure (PAP) Weight reduction Surgery

Question 34

Pharm treatment for Obstructive Sleep Apnea

Answer 34

Avoidance of alcohol and other CNS depressants | Modafinil (Provigil) and Armodafinil (R-isomer)

Question 35

Modafinil (Provigil) and Armodafinil (R-isomer) Use

Answer 35

Promote wakefulness in patients with residual daytime sleepiness

Question 36

Treatment of Narcolepsy Drugs

Answer 36

Modafinil (Provigil) Antidepressants for catelepsy Sodium Oxybate (Xyrem)

Question 37

Modafinil (Provigil) MOA and SE

Answer 37

Leads to increased histaminergic transmission | AE: Headache, N, anxiety, insomnia

Question 38

Antidepressants for catelepsy MOA

Answer 38

Blocks 5HT and NE reuptake to suppress REM sleep

Question 39

Sodium oxybate (Xyrem) MOA, Use, AE

Answer 39

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

Question 40

Sodium Oxybate Dosing

Answer 40

Oral solution | Taken at bedtime and then 2-4 hours later

Question 41

Primary Therapy for RLS

Answer 41

``` DA agonists (ropinirole, pramipexol) Iron Replacement Levodopa ```

Question 42

Secondary Therapy for PLS

Answer 42

Gabapentin/pregabalin esp if painful Opiotes (codeine) BDZ or Z drugs