Sleep Disorders

Question 1

Define chronic insomnia

Answer 1

When a person has trouble falling asleep or staying asleep at least 3 nights per week for over 3 months.

Question 2

List the side effects of zopiclone

Answer 2

Agitation, bitter taste in mouth, constipation, decreased muscle tone, dizziness, dry mouth, increased risk of falls (especially in elderly).

Question 3

Describe the 2 main features of sleep paralysis

Answer 3

Transient paralysis of skeletal muscles - occurs after waking up or shortly before falling asleep.
Hallucinations - images or speaking that appear during the paralysis.

Question 4

What is the treatment for sleep paralysis?

Answer 4

Clonazepam

Question 5

Primary vs secondary sleep disorder

Answer 5

Primary: intrinsic problem with sleep-wake cycle.
Secondary: due to underlying medical/psychiatric condition.

Question 6

Define dyssomnia and the subtypes

Answer 6

Problems with quantity, timing or quality.
Insomnia: insufficient sleep.
Hypersomnia: sleeping too much/excessive sleepiness during the day.

Question 7

Define parasomnias

Answer 7

Unusual episodes or behaviours during sleep e.g. sleep walking or night terrors.

Question 8

Describe the clinical features of insomnia

Answer 8

Decreased periods of sleep (difficulty initiating or maintaining sleep), impaired daytime functioning, poor concentration, dissatisfaction with sleep quantity/quality and early morning wakening.

Question 9

What can cause insomnia?

Answer 9

Stress, worry, over-arousal, depression, anxiety, mania, medications, pain.

Question 10

What are the factors contributing to chronic insomnia?

Answer 10

Poor sleep hygiene, worry about sleep, increased arousal, excessive focus on trying to sleep, fear of sleep.

Question 11

Describe the management for short-term insomnia

Answer 11

Sleep diary, address precipitating factors, sleep hygiene, Z drug (3-7 days), CBTi.

Question 12

Describe the management for long-term insomnia

Answer 12

CBTi, Z drug (3-7 days), modified-release melatonin (3-10 weeks).

Question 13

What is the MOA of Z drugs?

Answer 13

Facilitate and enhance binding of GABA to GABA-A receptor, depressing synaptic transmission.

Question 14

What aspects does CBTi focus on?

Answer 14

Over-attention, worry, sleep effort, poor sleep hygiene.

Question 15

What are the limitations of prescribing Z drugs for insomnia?

Answer 15

Dependence and withdrawal, daytime sleepiness, ‘hangover effects’, rebound insomnia (drug stopped), confusion, nightmares, taste disturbance, GI upset.

Question 16

Describe the principles of sleep hygiene

Answer 16

Avoid caffeine 4 hours before bed, avoid nicotine an hour before bed, avoid alcohol around bed, avoid eating large meals before bed, regular exercise, avoid exercise 2 hours before bed, keep bedroom clean and tidy, comfortable mattress, avoid bedroom being too hot or cold, keep bedroom quiet and darkened, keep bedroom for sleeping, go to bed and get up at regular times, avoid daytime napping, only go to bed when sleepy.